The Day of Surgery

Food and drink

Your doctor will tell you not to eat or drink anything after midnight on the night before surgery. This is to reduce the chance that food and stomach acids might be vomited during surgery and enter your lungs while you are under anesthesia. Vomiting into the lungs is a rare but potentially very serious complication of general anesthesia, so you should take to heart the rules about food and drink after midnight.

A buddy is a good idea

If you are going to have same-day or outpatient surgery, you're required to have someone with you to help you get home. Even if you are very strong and independent, find someone to be there with you. It's nice to have someone with you no matter what kind of surgery you're having. Just the process of being admitted to the hospital can be overwhelming. Going home on the same day is challenging. Many of the medications used during the surgery will still be in your system, making it hard to get around.

If you are staying in the hospital overnight and want your friend or relative to be admitted to your room after surgery, be sure to tell your doctor or the hospital staff.

Informed consent

When you are admitted to the hospital before surgery, you'll probably be asked to sign a form called "informed consent." This means that you are agreeing to the surgery, fully understanding what's going to happen and what risks you are accepting in the process. Be sure to ask for the form before you receive any anesthesia that may make you feel groggy, and long enough before surgery that you have time to read and understand it.

Informed consent forms are designed to make sure that:

• Your doctor has told you exactly what he or she is planning to do.
• You are aware of alternative treatment options.
• You understand the plan for surgery and its associated risks.

No matter how highly you regard your doctor, read over the form carefully. Be sure to sign a consent form only for the procedure you and your doctor have discussed and agreed upon in advance.

Anesthesia

You'll probably meet your anesthesiologist before your surgery to talk about your medical history, any allergies you may have, and the plan for administering anesthesia during your surgery. Since most breast cancer surgery happens outside of the body's core, on top of the ribcage, you probably won't have the deepest kind of anesthesia.

For lumpectomy, most patients have only a mild sedative to help them relax and a local anesthetic to numb the area involved in surgery, although some patients have general anesthesia. Mastectomy, axillary node dissection, and breast reconstruction require general anesthesia.

If you are going to have general anesthesia, the process usually goes something like this:

• A nurse will insert a needle connected to a long tube — usually in your arm —and tape it in place. This is the IV (intravenous infusion) line, which the surgical team will use to administer fluids and medication without having to stick you each time medication is required.
• A nurse or anesthesiologist will give you a medication through the IV line to put you to sleep. Most people find this a pleasant experience. By the time you reach the operating room, you will probably feel calm and relaxed.
• Once you are asleep, the anesthesiologist will place a mask over your nose and mouth to administer an anesthetic gas such as nitrous oxide or Ethrane (chemical name: enflurane). The gas will keep you asleep and pain-free during surgery. The anesthesiologist, who will watch you during the entire surgery, will continue to administer this gas for as long as it is necessary.
• The entire team, and especially the anesthesiologist, will monitor your vital signs (heart rate, blood pressure, and respiration) throughout the surgery to make sure that your body's systems are functioning normally.