Q: Can breast lumps be eliminated without surgery and only by taking medication? A: Cystic breast lumps are usually more obvious before menstruation and may shrink or disappear after menstruation, and medication has some effect on them; solid lumps usually cannot be eliminated on their own, and taking medication will not eliminate them completely, so it is necessary to consult your doctor to decide whether surgery is needed according to the actual situation. Q: Before the surgery, the doctor told me that my disease has not been fully diagnosed, why do I have surgery without a clear diagnosis? A: There are different levels of diagnosis. The highest level of diagnosis is pathological diagnosis, which requires tissue sectioning and clear pathological findings under a microscope. Doctors can make a preliminary diagnosis based on the medical history, physical examination, and auxiliary examination, but still need pathological examination for final confirmation. Therefore, the final diagnosis can only be obtained after surgery. Q: Why do I need to do many tests before breast lump surgery? A: Contraindications to surgery need to be ruled out before any surgery. The tests we do are basic screening tests, and further related tests are needed if a problem is found in a certain area. Breast-related examinations include ultrasound, molybdenum target, magnetic resonance imaging, etc. Each examination has a different focus, and your doctor will choose the most suitable one or more examinations for you according to the situation, in order to obtain a more accurate preliminary diagnosis before surgery. Q: What are the common surgical procedures for benign breast lumps? How to choose? A: Commonly used procedures include minimally invasive surgery with McMurtry and open surgery. The minimally invasive McMurtaugh procedure is particularly suitable for multiple lesions with a diameter of less than 2cm and not too close to the nipple and skin. It has the advantages of minimal trauma, quick recovery, minimal scarring, accurate localization, and short waiting time for surgery. Open surgery can be used for most breast lump surgeries, but it is more invasive, has a larger scar, is difficult to accurately localize small, multiple lumps, has more incisions and is not easy to remove. Q: How long does it take to operate on a benign breast lump? How many days do I need to stay in the hospital after surgery? When should I return to the hospital for follow-up? A: The operation time varies for each patient due to different lesion conditions, lesion quantity, depth, and operation methods. All you need to do is to wait patiently, and the surgeon will do every operation for you carefully. After the operation, you can be discharged from the hospital on the following day after the pathology report is sent back, which confirms that the lesion is benign. If the incision needs to be removed, you can have the stitches removed at your local medical institution 8-10 days after surgery. You may return to the hospital for a follow-up examination 1-2 months after surgery. Q: Before my breast lump surgery, my doctor made an appointment for me to have a rapid pathology exam. What is rapid pathology? What does it do? How is it different from routine pathology? A: Rapid pathology is a method of rapid pathologic diagnosis using frozen sections in a very short period of time. It is mainly used for intraoperative diagnosis of the nature of the lesion. The surgeon will decide on the surgical plan based on the results of rapid pathology. Due to the limitations of the frozen section technique itself, rapid pathology, although short, is more difficult to diagnose certain lesions between benign and malignant, fat and lymph node lesions, and rare lesions. It may not be possible to make a definitive diagnosis in a short time on the operating table. All specimens will be routinely pathologized after surgery. This usually takes 3-4 days. Routine pathology uses paraffin sections, which are highly accurate and can be considered the final diagnosis of the disease. Q: When my doctor suspects that a breast lump may be malignant, what time can I be scheduled for surgery? What are the preparations before surgery? A: After you are admitted to the hospital, you will complete the auxiliary examinations, have your blood drawn the next morning, and after 4:00 p.m., you will be able to get a preliminary idea of whether or not there are circumstances that make you unsuitable for surgery. On the third morning, we will decide whether or not to schedule surgery for you. Since surgery needs to be prepared one day in advance, if there are no contraindications to surgery, your surgery will be scheduled on the fourth day of your admission at the earliest. Special attention should be paid to the fact that if you are menstruating you cannot be operated on, as this may cause bleeding during the operation, and you should inform the doctor of your menstrual condition. The doctor and nurses will notify you when you are scheduled for surgery the following day to prepare you for surgery. You and your family members, especially your important relatives, should try not to leave the ward on the day before the surgery. If there are any special circumstances, you need to inform the doctors and nurses so as not to affect your preparation for the surgery and delay the surgery. The day before the surgery, you need to take a shower and prepare open-collared clothes for changing the medicine and observing the condition of the incision at any time after the surgery. Your family members will need to prepare and pay the surgery fee to the hospitalization office the day before the surgery, please ask the medical staff for details. Q: I have a large breast lump, why didn’t my doctor schedule my mastectomy as soon as possible? A: If your doctor suspects that your lump is malignant, he or she will need to decide on a treatment plan that takes into account your condition. The latest view on breast cancer treatment is that locally advanced breast cancer (large lumps or skin invasion) can be diagnosed with pathology before surgery, and neoadjuvant chemotherapy can be used before considering surgery. The method of obtaining a pathologic diagnosis is called biopsy, which is a minor surgery. Depending on the situation, either a minimally invasive McMurtry biopsy or a normal mass biopsy may be performed. Q: What is neoadjuvant chemotherapy? What benefits can I expect from it compared to adjuvant chemotherapy? A: Neoadjuvant chemotherapy is chemotherapy administered prior to surgery. It is called neoadjuvant chemotherapy to differentiate it from conventional postoperative chemotherapy (i.e., adjuvant chemotherapy). Neoadjuvant chemotherapy has the same overall effect as conventional adjuvant chemotherapy, but it can clarify whether your tumor is sensitive to the chemotherapy regimen, and if it is not, you can change the chemotherapy regimen in a timely manner; it can lower the stage of the local tumor so that patients who could not otherwise have breast-conserving surgery can receive breast-conserving surgery. Q: After neoadjuvant chemotherapy, when is the right time to undergo surgery? If the effect of neoadjuvant chemotherapy is very good, can I skip the surgery? A: Generally, after 2-3 cycles of neoadjuvant chemotherapy, the efficacy of chemotherapy will be evaluated: if the tumor shrinkage is not obvious, surgery will be arranged in time, and the chemotherapy regimen will be changed to continue chemotherapy; if the tumor shrinkage is obvious, the original chemotherapy regimen can be continued until the tumor shrinkage is not obvious, then surgery will be performed. The data from domestic and foreign bulk multicenter studies show that it is still believed that even if neoadjuvant chemotherapy is effective, there may still be islands of residual cancer cells, and it is still necessary to undergo surgery. Q: What are the surgical options for malignant breast masses? How to choose? A: They include: breast-conserving surgery + breast-conserving surgery + axillary lymph node dissection, mastectomy + sentinel lymph node biopsy, subcutaneous mastectomy + prosthetic reconstruction + sentinel lymph node biopsy, subcutaneous mastectomy + prosthetic reconstruction + axillary lymph node dissection, modified radical mastectomy for breast cancer, radical mastectomy for breast cancer, and enlarged mastectomy for breast cancer, and so on. You can choose the surgery according to your doctor’s advice and your own wishes. Q: Can family members decide on the surgery instead of the patient? What if my friends and relatives object to the surgery chosen by the patient? A: No. Male family members often hide the patient’s condition before surgery and are eager to remove the patient’s breasts, with little consideration of the patient’s postoperative cosmetic requirements and psychosocial changes. It is not uncommon for male family members to make the decision to remove the breasts alone, resulting in patient dissatisfaction, regret, and family discord after the surgery. Therefore, no matter which type of surgery is performed, the final decision should be made and signed by the patient himself. Friends and family often object to breast-conserving surgery as “not going to the root of the problem” due to their lack of knowledge about advanced breast cancer treatment. What you need to do is to talk to your doctor about your thoughts and discuss the surgery, and not pay any attention to what the outside world is saying, so as not to leave you with lifelong regrets. Q: When will the incision be changed after surgery? When will the drains be removed? When will the stitches be removed? A: Generally, the incision will be changed 3-4 days after surgery, and then every 3 days thereafter. The time to remove the drain depends on the amount of drainage flow. The suture removal is usually done 12-14 days after surgery, but not for absorbable sutures. Q: How should I perform functional exercises after surgery? How to improve the embarrassment of breast loss after surgery? A: On the first day after surgery, you can make a fist on the affected side; on the second day, you can move the wrist joint; on the third day, you can move the elbow joint; in about a week, you can move the shoulder joint; and two weeks after surgery, you need to climb the wall of the upper limb on the affected side and practice combing hair. Functional exercise of the upper limbs after surgery is crucial to the recovery of labor ability in the future, and patients should pay enough attention to it. If you are embarrassed by the lack of breasts after surgery, you can contact the nurse to choose a silicone breast prosthesis that suits your needs, so as to alleviate your concerns in socializing and to avoid the impact of bad comments on you. Q: Why is treatment not over after breast cancer surgery? What other treatments are needed? A: Breast cancer is a systemic disease, and many breast cancers can develop systemic metastasis at an early stage. Due to medical limitations, we are unable to detect whether there are residual cancer cells and subclinical lesions in your body after surgery, so you still need to continue treatment. Systemic treatment for breast cancer includes surgery, chemotherapy, radiation therapy and endocrine therapy. Your doctor will determine which treatments you need based on your specific condition, so please choose your treatment plan based on your doctor’s recommendations. Q: When should I start adjuvant chemotherapy after breast cancer surgery? Is chemotherapy unbearable? A: Adjuvant chemotherapy is usually started 7-10 days after surgery. Most patients can tolerate chemotherapy well, but of course there are many adverse effects of chemotherapy, such as: decreased blood count, infection, hair loss, abdominal pain, diarrhea, nausea and vomiting, inflammation of oral mucous membranes, and a certain degree of damage to the heart, liver, lungs and kidneys of the human body. Adverse effects vary according to the regimen used and the patient’s physical condition, but most of them can be relieved through drug control. Q: How do I choose a chemotherapy regimen? A: The chemotherapy regimen will be determined by your doctor based on your lesions, age, menstrual status, pathology report and other factors. Generally, your doctor will recommend several chemotherapy regimens for you, inform you of the advantages and disadvantages of each regimen, and you need to make a choice based on your own financial situation. Once you start chemotherapy, it is not advisable to change the regimen due to personal wishes and financial reasons. Q: My adjuvant chemotherapy regimen contains paclitaxel, what should I do if I am allergic to it? A: Paclitaxel is a very effective drug in the treatment of breast cancer. Since it is extracted from plants, allergic reactions are inevitable. The chances of allergic reaction are small if desensitization treatment is performed routinely before the administration of chemotherapy containing paclitaxel, but there are still a few patients who may develop allergy. Since chemotherapy drugs cannot be tested for allergies, doctors cannot predict which patients will become allergic. In the event of an allergic reaction, you will have to turn off the infusion and notify your healthcare provider urgently. You will not be allowed to use paclitaxel again for the rest of your life. Q: Why is an IV line placed before chemotherapy? How long can an IV line be used? What are the risks of having an IV line placed? What should I be careful of? A: Intravenous chemotherapy is different from regular intravenous fluids. If the chemotherapy drug leaks into the subcutaneous tissue, it may cause necrosis of the subcutaneous tissue. Repeated intravenous chemotherapy can also lead to severe phlebitis and pain, and further atresia of the peripheral veins. It will be difficult to establish intravenous access when you need intravenous fluids at a later date. Intravenous catheterization prevents these problems by placing a catheter into your central vein. As an invasive procedure, IV catheterization is associated with bleeding, infection, sepsis, catheter ectasia, and puncture failure. After placement, you will need to have the catheter placed 1-2 times per week and be careful to maintain personal hygiene and keep the site of the placement free of contamination. Q: How long does adjuvant chemotherapy take? What do I need to prepare each time I come to the hospital for chemotherapy? A: The duration of adjuvant chemotherapy depends on the length and number of cycles of different regimens. Each time you come to the hospital for chemotherapy, you must bring a copy of your hospitalization record from the surgery, and you can bring some necessities and your favorite food with you. Q: After a cycle of adjuvant chemotherapy, what should I pay attention to while at home? A: It is necessary to pay attention to the review of blood routine 5-7 days after the end of chemotherapy, to prevent colds and flu, to avoid going to crowded and messy places, and to wear a mask during the flu season or when there are patients with flu around you. If you have fever, or if your blood white blood cell count is lower than 3.0*109/L, please contact your doctor in time and return to the hospital for treatment if necessary. Q: Do I need endocrine therapy? How is the endocrine treatment carried out? A: Endocrine therapy is an important part of comprehensive treatment for breast cancer. However, not all patients are suitable for endocrine therapy. First of all, you need to clarify your menstrual status. If you have reached the age of 60, or have stopped menstruating for 1 year without chemotherapy or ovarian suppression, you are basically considered to be menopausal. Your doctor will develop an endocrine treatment plan for you based on your post-surgical pathology report, and your menstrual status. Most endocrine treatments are oral medications that can be taken at the convenience of your home. The medication can be taken for up to 5 years or more, so you will need to discuss this with your doctor in light of your financial situation. Q: What is the best time for breast cancer patients to come to the hospital for follow-up after hospitalization? A: Generally, within 2 years after surgery, every 3 months; 2-5 years after surgery, every 6 months; more than 5 years after surgery, every 1 year. When you come for review, make sure you bring a copy of your hospitalization record, otherwise you may not be able to complete the review successfully, and the doctor will not be able to guide you to the next step of treatment.