Topic: Outpatient masectomy becoming the norm in Covid times?

Forum: Surgery - Before, During, and After — Surgical options and helpful tips for recovery and side effects.

Posted on: Jan 11, 2022 07:54PM - edited Jan 11, 2022 07:55PM by olympicmtgirl

Posted on: Jan 11, 2022 07:54PM - edited Jan 11, 2022 07:55PM by olympicmtgirl

olympicmtgirl wrote:

Had 1 of 2 surgery consults and learned my great local hospital is doing "elective" surgeries outpatient only (with max 24 hours observation from entry to exit). With no support person allowed in facility, wondering how drain training even happens. Just sharing my trepidation.

Also another unrelated learning, I should have started genetic testing STAT? Now asking for counseling to help me with decision on unilateral or bilateral, and learned it would be helpful to have genetic testing results for that discussion (plus for insurance approval if I go bilateral).

Waiting 4 more weeks for the second consult with a breast cancer oncology surgeon at the university (where I will likely get my care). No idea what their surgery capacity will be sd 4 weeks is many lifetimes in Omnicron!

Just a ramble but it felt like a bad day.


Surgery 3/9/2022 Lymph node removal (Left); Mastectomy (Left): Simple; Mastectomy (Right): Simple; Prophylactic mastectomy (Right) Hormonal Therapy 4/1/2022 Femara (letrozole) Dx IDC, Left, 1cm, Stage IA, Grade 1, ER+/PR-, HER2-
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Jan 11, 2022 08:17PM beesie.is.out-of-office wrote:

Many facilities have been doing mastectomies as an outpatient procedure for years. I was lucky that both times I had overnight hospital stays but I don't think that's been the norm for a while.

Not having someone with you at the hospital stinks, but with regard to drains...you are the person who needs to be trained - I think most often patients do their own drains. I did and never had a problem. If you want someone else to do them for you, you can show that person how to do it. It's actually pretty easy

Genetic testing... are you young and/or do you have a family history of breast cancer? Those are usually the criteria for testing. And in the end, only about 15% of breast cancers are caused by genetic mutations; even many people with extensive family histories of cancer are often found to have no genetic mutations - that was the case for me.

A bilateral is something you may choose for reasons other than genetics, and to my understanding, in the U.S. it is the law that your insurance company has to pay for surgery to the contralateral breast. With regard to the mastectomy vs. bilateral mastectomy decision, this thread might be helpful:

Topic: Considerations: Lumpectomy w/Rads vs. UMX vs. BMX https://community.breastcancer.org/forum/91/topics...



Sorry you've had a bad day! The whole situation is overwhelming and sometimes it just hits you. Hope tomorrow is better!




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Jan 11, 2022 08:35PM 2019whatayear wrote:

that is what I had for my BMX in 2019

:-)

5/6/2019 IDC 2cm, micromet 1/9 nodes, BRCA2+, ER+, PR+, HER- BMX 6/2019, A/C & Taxol 2019, Radiation, BSO - preventative 2/2020, Letrozole 3/1/2020, Started Lynparza for 1 year preventative on 7/18/2021
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Jan 11, 2022 08:39PM olympicmtgirl wrote:

Heading to the link you suggested!!

I met the criteria for genetic counseling with family cancer and one first cousin deceased from breast cancer. The local surgeon's scheduler said that genetic counseling is useful in getting a prophylactic breast removal approved. I don't know if it's US law? Will see what I can learn

Okay going to woman-up if the drains are my job!

Surgery 3/9/2022 Lymph node removal (Left); Mastectomy (Left): Simple; Mastectomy (Right): Simple; Prophylactic mastectomy (Right) Hormonal Therapy 4/1/2022 Femara (letrozole) Dx IDC, Left, 1cm, Stage IA, Grade 1, ER+/PR-, HER2-
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Jan 11, 2022 08:40PM dancemom wrote:

I was "outpatient " for my masectomy last week. Dr office said that is normal for billing purposes, even pre- omicron. Generally you go home in 23 hours if there are no complications. (Kind of like child birth) I went in for nuclear injection at 9am mon, surgery at 1 and was cleared for discharge at 8 am tue, but the paperwork takes time. I actually left about 11. It was fine. I had put in a call the social worker at my cancer center a few weeks prior and asked what services are available to me and basically requested them all. So I had a visiting nurse come the following day to do vitals, check the dressing, set up a PT request for when drains come out, and answer any questions. If you have access to a care coordinator or program like that, use it! It is very helpful.

I was allowed to have a fully vaccinated pickup person. Also, masks are strictly required.(I was allowed to take mine off to sleep once my nurse left the room. She very gently put it back on me to do vitals and IV every couple of hours). My daughter learned the drain stuff ( it sounds much worse than it is) then helped me dress and pack up. You Do really need help with the drains because especially the first few days it is just too hard to reach around to the site to strip the drain, the hand on that side was too weak to squeeze hard enough to strip or to squeeze the bulb, and it was a 3 hand job until I hang of it, the mobility and strength around day 5. Also, she wrote down all the measurements on a chart and kept track of and set up all my meds. (Antibiotics 4x/day until all drains come out, pain management depending on your needs, stool softener, plus continued on letrozole) . I could not have kept track of it all or been able to open the bottles especially the first 3 days when I was exhausted. They do have good videos about the drains so it wouldn't be too hard to learn in case someone is not allowed in to pick you up. It's just squeamish.

My surgical onc sent me for genetic testing right away. Also, millions of scans. Those changed ny course of treatment which is why I just had the mastectomy last week.

I keep writing too many details about all this because I was SO anxious going in. It really was no where near as terrible as I feared. You got this!

Dx 3/16/2021, IDC, Right, 3cm, Stage IV, metastasized to other, Grade 2, ER+/PR+, HER2- Hormonal Therapy 3/28/2021 Femara (letrozole) Targeted Therapy 4/26/2021 Ibrance (palbociclib) Surgery 1/3/2022 Lymph node removal (Right): Sentinel; Mastectomy (Right): Skin Sparing Surgery 1/3/2022 Lymph node removal (Right): Sentinel; Mastectomy (Right): Skin Sparing Radiation Therapy 3/14/2022 Whole breast, Radiation boost: Right breast, Chest wall, Lymph nodes, Other part
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Jan 11, 2022 08:50PM olympicmtgirl wrote:

Thanks. I really appreciate you taking the time to share your experiences. While the first radiologist that saw me said a mastectomy was likely, I think I somehow internalized all the people that immediately say to you no, don't think that way.

I will have this. Thank you for reminding me.

Surgery 3/9/2022 Lymph node removal (Left); Mastectomy (Left): Simple; Mastectomy (Right): Simple; Prophylactic mastectomy (Right) Hormonal Therapy 4/1/2022 Femara (letrozole) Dx IDC, Left, 1cm, Stage IA, Grade 1, ER+/PR-, HER2-
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Jan 12, 2022 12:40AM sarah_78 wrote:

Thank you for starting the thread. I am facing something similar to this. I had surgeon's appointments this week (2 more to go) and seems like they will take lymph nodes and left breast. They said probably I will be in hospital for 4 days. I am located in Germany and the city I am thinking to have the surgery has very strict Covid regulations. No visitors at all (as opposed to some other close by city who allows 1 visitor for 1 hour daily).

First surgeon drew how the wound will look like and since my tumour is very high up in the inner quarter of my breast, it looks terrible. I already dread I am not ready for the procedure psychologically and seeing that and learning not even my husband can be with me while dealing with the aftermath is leaving me sleepless. I had never been so down since I started treatment, when I went through the diagnosis and chemo.

I can't seem to get to a point and pull myself together. When it rains, it pours. BC wasn't enough so covid on top and the worst timing for surgery. I am so stressed I can't find words when I talk or think straight, I don't think i can manage the stuff written above alone.

Any experience of how I'll manage to go through this is appreciated.

DIagnosed at 43, Hodgkin's Survivor (at 33)
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Jan 12, 2022 05:12AM dancemom wrote:

Sarah, if you stay in the hospital 4 days you won't need any help. The first few days are when its nice to have someone keep track of your meds for you, and get you food and help strip the drains. By day 4 that is all easy to do alone. Here, my test for discharge was to be able to walk to the restroom 2 rooms down SUPERVISED.

Dx 3/16/2021, IDC, Right, 3cm, Stage IV, metastasized to other, Grade 2, ER+/PR+, HER2- Hormonal Therapy 3/28/2021 Femara (letrozole) Targeted Therapy 4/26/2021 Ibrance (palbociclib) Surgery 1/3/2022 Lymph node removal (Right): Sentinel; Mastectomy (Right): Skin Sparing Surgery 1/3/2022 Lymph node removal (Right): Sentinel; Mastectomy (Right): Skin Sparing Radiation Therapy 3/14/2022 Whole breast, Radiation boost: Right breast, Chest wall, Lymph nodes, Other part
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Jan 12, 2022 05:13AM typhoon wrote:

Olympic - My BMX was outpatient in Dec 2020 during the height of COVID, before the availability of vaccines; I'm single and live alone, so the brother who came to stay with me and help out was only allowed to drop me off and pick me up. Surgery started at half past noon, was finished by 5 pm, and I was cleared to go home by 8 pm. The decision to allow me to go home was based on a quick recovery from anesthesia, the ability to eat & drink (I was starving!) without throwing up, the ability to walk around steadily and dress myself, and on a lack of any brain "fogginess" from the anesthesia. If I hadn't been able to do all of those things, they would have kept me in outpatient observation until the next morning. Drain management training took just a couple of minutes (it's actually pretty easy), although training to manage the wound vac system my PS used took a little bit more time. They pack your chest full of painkillers, so pain at home was never an issue; I did go home with a day's worth of codeine (which I didn't need at all), and three days of gabapentin (also not needed beyond the first day). Extra-strength Tylenol for the first few days, then the Tylenol plus Advil after that, was more than sufficient to manage discomfort. I was very, very happy to go home, and it was a joy to wake up the next morning on my comfortable recliner, next to the fire in my family room, with the smell of fresh coffee brewing and a full breakfast being cooked by my brother.

Sarah_78 - My PS showed me some post-surgery pictures to give me an idea of what I might look like immediately after surgery, and I was kind of freaked out. That said, and one year on, I'm very happy with how it all turned out, and the scars are barely noticeable to me.

I hope you are both able to find the best arrangement for your needs and to ease your concerns, and I wish you both an easy surgery and quick recovery!

Dx 10/23/2020, IDC, Both breasts, <1, Stage IA, Grade 2, ER+/PR+, HER2-, IHC Surgery 12/1/2020 Lymph node removal (Left): Sentinel; Lymph node removal (Right): Sentinel; Mastectomy (Left): Nipple Sparing; Mastectomy (Right): Nipple Sparing Surgery 12/9/2020 Lymph node removal; Lymph node removal (Left): Sentinel; Lymph node removal (Right): Sentinel; Mastectomy; Mastectomy (Left); Mastectomy (Right); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Hormonal Therapy 1/1/2021 Arimidex (anastrozole) Hormonal Therapy 1/14/2021 Arimidex (anastrozole)
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Jan 12, 2022 07:37AM - edited Jan 12, 2022 07:40AM by laughinggull

24h was already the practice when I had my mastectomy (with complete axillary lymph node dissection) pre-Covid. I was freaked out when I learned this, because we lived in a small, cramped apartment, and I had two kids and a blind dog (who was always on the worst possible spot), so I dreaded the idea of going home so soon after surgery. I totally understand the trepidation, because I was there myself. I couldn't sleep with anticipation of catastrophic scenarios like tripping on the dog and falling, and worrying about how I would do this or that. I begged the surgeon to do something, anything, to keep me at the hospital for a few days. The surgeon explained to me what kind of shape I would be in after a day; he reassured me that I would be ready to go home in a day, and that they tried to limit the time patients spend at hospital, to the strictly minimum necessary, for good reasons -hospital bugs etc. I would say there are even better reasons now. I recommend that you discuss with your doctors your specific fears and concerns about going home the next day: support, pain, mobility, one by one. They have a lot of experience and should be able to give you guidance and reassurance.

In the end, the surgeon was right and I happily went home the next day. I was in much better shape than I anticipated. I was much more comfortable in my own bed, in my own place (cramped as it was), getting organized to start my exercises and physical therapy, going for walks and fresh air, eating and doing whatever I wanted. And getting ready to fully move on from the surgery phase. The drains are easy to empty and you learn that in like, a minute. You don't need days of practice to master that. And after they remove the drains a few days later, you start feeling much more normal and comfortable.

Also, after three breast surgeries, my personal experience is that the opioid painkillers they prescribed me were completely unnecessary. I needed them the day of the surgery, and after that I was fine with the OTC stuff -dont remember if it was ibuprofen or acetaminophen. All in all, these were easier surgeries than I anticipated the first time when I was heading to the operating room.

You can do this!

Heart


ACx4, THPx4, HP (to complete 1y); Nerlynx (1y); AI (expected 10y), Surgery: BMX + ALND, Reconstruction, Oophorectomy. Radiation. Dx 10/26/2017, IDC, Right, 3cm, Stage IIB, Grade 3, 2/6 nodes, ER+/PR+, HER2-
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Jan 12, 2022 07:40AM threetree wrote:

OlympicMtGirl - I had my surgery in 2019 (pre-Covid) at a neighborhood/community branch of the university that I believe you say you are likely to go to for treatment. I was initially admitted as an outpatient and was told that it was for insurance billing purposes. I got the distinct impression that they did not expect to send me home that day, even before the surgery. Like DanceMom above, I went in in the morning for the dye or whatever they did (they did it under general anesthesia at my request thank goodness, as I'd heard horror stories), and the surgery was around noon or so. Long story short, I wound up spending several days in the hospital, but had no complications. The surgeon simply knew that I lived alone and would have to go home alone to my apartment afterward. At one point (3rd day?) he asked me how I felt about going home that afternoon and that if I wanted to stay another day, he thought he could arrange it. We went with the final extra day. I think I spent 3 or 4 nights there. I can't remember anymore! I had a friend who took me there and stayed until I went into surgery, then she went back to her office to work. Since it wasn't Covid times, I was able to have visitors, so both my friend and some extended family came to see me a couple of times in the evenings. I was supposed to be discharged around 1 pm on that final day and the surgeon came and asked me if I had a ride home. I told him my friend was at work waiting for the call and that she was going to come get me, take me home, and then go back to work. He moved my discharge time up to 4:30 pm, so she could stay at work longer, and not have to go back. I was pleased with the whole thing. She walked me up to my apt, but then I felt totally fine being alone at that point.

The nurses had showed me how to do the drains and it was easy - an easy 5 minute lesson/demonstration. I think you'll do fine, and I seriously doubt that you will be sent home same day if you have a mastectomy, and certainly not if you have any grogginess from the anesthesia or will be alone, etc.

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