Gynecologic or Breast Surgery
Most often treatment for gynecologic cancers involves surgery. The type of surgery performed depends on the type of cancer and the stage of disease at the time of diagnosis. The stage of cancer describes its size, depth of invasion, and extent of spread. The choice of surgical procedure may also be based on a woman’s age and general state of health. Some benign or pre-cancerous conditions may also require surgery.
- Exploratory Laparotomy: This surgery involves a 4- to 6-inch vertical or horizontal incision in the lower abdomen, which allows the surgeon to see the female organs and surrounding area.
- Total Abdominal Hysterectomy: This surgery involves removing the uterus and cervix. Lymph nodes in the pelvis and abdomen may also be removed to see if they contain cancer cells.
- Bilateral Salpingo-Oophorectomy: This surgery is usually performed with a hysterectomy and involves removing the ovaries and fallopian tubes.
- Vaginal hysterectomy: This surgery involves an incision in the vagina and removal of the uterus through the vagina.
- Radical hysterectomy: This surgery also removes the uterus along with the tissues next to the uterus and the upper part (about one inch) of the vagina next to the cervix. Lymph nodes may also be removed.
- Tumor debulking: This procedure involves removing as much of the cancer as possible if it has spread to other parts of the pelvis or abdomen. This can improve survival and reduce the amount of cancer to be treated later with chemotherapy or radiation therapy.
- Vulvectomy: This surgery involves removing all or part of the vulva. Lymph nodes near the vulva may also be removed.
- Vaginectomy: This surgery involves removing all or part of the vagina and surrounding tissues. Lymph nodes in the groin area or inside the pelvis near the vagina may also be removed.
- Lumpectomy: A removal of the breast tumor with approximately 1-2 centimeters of healthy tissue surrounding the tumor. Women who are interested in preserving their breast may be offered this option since this surgery does not require the removal of the entire breast. One of the risks with this surgery is the possibility of needing further surgery (either a wider lumpectomy or a mastectomy if the cancer is not completely removed during the initial surgery). Almost always, after you have a lumpectomy, you will need to have radiation to that side of your chest. Studies have shown that lumpectomies were equal to mastectomies in preventing cancer spread or recurrence. These studies compared lumpectomies that were followed by radiation with a mastectomy. After you have a lumpectomy, you will have an incision 2-4 inches long, which will be closed with a long running stitch. The stitch will stay in for about 2 weeks.(If you also have lymph nodes removed, you will have another incision in the underarm (axillary) area. You may have drains to help remove tissue fluid, whether you have a lumpectomy or mastectomy. See information below regarding drains and drain care.
- Mastectomy: A removal of the entire breast, but none of the muscle tissue under the breast. The result is a flat chest with a long horizontal incision. Women who are interested in reducing their risk of needing further surgery often pick this surgery option. Radiation is often not needed after a mastectomy, which simplifies a patient’s treatment plan.
- Drains: A drain is a tube that comes out from the body to drain lymph fluid from your surgery incision into a small bulb. Most breast patients will have a drain, which is held in place with stitches. Drains should be emptied at least twice daily and your hospital nurses should show you or a caregiver how to do this.
DISCLAIMER: This information is not intended to be a complete discussion of breast surgery. It is only a brief summary for purpose of comparison of the available options. You will be given recommendations by your surgeon. For further details, ask your health care professional or refer to recommended reading material. One source we recommend is Dr. Susan Love’s Breast Book, 3rd edition.
Prior to surgery, patients meet with a nurse in our office to discuss the surgery, receive instructions for before and after surgery, and sign the consent form. After meeting with the nurse, the patient most often has an appointment at the Surgical Admission and Testing Unit at Mission Hospitals. Pre-op testing, which may include blood tests, chest x-ray, and EKG, is done at this appointment. If a woman is having abdominal surgery, the day immediately prior to surgery involves diet restrictions and bowel preparation. Instructions will be given at the nurse appointment.
Certain medicines and supplements must be stopped two weeks prior to surgery, because they may cause bleeding during surgery and/or react with anesthesia. These include: aspirin, ibuprofen, naproxen, headache powders, anti-inflammatory drugs, all herbal products and supplements, and vitamin E (more than 200 IU per day).
After surgery, a patient will be observed in the recovery room for several hours before moving to a room. The length of stay in the hospital varies, depending on the type of surgery and the patient’s condition after the procedure. The usual length of stay after an abdominal hysterectomy is 4-5 days, while that for a vaginal hysterectomy or vulvectomy may be 1-2 days. Lumpectomy patients often go home the same day and mastectomy patients may go home the next day.
In the first days after abdominal or vaginal surgery the patient can expect:
- The abdominal incision may be closed with stitches or staples and covered with a gauze dressing. Staples are usually removed one to two weeks after surgery by a nurse in our office.
- Patients may have pain in the lower abdomen after surgery. The surgeon will order medication to control pain and send you home with a prescription for pain medicine. The pain medicine can cause constipation, so it may be necessary to use a stool softener after surgery.
- Urination may be aided by a tube or catheter, which is put in the bladder during surgery. In most cases, it is removed a day or two after surgery. After certain surgeries, like a radical hysterectomy, the catheter may not be removed until two weeks after surgery. This allows for healing after surgery.
- Some women may have a drain in the lower abdomen or groin after surgery to help remove tissue fluid. This is most often removed before discharge. Certain surgeries, such as a vulvectomy with lymph node removal, may require that the drain be left in from one week to a month. The hospital nurses will give instructions on how to care for the drain at home. The drain will need to be emptied at least twice a day and a record kept of the drainage amount.
- After most abdominal surgeries, eating and drinking are prohibited until the doctor determines that the digestive system can safely process food and drink. The diet usually starts with light liquids, and then slowly progresses to soft food prior to discharge from the hospital.
- A patient’s lungs need to be kept clear of excess fluid to prevent problems such as pneumonia. The hospital nurses will teach how to use a breathing apparatus, called an incentive spirometer, for this purpose.
- Walking soon after surgery helps with recovery. Walking lowers the risk of blood clots and breathing problems and helps the bowels recover from anesthesia.
- After a hysterectomy, women may experience gas pains and bloating. Walking is helpful as well as an over-the-counter medication for gas relief.
In the first days after a lumpectomy or mastectomy:
- After your tumor is removed, your surgeon will send it to the pathologist who will examine the tumor and perform some tests that will help your doctor determine what further treatment you may require.
- When you wake up from surgery, you will have a thick gauze dressing over the incision., and probably an Ace bandage wrapped all around your chest. The gauze will be removed before you go home. You can wear your bra home from the hospital, or you may want to wear the Ace bandage.
- You will be given a prescription for pain pills when you go home, although often pain with breast surgery is generally mild.
- Patients should keep arm and upper body movements to a minimum. You will be able to eat and write, but you should not lift anything heavier than a half-gallon of milk. Do not raise your arms on the surgery side above your shoulders for the first 5 to 7 days after surgery.
- DO NOT DRIVE FOR TWO WEEKS.
- After a mastectomy, you may want to wear a breast prosthesis. Ask the nurse to show you some prosthesis samples when you come for your postoperative visit. You will be ready to be fitted for a prosthesis seven weeks from the date of your mastectomy. Your insurance usually will pay for a prosthesis and 2 mastectomy bras.
- During the 7-week post-operative period, patients often were a Soft-Tee. This is a t-shirt that has pockets for fiberfill padding. Your insurance should help with the cost of a Sof-Tee.
- Mastectomy patients always have the option of having breast reconstruction. Enough skin is left in place after the surgery to make this possible. Our surgeons usually prefer that you wait at least six months after having a mastectomy, before making a decision about breast reconstructive surgery. A plastic surgeon would perform this surgery, and HOPE is happy to make a referral. Keep in mind that breast reconstruction is another major surgery and it is not without potential complications.
Recovery after surgery may take 6-8 weeks depending on the type of surgery. During that time, it is important to rest and increase activity gradually. We recommend not driving for two weeks after surgery. Avoid tasks or movements that can strain the incision, such as lifting or bending. To allow the body to heal, it is best to take showers instead of baths, to not use tampons or douches, and to not have intercourse for the length of time your surgeon suggests, usually 6-8 weeks.
Usually one to two weeks after surgery, a patient will have a post-op appointment in the office with a nurse to check the incision and remove any staples or drains if needed. An appointment with the surgeon will be scheduled 2-4 weeks after surgery, depending on whether the results of surgery were benign or malignant. At that time, the surgeon will review the pathology report of the surgery with the patient. The pathology report is an important tool in helping to determine whether any further treatment is necessary.
It is important to call the office, even after office hours, if a patient develops any of the following symptoms: fever or chills; heavy vaginal bleeding or a smelly discharge; redness, bleeding, or discharge at the incision site; pain or swelling in the legs; shortness of breath or chest pain; or severe abdominal pain or pelvic pain.