PREPARING FOR SURGERY
- Your doctor will prescribed pain medication and antibiotics to take after your surgery. We recommend that you pick these up before your surgery.
- Do NOT take blood thinners for 10 days prior and 10 days after surgery.
- Additionally, avoid aspirin, ibuprofen, fish oil, flax seed, gingko biloba, or vitamin E.
WHAT TO BRING TO THE HOSPITAL
- A two-piece, loose outfit with a zipper or buttons in the front
- A stretchy camisole or a softee with pockets for the Jackson-Pratt drain(s)
- Personal items (eyeglasses, toothbrush, hairbrush, slippers, earplugs)
- Music player and headphones, audiobooks, light reading
- Leave valuables (such as jewelry) at home
WHAT TO EXPECT WHEN YOU WAKE UP FROM SURGERY
- Your doctor will place an IV, and have compression devices on your legs to avoid clots. There will also be a catheter in place collecting urine.
- Jackson-Pratt (JP) drain
- If you are having a mastectomy (or sometimes for lumpectomy with reconstruction), you will have a JP drain for the first 1-2 weeks after surgery.
- This device promotes healing and reduces the risk of infection by suctioning and collecting fluid from your surgical area.
- Refer to your nurse navigator for specific drain care instructions.
PAIN CONTROL DURING MASTECTOMY RECOVERY
- Your doctor will give you pain medication through your IV right after surgery
- It is recommended to take your pain medication at home on a regular schedule to help control your pain. Healing and recovery improve with good pain control.
- Avoid driving while taking the pain medication.
- Pain medication can also cause or worsen constipation
- Increase your fluids (8-10 cups/day)
- Eat high fiber foods
- Take small walks
- Over the counter medication (Miralax) can be beneficial if experiencing constipation
- Contact your nurse navigator or doctor for further concerns
INCISION AND DRESSING CARE DURING MASTECTOMY RECOVERY
- It is important to monitor your incisions after surgery.
- Your incision is sealed with surgical glue and/or steri-strips and may be covered with gauze and/or a transparent dressing
- Bruising and some swelling are common after surgery.
- A low-grade fever (under 100 degrees F) is normal the day after surgery
- Please refer to your post-op instructions given to you by your doctor regarding care of your dressing and showering. If you have a plastic surgeon, the breast surgeon defers to the plastic surgeon for dressing care/showering
WHEN TO CONTACT YOUR DOCTOR
- Pain is not relieved by medication
- Fever more than 101 degrees F or chills
- Excessive bleeding or swelling
- If the gauze beneath the plastic dressing becomes wet
- Redness outside the dressing and if the skin around your incision feels warm or hot to the touch
- Discharge or bad odor from the wound or the drains
- If the Jackson-Pratt drain(s) is not working or the drainage output is less than 30 cc for 24 hours for 2 days in a row.
FOLLOW UP CARE DURING MASTECTOMY RECOVERY
- You will be scheduled for an appointment to see your Breast Surgeon after your surgery. They will either call you with the pathology results or discuss the results at the post-op visit. Call your Breast Health Department if you do not have or do not remember your appointment.
- If you have a mastectomy, you will be referred to physical therapy to help with swelling, pain, and return to function.
- For patients having a lumpectomy, the breast surgeon decides whether or not you need a physical therapy appointment.
REST DURING MASTECTOMY RECOVERY
- We want to give your body the best chance to heal during mastectomy recovery.
- Studies show that people who follow these precautions have their drains taken out earlier, have less fluid in the drains, and have less chance of developing a seroma (pocket of fluid).
- There are several things you can during the initial days of mastectomy recovery to ensure the best outcomes and to avoid complications:
- Avoid excessive movement of the arm
- Perform manual lymphatic drainage (MLD) to control swelling
- Healing occurs in the lymphatic fluid-collecting vessels. These vessels are trying to reconnect through the armpit and the chest wall area. This may be where skin was cut or where lymph nodes may have been removed.
- Studies show it takes 7-10 days for these vessels to start reconnecting. Therefore, we want you to significantly limit the use of your arm on the surgical side while your drains are in, plus three more days.
- Keep your arm relaxed and below shoulder height while your drains are in, plus three days. Avoid muscle guarding or tensing.
- You can eat and use your hands as needed, but avoid any unnecessary activity – including computer use, pet care, and household chores.
- If you do have more drainage on certain days, log what activities you have done. You most likely did too much too soon. This is your body telling you to move your arm less to give your body a chance to heal.
HELPFUL MOVEMENT DURING MASTECTOMY RECOVERY
- Shoulder rolls
- Gently lift your shoulders towards your ears while keeping your arms by your side. Roll them back and complete a full circle
- Do this 10-15 times several times per day.
- Deep breathing
- This moves the skin and muscles surrounding the rib cage
- It can help prevent pneumonia and blood clots
- Light walking around your house
- These vessels are trying to reconnect through the armpit and the chest wall area
- MLD can be started immediately post-op
- Paying attention to your posture after surgery is VERY important during mastectomy recovery!
- Avoid hunching forward, rolling your shoulders in, and slouching.
- These are all positions that may feel more natural when you come out of surgery, but staying in them all day can cause more issues and discomfort down the road.
- Although movement of your arm is restricted during the first week, you can work on your posture and body position immediately. This can provide some pain relief.
A NOTE ABOUT EXPANDERS
- Many people have tissue expanders placed for the initial part of the reconstructive process. These expanders are commonly placed under the muscles in the front of the chest, and sometimes just above these muscle.
- As the expander is inflated, stretch is applied to the tissues over it. This stretch can make the chest wall feel tight, and slouching can briefly add slack to the system.
- If you are able to maintain a more upright posture as much as possible, these tissues will gradually grow accustomed to their new stretched position.
REHAB DURING MASTECTOMY RECOVERY
- Physical therapy following mastectomy with or without reconstruction is vital in helping you regain functional mobility, decrease pain, and reduce swelling.
- You may already have scheduled appointments starting two weeks after your surgery date.
- Everyone has different rehab needs. Some people only need 3-4 visits and others need to be followed throughout chemotherapy and radiation.
- It depends on your prior level of function, your level of involvement and functional limitations, and the type of surgery that you undergo.
- Our goal is to get you back to all the things you love to do in the safest and most efficient way possible!
POST-MASTECTOMY RESOURCES IN THE BAY AREA
- Late Bloomers – San Mateo
- Nordstrom Lingerie Department – Palo Alto, San Jose, San Mateo
- The Next Step – Los Gatos
- Bischoff's Medical & Mobility – San Jose
- Hanger Prosthetics & Orthotics – locations throughout California
- HERS Breast Cancer Foundation – Fremont, Pleasanton
- Marzels – Pleasanton, Walnut Creek
- Horsnyder Pharmacy – Santa Cruz