Questions to Ask Breast Surgeon Before Mastectomy
Questions to take into a surgical consultation before a mastectomy: which operation is planned and why, what happens to the lymph nodes, how reconstruction timing works, what recovery restricts, and who to call if something goes wrong.
The questions
Open any question for the note
Which type of mastectomy are you recommending for me, and why that one?
Why ask it
Skin-sparing, nipple-sparing and total mastectomy are not interchangeable, and the reason usually comes down to tumour size, how close it sits to the skin or nipple, and whether radiation is planned. An answer given in generalities suggests your case has not been looked at closely yet.
Will you be taking lymph nodes, and how do you decide how many?
Why ask it
A sentinel node biopsy takes a few nodes; a full axillary dissection takes many more and carries a much higher chance of lasting arm swelling. Ask what would make the surgeon switch to the larger operation mid-procedure, because that decision is often made while you are asleep.
Where will the incision be, and what does the scar look like once it has settled?
Why ask it
Incision placement varies between surgeons and affects both reconstruction options and how clothes sit later. Ask to see photographs of healed results rather than fresh ones, since the two look nothing alike.
Am I a candidate for lumpectomy and radiation instead, and how would the two compare for me?
Why ask it
For many people the two paths differ less in survival than in radiation, surveillance and recurrence risk. If mastectomy is genuinely the only option, the surgeon should be able to name exactly what rules the alternative out.
How many of these operations do you do in a year?
Why ask it
Volume is a reasonable thing to ask and most surgeons answer it without taking offence. An answer about the practice as a whole, rather than about the surgeon who will hold the scalpel, is worth following up on.
Will I have surgical drains, and how long do they usually stay in?
Why ask it
Drains shape the first week or two more than people expect: sleeping, showering and dressing all change while they are in. The answer tells you what help you need at home and for how long.
Will this be day surgery or an overnight stay, and what decides that?
Why ask it
Stays after mastectomy range from same-day discharge to a couple of nights depending on reconstruction and your general health. This one answer sets your childcare, work and travel arrangements.
What do the first two weeks at home usually feel like for your patients?
Why ask it
Ask about ordinary things: reaching a cupboard, washing your hair, sleeping propped up. A surgeon who can only describe pain levels may not know much about life at home, in which case ask to speak to a breast care nurse instead.
Which complications do you see most often, and how often?
Why ask it
Seroma, infection and delayed healing are common enough to plan around. Being told complications are rare without any being named is not an answer, and you need to know what to watch for more than you need percentages.
What will the numbness across my chest and under my arm be like, and does feeling come back?
Why ask it
Nerves are cut during this operation, so numbness is an expected result rather than a complication. People are often unprepared for it, and hearing it now is easier than discovering it afterwards.
If I might want reconstruction, do I have to decide before this surgery?
Why ask it
Immediate and delayed reconstruction lead to different operations, so the deadline for deciding usually falls earlier than people assume. If you are told to decide now, ask which choice keeps more options open later.
Who would do the reconstruction, and have the two of you worked together before?
Why ask it
Immediate reconstruction means two surgeons in one operation, and coordination affects both the result and the length of the anaesthetic. A named colleague they operate with regularly tells you more than a referral still to be arranged.
How long until the full pathology comes back, and how will I hear it?
Why ask it
The wait is usually one to two weeks and many people find it the hardest part. Knowing whether the result comes by phone or at an appointment, and who makes the call, removes one source of uncertainty.
Could what the pathology shows change the plan for chemotherapy or radiation?
Why ask it
Final pathology sometimes differs from the biopsy, and further treatment can follow. Hearing that possibility now stops it arriving later as a shock.
What limits will I have on lifting and reaching, and for how long?
Why ask it
Useful answers are specific: nothing above shoulder height for a set number of weeks, nothing heavier than a full kettle. General reassurance is harder to plan a household around than a number.
When can I drive, and when could I realistically go back to my kind of work?
Why ask it
Driving usually depends on being off strong painkillers and able to perform an emergency stop. Describe your actual job, because desk work and physical work produce very different answers.
How will pain be managed in hospital and in the first week at home?
Why ask it
Ask what you will be sent home with and what to do if it turns out not to be enough. A named contact for that situation matters more than which drugs are on the list.
What is my risk of lymphedema, and what should I be doing to lower it?
Why ask it
Risk depends mostly on how many nodes are removed and whether radiation follows. Ask for a referral to a physiotherapist who works with breast surgery patients, which is more useful than a list of things to avoid.
If something looks wrong at nine in the evening or on a weekend, who do I call?
Why ask it
You want a name, a number and a threshold: which symptoms mean phone now, which can wait until morning. Being told to go to an emergency department for anything at all suggests follow-up support is thin.
If I want a second opinion, how much time do I have before it affects my treatment?
Why ask it
Most breast cancers leave room for a second opinion, and a surgeon who says so plainly is telling you the decision belongs to you. Pressure to commit at the first appointment is worth questioning.
Preparing for the Consultation
Practical guidance for the conversation itself
Before the appointment
- Ask for copies of your biopsy pathology and imaging reports in advance so the conversation starts from the same facts.
- Bring someone whose only job is to write down answers. Most people retain very little of a consultation like this.
- Put your questions in order of what matters most to you. Appointments run short more often than long.
- Ask whether you can record the conversation. Most surgeons agree, and it saves arguing later about what was said.
Decisions that have a deadline
Reconstruction timing
Immediate reconstruction is decided before surgery, not after, because it changes the operation itself. If you are undecided, ask which choice leaves more options open a year from now.
One side or both
If you are considering a preventive mastectomy on the healthy side, ask what it does and does not change about your risk, and whether it can be done as a separate operation later.
Genetic testing
A result can change which surgery is recommended. Ask whether testing is underway and whether it is expected back before your surgery date.
Setting up home before surgery
- Front-fastening tops and a soft pillow for the car ride home come up in almost every patient account afterwards.
- Move everyday items down to waist height. Reaching upward is restricted for weeks, not days.
- Arrange help for the first week specifically: driving, shopping, and anything that involves lifting.
- Direct questions about drains, dressings and post-surgery camisoles to the breast care nurse. That is their area, and they usually have more time than the surgeon.
When to press for more
- You cannot get a straight answer on why this operation rather than the alternative.
- Nobody can tell you who to phone out of hours.
- You are asked to decide about reconstruction on the same day you first hear the plan.
- Pathology results, and what happens if they change the plan, have not been mentioned at all.