More about Mastectomy

Mastectomy Surgery and Recovery 

What To Expect What to expect on the day of, during, and after mastectomy surgery as well as the recovery period in the weeks after surgery.

Getting your pathology report after mastectomy Surgery can be a stressful experience. Having as clear a picture as possible about how things go the day of the procedure — and immediately afterward — can help. It’s a good idea to ask someone on your cancer care team any questions you may have about the pre-surgery and post-surgery instructions so you can follow them accurately. Here’s what you can expect before, during, and after mastectomy surgery and recovery.    

Before mastectomy surgery 

In the hospital on the day of surgery, you change into a hospital gown and wait in a preoperative holding area. Some hospitals allow you to have one or two friends or family members in the room. Before surgery, you typically meet the anesthesiologist to talk about your medical history, any allergies you may have, and the plan for administering anesthesia during your surgery.  Your surgeon or the surgeon assistant may draw markings with a felt-tip marker on your breast that shows where the incision is going to be. You sit up while this happens so they can mark the natural crease of your breast. A nurse inserts an intravenous infusion (IV) line into your hand or arm and tapes it into place so you can receive relaxing medication through the IV line. Once you are wheeled into the operating room, you are given general anesthesia. After you’re asleep, a breathing tube is placed through your mouth and into your windpipe to help you breathe.   

During mastectomy surgery 

A mastectomy without immediate breast reconstruction can take one to three hours. If you are having breast reconstruction during the mastectomy, the surgery takes longer. Reconstruction with tissue expanders or breast implants takes about three to four hours, reconstruction with tissue flaps takes about six to eight hours. During the mastectomy, the surgeon separates the breast tissue from the skin and muscle. All of the breast tissue that the surgeon can see — which lies between the collarbone and ribs, from the side of the body to the breastbone in the center — is removed. Depending on the type of mastectomy you are having, your surgeon may remove other parts of the breast. 

Lymph node dissection 

In most cases, your breast surgeon also performs either a sentinel lymph node dissection (in which one to five underarm lymph nodes are removed) or an axillary lymph node dissection (in which about 10 or more underarm lymph nodes are removed). This is done to see if the cancer has spread to the lymph nodes. Your surgeon may send the lymph nodes that were removed to the pathology department to be checked for cancer cells during the surgery. If the pathologist finds cancer cells, your surgeon may remove more lymph nodes during the surgery. 

If you’re having a sentinel lymph node dissection, your surgeon uses a lymphatic mapping procedure to find the sentinel lymph nodes. This is done either on the day before the mastectomy, the morning of the mastectomy, or during the mastectomy. The procedure involves injecting a radioactive liquid, a blue dye, or both, underneath the nipple or near the tumor site. The liquid and/or dye travel to the sentinel node or nodes, allowing the surgeon to see where they are and remove them. The surgeon may also use a small handheld device to measure the radioactivity from the liquid and check how much of it was absorbed. 

Breast reconstruction during mastectomy 

If you’re having immediate breast reconstruction with tissue expanders, breast implants, or tissue flaps, your plastic surgeon performs the reconstruction during the same procedure. If you’re not having immediate reconstruction, the breast surgeon or plastic surgeon performs a flat closure, so the chest appears flat.

The last steps of mastectomy surgery 

When the procedure is nearly over, your breast surgeon checks the surgery areas for bleeding and may insert one or more thin, flexible tubes called surgical drains in your breast area, armpit, or both. The drains collect the excess fluid that can otherwise build up in those areas after surgery. Each tube carries the fluid outside your body and is attached to a soft plastic bulb that collects the fluid, and that must be periodically emptied. After the drains are inserted, your surgeon stitches the incision closed. The surgery site is covered with a bandage that wraps closely around your chest. In most cases, your breathing tube is taken out while you’re still in the operating room.   

Post-mastectomy surgery 

You are moved to the recovery room after mastectomy surgery, where staff monitors your heart rate, body temperature, blood pressure, breathing, and oxygen levels. If you are in pain or feel nauseous from the anesthesia, let a nurse know so that you can be given medication. After that, you may be admitted to a hospital room. You may be able to go home on the same day as the operation, especially if you had no lymph nodes removed, only sentinel lymph nodes removed, no reconstruction, or immediate reconstruction with a tissue expander or breast implant. Otherwise, you can expect to stay in the hospital for an average of three days or less. If you had immediate reconstruction with tissue flaps, you can expect to stay an average of two to five days because your surgical team needs to monitor the blood flow to the flap. Before you leave the hospital, your surgeon or nurse talks with you and gives you written instructions about the following: 

Taking pain medication 

Your surgeon is probably going to give you a prescription for pain medication to take with you when you leave the hospital. You might want to get it filled on your way home or have a friend or family member get it filled for you right away.

Your surgical team may use a new approach to pain management called ERAS (enhanced recovery after surgery). These protocols can control your pain for up to 3 or 4 days after surgery without the use of opioids and can help you have a shorter hospital stay. Some medications that may be used as part of an ERAS protocol during surgery include lidocaine and liposomal bupivacaine (brand name: Exparel). Gabapentin (a nerve medication) and Tylenol may be used after surgery. You may want to ask your surgical team before your mastectomy if they can use an ERAS pain management protocol.

Side effects from a lymphatic mapping procedure 

If you had a lymphatic mapping procedure before a sentinel lymph node dissection and blue dye was used, your skin, pee, and poop may be bluish-green for one to two days after the surgery. The blue dye can stain the skin at the injection site for months and sometimes permanently.

Caring for the bandage (dressing) over your mastectomy incision 

Ask your surgeon or nurse how to take care of the mastectomy bandage. The surgeon may ask that you not try to remove the bandage and instead wait until your first follow-up visit so that he or she can remove the bandage. 

Caring for a surgical drain after mastectomy surgery 

If you have one or more surgical drains in your breast area or armpit, they might be removed before you leave the hospital. Sometimes, a drain should stay inserted until the first follow-up visit with your doctor, usually one to two weeks after surgery. If you’re going home with a drain inserted, you need to empty the fluid from the detachable drain bulb a few times a day. Make sure your surgeon gives you instructions on caring for the drain before you leave the hospital.

Mastectomy stitches 

Most surgeons use sutures (stitches) that dissolve over time, so there’s no longer any need to have them removed. Occasionally, you see the end of the suture poking out of the incision like a whisker. If this happens, your surgeon can easily remove it.

Recognizing signs of infection post-mastectomy 

Your surgeon should explain how to tell if you have an infection in your incision and when to call your doctor’s office. Some signs of infection to look out for include fever, increased redness around the incision, and pus draining from the incision.

Exercising your arm after mastectomy 

Your surgeon or nurse shows you an exercise routine you can do to prevent arm and shoulder stiffness and to help prevent the formation of significant scar tissue. Usually, you start the exercises the morning after surgery. Your surgeon should also give you written, illustrated instructions on how to do the exercises. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Some exercises should be avoided until the drains are removed.

Recognizing signs of lymphedema after lymph node dissection 

If you have had any underarm lymph nodes removed, you are going to receive information on taking care of your arm and being alert to signs of lymphedema. Lymphedema is abnormal swelling in the arm, hand, breast area, underarm, or torso. It occurs when the normal flow of lymph — a thin, clear fluid that circulates throughout the body to remove wastes from tissues — is disrupted. Lymph fluid normally drains from body tissues through the lymph nodes and lymph channels. When some lymph nodes and channels are removed or damaged during surgery, lymph fluid may not drain properly and can collect in the tissues on the side of the body where the lymph nodes were removed. Symptoms of lymphedema include swelling, achiness, tingling, heaviness, tightness, or a feeling of fullness in the hand, arm, chest, or armpit area. Detecting lymphedema early increases the likelihood of successful treatment. There are also things you can do to reduce your risk of it or reduce the severity. (Learn about Lymphedema)

Scheduling your follow-up appointments  

Your surgeon may arrange for a home health care provider to evaluate you at home within the first day or two after you return home from the hospital. Your follow-up appointment with your surgeon should usually be scheduled for within one to two weeks after you leave the hospital.

How long to avoid certain activities after mastectomy 

Your doctor may instruct you not to lift objects heavier than 5 pounds for four to six weeks. Ask your doctor how long you need to avoid more strenuous activities (like jogging, tennis, or weightlifting) and about exercises and movements you can do while you are healing.

When you can start wearing a prosthetic breast form or resume wearing a bra 

The site of mastectomy surgery, and especially mastectomy with reconstruction, needs time to heal before you can wear a breast prosthesis or bra. Follow your post-surgical instructions or ask your doctor to let you know how long you need to wait after your mastectomy surgery.   

At-home mastectomy recovery 

Mastectomy recovery time can last a few weeks after surgery, and longer if you have had reconstruction. It’s important to take the time you need to heal. Here are some general mastectomy recovery guidelines to follow at home: 

• Rest. When you get home from the hospital, you probably are going to feel fatigued from the experience. Allow yourself to get extra rest in the first few weeks after surgery. Read more about managing fatigue. 
• Take pain medication as needed. You probably are going to feel a mixture of numbness and pain around the breast incision, the chest wall, and the armpit incision (if you had lymph nodes removed). If you feel the need, take pain medication according to your doctor’s instructions. Learn more about managing chest pain, armpit discomfort, and general pain.  
• Follow your doctor’s instructions on when you can take a shower. You may be instructed to take sponge baths until your doctor has removed your drains or sutures. 
• Continue doing arm exercises each day. It’s important to continue doing arm exercises on a regular basis to prevent stiffness and to keep your arm flexible. 
• Have friends and family pitch in around the house. Recovery from mastectomy can take time. Ask friends and family to help with meals, laundry, shopping, and childcare. As your body heals, try not to take on more than you can handle. 
• Be aware that your body continues to adjust to the effects of the surgery over a period of months. You may have sensations such as tingling, burning, pins and needles, numbness, unbearable itching, pressure, and tenderness in the chest, arm, and/or armpit in the first few months after surgery. Your discomfort may go away by itself, or it may persist. The sensations are typically caused by the damage to the sensory nerves in the chest and armpit that occurred during the surgery. Talk with your doctor about treatments to manage these symptoms if they are bothering you.  

For tips on preparing for mastectomy and recovery, read Before Mastectomy: 10 Tips to Get Ready for Your Hospital Stay and Recovery.

Getting your pathology report after mastectomy 

Your surgeon sends the breast tissue and any removed lymph nodes to a laboratory for testing. The tests provide information about the cancer’s characteristics. Just like the pathology report you received after your biopsy, you receive a pathology report about a week after a mastectomy. Once all the results are in, your doctor reviews the pathology report with you and discusses the next steps, including the need for additional therapy such as chemotherapy, radiation therapy, hormonal therapy, or targeted therapy. The treatment plan your medical team discussed with you before the mastectomy might change based on the test results in the pathology report from the surgery.    If you had a prophylactic mastectomy, the pathology report tells you whether or not any cancer is present. 

Learn more about Understanding Your Pathology Report.

Source: Breast Cancer. Org