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1. Preparation

WHAT IS A LUMPECTOMY?

A Lumpectomy is the surgical removal of a breast lump. The tissue that is removed is sent to pathology to determine whether it is benign or cancerous. If the tissue is benign you will most likely require no further treatment or surgery. However, if cancer cells have been detected, further surgery may be required.

If the lump is difficult to find it will be located using an ultrasound. A wire may be inserted prior to surgery in order to assist the surgeon locate the lump. This procedure is performed in the radiology department. If your surgeon thinks there is the possibility of having to remove any lymph nodes with the lump, you may also have a test called a lymphoscintogram prior to your surgery. This test locates the lymph nodes closest to the lump and helps to guide the surgeon if these nodes require removal. This test is also performed in the radiology department.

Should there be an early-stage diagnosis, a lumpectomy is performed to remove the lump and a small amount of healthy tissue around it. This procedure is sometimes referred to as a wide local excision, complete local excision, or a partial mastectomy.

After the surgery a pathologist will examine the breast tissue. If there are healthy cells surrounding the lump that has been removed, it is called a clear margin and no further treatment is required.

If the lump and surrounding tissues are cancerous, further extensive surgery may be required. Otherwise, radiotherapy and or chemotherapy treatment may be offered to minimise the risk of the cancer recurring.

WHAT IS A MASTECTOMY?

If cancer is diagnosed in the locally advanced stage, it may be necessary to have a partial or total Mastectomy. A Mastectomy is the removal of part of or the entire breast as well as affected lymph nodes under the armpit.

Depending on the stage of breast cancer, there are 4 types of mastectomy and they are:

• Radical Mastectomy – removal of the breast and lymph nodes in the armpit with other neighbouring tissues.
  
  
• Simple Mastectomy – removal of the breast tissue, nipple and a small part of the overlying skin.
  
  
• Segmental Mastectomy – removal of enough breast tissue to ensure that the area of the resected specimen is free of tumour.
  
  
• Subcutaneous Mastectomy – removal of breast tissue while preserving the overlying skin, nipple and areola (circular pigmented area surrounding the nipple).

WHY IS A LUMPECTOMY OR MASTECTOMY PERFORMED?

The breasts mostly consist of glands lined with cells that produce milk. Sometimes these cells grow rapidly which may result in the formation of a lump or tumour.

Tumours may be identified as benign or malignant. Your doctor will conduct a biopsy to identify the tumour. This is done by taking a sample of the cells from the breast and sending it for testing by a pathologist for examination under a microscope. Malignant tumours in the breast are diagnosed as breast cancer.

The tumours identified as benign usually do not spread, but malignant tumours consist of cells which can spread to other parts of the body. The spreading of these cells does not occur in all women who have had breast cancer.

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a General Surgeon who can perform the procedure.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the Royal Australasian College of Surgeons via their website www.surgeons.org. This is a very informative website.

The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).

To access a list of General Surgeons who participate in HCF’s Medicover no gap arrangement:

• Call HCF Member Services on 13 13 34
• Visit one of HCF’s customer service branches
• Access HCF’s website at www.hcf.com.au/members/findahealthprofessional/findadoctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

WHAT SHOULD I ASK MY SPECIALIST?

• Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.

• In addition to what the procedure involves, you should also ask about:

• Preparation
• Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
• Aftercare

• Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:

• Aspirin (or any related products)
• Blood thinners (Warfarin, heparin.)
• Arthritis medication
• Pain medication
• Insulin

Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

WHERE ARE THEY DONE?

A Lumpectomy is performed in a hospital and the average length of stay is 1-2 days.

A Mastectomy is also performed in a hospital and the average length of stay is 4.5 days.

HOW LONG ARE THE PROCEDURES?

A Lumpectomy takes approximately 1½ hours for the procedure excluding preparation and recovery time.

A Mastectomy takes approximately 1-2 hours for the procedure excluding preparation and recovery time.

WHO IS INVOLVED?

The people involved in the procedure are:

• The General Surgeon, your Specialist doctor
• There may be an assistant surgeon
• Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
• Nurses for the procedure and recovery
• Pathologist for blood tests and/or specimen samples
• Radiologist for x-rays

HOW DO I PREPARE FOR A LUMPECTOMY OR MASTECTOMY?

You will usually be required to attend a pre-admission clinic where you will undergo basic tests to assess your general fitness for surgery. Your doctor should advise you of any lifestyle changes such as giving up smoking or weight loss that you should make prior to your operation. As with any surgery, part of the preparation is to find out as much information needed to feel as comfortable as possible with what is going to happen to you.

You will be notified of your fasting times prior to theatre. If surgery is scheduled for the morning, you will usually have to fast from midnight, otherwise if your operation is scheduled for the afternoon you will be required to fast for at least 6 hours prior to surgery.

Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.

WHAT DO I TAKE WITH ME TO THE HOSPITAL?

• Do not bring any valuables with you
• Leave all jewellery at home, a wedding ring is acceptable
• Wear comfortable clothing
• Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
• Bring any relevant x-rays or scans

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

MASTECTOMY

For your information, the average charges for claims paid for Mastectomy admissions for the financial year 06/07 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 98 overnight admissions with an average length of stay of 3.9 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 31518.
  
  
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

¹These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. specialist consultations. Therefore, the total average medical service charge ($2,995) differs from the sum of the individual average charges as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all mastectomies. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

LUMPECTOMY

For your information, the average charges for claims paid for Lumpectomy admissions for the financial year 06/07 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 125 overnight admissions with an average length of stay of 1.6 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 31512.
  
  
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

¹ These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. specialist consultations. Therefore, the total average medical service charge ($2,989) differs from the sum of the individual average charges as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all lumpectomies. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

When you arrive at the hospital, the receptionist will do all the paperwork necessary for your stay. Please ensure that you let the staff know of any medication you are taking and any allergies that you may have.

The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. A general anaesthetic is given for both lumpectomies and mastectomies which means that you are asleep throughout the procedure. You will also discuss the type of pain relief you will receive after the operation.

3. Aftercare

WHAT HAPPENS AFTER A LUMPECTOMY/ MASTECTOMY?

You will wake up in the recovery room outside the theatre and once you are fully awake, you will be taken to the ward. Both the anaesthetic and pain medication will make you feel drowsy for a while.

You will have some tubes in place after the surgery and these may include:

• An intravenous drip providing fluid and medication
  
  
• A tube in your breast to drain fluid away from the operated area.

The tubes will be removed within 3-5 days following surgery but in some cases, you may be discharged with some tubes still in place depending on the support you have at home.

The dressing that was placed on the incision to keep it clean will be removed after a day or so. You will be given medication or an injection for pain relief and nausea while you are in hospital and will be given pain medication to take home upon discharge.

You are encouraged to move around the day after surgery to prevent blood clots. Try to do a little more each day. You will probably have some physiotherapy after surgery encouraging you to move your arm on the side of the operated breast until you can stretch it out as far as you could before.

Eat regularly and drink plenty of fluids to avoid constipation while in hospital.

You may be discharged after 2-3 days if you don’t have a drain or if your surgeon agrees to an early discharge.

Before discharge you should be given specific advice about how to look after yourself at home. You should be clear on the following issues:

• Recovery times may vary. Most people feel better within six weeks.
  
  
• Try to take a nap or two each day to regain your strength. It may be easy to overdo it as most people don’t feel very sick afterwards.
  
  
• You will have a scar that runs across your chest. Gently massage the scar and moisturise it daily.
  
  
• Try to walk every day, increasing the distance each time. Do some gentle stretching as instructed by the physiotherapist.
  
  
• Your meals should be healthy, including protein and fruit, vegetables and grains.
  
  
• If you swim, avoid freestyle as this can overstretch the arm area while you are in the recovery stage.
  
  
• You may be able to perform light household duties.
  
  
• Avoid driving for several weeks after surgery and only do so if permitted by your doctor.
  
  
  
• Do not lift heavy objects or do anything which requires strenuous effort .
  
  
• Please talk to your doctor about the resumption of activity after your surgery.

You may experience the following side-effects of breast surgery:

• When the lymph nodes are removed your arm may swell (lymphoedema).
  
  
• The surgery may have damaged nerves causing your arm and shoulder to feel numb. This will improve but may not fully go away. Shoulder exercises will assist in improving movement.
  
  
• Fluid called seroma may collect around the operated site in your breast or lymph nodes and you will need to consult your doctor to have it removed.
  
  
• You may be aware of some difference in body weight on either side of your body, especially if your breast on the other side is large. Breast reconstruction or the option of wearing an external prosthesis could be considered.
  
  
• You may experience some degree of distress regarding body image, sexuality and self esteem after losing your breast. You could consider speaking to someone who has had a similar operation. The Cancer Council can assist you with providing a person who has experienced the same operation or a counsellor who may be able to discuss these issues with you. You may contact the Council on 13 11 20.

1. Preparation

WHAT IS A LUMPECTOMY?

A Lumpectomy is the surgical removal of a breast lump. The tissue that is removed is sent to pathology to determine whether it is benign or cancerous. If the tissue is benign you will most likely require no further treatment or surgery. However, if cancer cells have been detected, further surgery may be required.

If the lump is difficult to find it will be located using an ultrasound. A wire may be inserted prior to surgery in order to assist the surgeon locate the lump. This procedure is perfomed in the radiology department. If your surgeon thinks there is the possibility of having to remove any lymph nodes with the lump, you may also have a test called a lymphoscintogram prior to your surgery. This test locates the lymph nodes closest to the lump and helps to guide the surgeon if these nodes require removal. This test is also performed in the radiology department.

Should there be an early-stage diagnosis, a lumpectomy is performed to remove the lump and a small amount of healthy tissue around it. This procedure is sometimes referred to as a wide local excision, complete local excision, or a partial mastectomy.

After the surgery a pathologist will examine the breast tissue. If there are healthy cells surrounding the lump that has been removed, it is called a clear margin and no further treatment is required.

If the lump and surrounding tissues are cancerous, further extensive surgery may be required. Otherwise, radiotherapy and or chemotherapy treatment may be offered to minimise the risk of the cancer recurring.

WHAT IS A MASTECTOMY?

If cancer is diagnosed in the locally advanced stage, it may be necessary to have a partial or total Mastectomy. A Mastectomy is the removal of part of or the entire breast as well as affected lymph nodes under the armpit.

Depending on the stage of breast cancer, there are 4 types of mastectomy and they are:

• Radical Mastectomy – removal of the breast and lymph nodes in the armpit with other neighbouring tissues.
  
  
• Simple Mastectomy – removal of the breast tissue, nipple and a small part of the overlying skin.
  
  
• Segmental Mastectomy – removal of enough breast tissue to ensure that the area of the resected specimen is free of tumour.
  
  
• Subcutaneous Mastectomy – removal of breast tissue while preserving the overlying skin, nipple and areola (circular pigmented area surrounding the nipple).

WHY IS A LUMPECTOMY OR MASTECTOMY PERFORMED?

The breasts mostly consist of glands lined with cells that produce milk. Sometimes these cells grow rapidly which may result in the formation of a lump or tumour.

Tumours may be identified as benign or malignant. Your doctor will conduct a biopsy to identify the tumour. This is done by taking a sample of the cells from the breast and sending it for testing by a pathologist for examination under a microscope. Malignant tumours in the breast are diagnosed as breast cancer.

The tumours identified as benign usually do not spread, but malignant tumours consist of cells which can spread to other parts of the body. The spreading of these cells does not occur in all women who have had breast cancer.

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a General Surgeon who can perform the procedure.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the Royal Australasian College of Surgeons via their website www.surgeons.org. This is a very informative website.

The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).

To access a list of General Surgeons who participate in HCF’s Medicover no gap arrangement:

• Call HCF Member Services on 13 13 34
• Visit one of HCF’s customer service branches
• Access HCF’s website at www.hcf.com.au/members/findahealthprofessional/findadoctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

WHAT SHOULD I ASK MY SPECIALIST?

• Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.

• In addition to what the procedure involves, you should also ask about:

• Preparation
• Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
• Aftercare

• Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:

• Aspirin (or any related products)
• Blood thinners (Warfarin, heparin.)
• Arthritis medication
• Pain medication
• Insulin

Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

WHERE ARE THEY DONE?

A Lumpectomy is performed in a hospital and the average length of stay is 1-2 days.

A Mastectomy is also performed in a hospital and the average length of stay is 4.5 days.

HOW LONG ARE THE PROCEDURES?

A Lumpectomy takes approximately 1½ hours for the procedure excluding preparation and recovery time.

A Mastectomy takes approximately 1-2 hours for the procedure excluding preparation and recovery time.

WHO IS INVOLVED?

The people involved in the procedure are:

• The General Surgeon, your Specialist doctor
• There may be an assistant surgeon
• Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
• Nurses for the procedure and recovery
• Pathologist for blood tests and/or specimen samples
• Radiologist for x-rays

HOW DO I PREPARE FOR A LUMPECTOMY OR MASTECTOMY?

You will usually be required to attend a pre-admission clinic where you will undergo basic tests to assess your general fitness for surgery. Your doctor should advise you of any lifestyle changes such as giving up smoking or weight loss that you should make prior to your operation. As with any surgery, part of the preparation is to find out as much information needed to feel as comfortable as possible with what is going to happen to you.

You will be notified of your fasting times prior to theatre. If surgery is scheduled for the morning, you will usually have to fast from midnight, otherwise if your operation is scheduled for the afternoon you will be required to fast for at least 6 hours prior to surgery.

Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.

WHAT DO I TAKE WITH ME TO THE HOSPITAL?

• Do not bring any valuables with you
• Leave all jewellery at home, a wedding ring is acceptable
• Wear comfortable clothing
• Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
• Bring any relevant x-rays or scans

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

MASTECTOMY

For your information, the average charges for claims paid for Mastectomy admissions for the financial year 06/07 are provided below: