• Reference Number: HEY1419-2023
• Departments: Breast Services
• Last Updated: 1 December 2023

Introduction

This leaflet has been produced to give you information prior to and after your revision surgery.  Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but if, after reading it you have any concerns or require any further explanation, please discuss this with a member of the healthcare team.

What will happen after your post-surgery consultation?

Following discussion with your surgeon and agreement on which revision surgery is required your name will be added to the waiting list. When a suitable date becomes available for your surgery, you will receive a letter/parcel with appropriate details including:

1. A date for your pre-assessment appointment – this will be a phone call from the breast clinic nurse.
2. Date for your surgery, where at the hospital to attend and time to arrive.
3. MRSA swabs and instructions how to collect and send back.
4. Post-surgery information leaflet.

Prior to your phone pre-surgery assessment there is some essential information and samples for you to send to the hospital:

1. MRSA body swabs
2. Your current Height, Weight, BMI, Blood Pressure, Heart Rate, Temperature and if possible Oxygen Saturations

We need you to send these back to us as soon as possible, to allow us to arrange your phone appointment.

We will send you two swabs for you to collect the necessary samples for screening, one is labelled Nose and the other is labelled Axilla/Groin.  If you feel that you cannot carry out this procedure please contact your GP surgery and ask for help and guidance in obtaining the samples.

HOW TO USE BODY SWABS:

Please follow the instructions below:

Before you begin, please wash your hands using warm water and soap.

To collect the sample from your Nose:

1. Open the packaging labelled Nose
2. Remove the white cap from the tube (put this in the bin).
3. Take the swab and place it into the fleshy part of your nose – rotate swab around the nostril for 3 seconds.
4. Using the same swab repeat step 3 in the other nostril.
5. Place swab back into plastic tubing and push together securely.
6. Place tube back into plastic packaging labelled Nose.

To collect the sample from your Axilla/Groin (armpit/groin crease):

8. Open the packaging labelled Axilla/Groin
9. Remove the white cap from the tube (put this in the bin).
10. Take the swab and place it in your armpit and rotate the swab around the area for 3 seconds and repeat in the other armpit.
11. Using the same swab place it into the crease of your groin (where thigh and groin meet) and rotate the swab in the area for 3 seconds and repeat in the other groin.
12. Place swab into plastic tubing and push together securely.
13. Place tube back into plastic packaging labelled Axilla/Groin.

Once you have collected the swabs, please place the two swabs inside the clear bio-pouch in between the white protective pad, seal the bag, fold the bag and place inside the bubble wrap pouch. Place the pouch inside the pre-labelled cardboard box and seal the box with tape. Take the now sealed addressed box to the post office and pay for the postage to return the samples. Unfortunately, without these samples your surgery will be postponed or cancelled.

Also, please, attend your local pharmacy, health centre or GP practice to obtain recordings of your current Height, Weight, BMI, Blood Pressure, Heart Rate, Temperature and if possible Oxygen Saturations. This information will be required to complete your Pre-surgery assessment. You can either share the information during your phone call or you can send the information via the clinics e-mail address, please include your name/ DOB/ HEY number:  –  hyp-tr.breastcareunit.nurses@nhs.net.

Telephone Pre-operative assessment

You will receive an appointment for a telephone pre assessment approximately 2 weeks prior to surgery.  Please make sure we have an up-to-date telephone number to contact you. The appointment takes around 30 minutes so please make sure you are somewhere where you can concentrate on the call.

During the telephone pre assessment we will confirm your details and you will be asked questions relating to your medical history. Please have information about current medications, significant illnesses and previous surgeries to hand. We will confirm time, date and location of surgery.

Preparing for surgery

You will need to fast prior to your surgery as you will be having a general anaesthetic.

Fasting Instructions for Adult Patients attending for surgery at 12:30pm

• Please eat normally the day before your operation unless otherwise instructed.
• Your last meal should be before 7am on the day of your operation. This should be a light breakfast.
• On the day of your operation you may drink normally up until 7am.
• Between 7am and 11am you may drink unlimited clear fluids.
• Please do not smoke or vape on the day of your operation.

Fasting Instructions for Adult Patients attending for surgery at 07:30 am

•  Please eat normally the day before your operation unless otherwise instructed.
• Your last meal should be before 12 midnight prior to your admission to the hospital.
• On the day of operation, up until 6am, you may drink unlimited clear fluids.

CLEAR FLUIDS:

• Water
• Black Tea/Coffee
• Herbal Teas
• Clear Diluted Squash

Please do not drink milk based products, fizzy drinks, fruit juices or alcohol on the day of your operation.

Please do not eat boiled sweets or chewing gum on the day of your iperation.

Please do not smoke or vape on the day of your operation.

Please Note:  Failure to adhere to these fasting instructions may result in your operation being cancelled.

 Please avoid bringing any valuables into hospital and ensure you have removed all piercings or exchanged them for silicone. Wedding rings may be taped. Please do not wear any make up or nail varnish and ensure that you have had a bath or shower and washed your hair prior to admission. 

The Day of Surgery

On arrival to the Ward or Day Surgery Centre you will meet the nursing staff who will complete admission paper work. You will be shown to your room if you are on the Ward or the waiting area in the Day Surgery Centre.

You will meet your surgeon who will go through your surgery, explain any potential risks or complications, mark any areas and get you to sign your consent form. If you have any questions about the surgery this is the time to ask them.

You will meet the anaesthetist who will go through previous anaesthetic and resolve any problems you may have had.

There may be some waiting so bring something to occupy your time.

When your surgery time nears the Ward or Day Surgery Centre staff will ask you to put on a surgical gown, this is backless so you will need a dressing gown to put on over it and a pair of soft shoes/slippers as you will walk to theatre. You will also be fitted with a pair of white anti embolic socks which help to prevent blood clots post-surgery. We do advise that you continue to wear these for 2 weeks post-surgery.

You will wake you in recovery following your surgery and then brought back to the Day Surgery Centre or Ward once you have recovered. You will be staying on in the Day Surgery Centre for 2 hours or 4 hours on the Ward following your surgery to ensure you are OK and have had something to eat. The nurses will check your observations and surgical wound to ensure everything is alright and will ensure that you receive pain relief and anti-sickness medication if required

You will have simple taped dressings over your incisions. These will need to stay on for 7 to 10 days and you can take them off yourself or attend your local nurse’s clinic if you feel unable to take them off.  All the stitches are dissolvable so you do not need to have them removed or have your dressings changed.

Your dressings are not waterproof so try not to get anything wet. We advise you to shower on your back or have a shallow bath and wash your hair over the sink until you take your dressings off.

The Day Surgery Centre or Ward staff will give you any further information about your dressings

You will be reviewed by your surgeon following your surgery and if everything is okay and you have had had no problems you will be discharged at this point. You may wish have to stay locally for the night following your surgery and would need someone with you for this night. If you are travelling by car, it is advisable to put a cushion or soft pillow under your seat belt for comfort and protection. You still need to wear a seat belt by law. Before you go home your surgeon will advise you of any activities you will need to avoid and give you advice about the type of exercises you will need to perform. Please can you ensure you have supply of pain relief at home or wherever you are staying as the ward may not discharge you with any. We suggest simple over the counter pain relief such as paracetamol or ibuprofen.

What follow up care will I need?

Recovery from revision surgery is about 2 weeks depending on the surgery. If you have had your dog-ears revised under local anaesthetic it may be only a week.

We do advise that you keep yourself active post-surgery, you can do most of your normal activities and can go out and about you do not need to stay inside.

We advise you though to refrain from lifting anything heavy or carry anything heavy for the first week or so to allow everything to settle down. If you have a manual job which involves heavy work you may need a couple of weeks off. The ward or Day Surgery Centre should provide a sick note for you if needed.

You will need to wear your white anti-embolic socks for 2 weeks or until you are totally back to normal and doing everything you would normally do. This is to prevent deep vein thrombosis. You will need to keep yourself hydrated by drinking plenty of fluids, keep as active as you can and continue to wear the white anti-embolic socks. If you visit the hospital web site at HUTH Hospital and follow the link to the patient leaflets you will find the information leaflet “Venous thromboembolism (VTE) reducing the risk “which will give you more information

What symptoms should I look out for after my surgery?

• Swelling that is causing you a lot of discomfort or pain.
• The area looks red or feels hot to touch.
• There is a lot of leakage through the dressing.
• Some patients develop a sensitivity to the dressings so this may need to be removed or changed.

If you develop any of these symptoms please don’t hesitate to contact us on tel. no. 01482622679 or hyp-tr.breastcareunit.nurses@nhs.net. We may advise you to attend your local GP, give advice over the telephone or arrange for you to come back to see your surgical team.

Follow up and further treatments

You will be reviewed at 6 months post-surgery which will allow your surgeon to access how well you have healed and whether any further surgery is necessary. Photographs will be recorded for audit purposes to ensure an accurate record.

At this point you may be discharged or added to the waiting list for further revision surgery.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.