Mastectomy: What to Expect
Before
mastectomy surgery
In the hospital
on the day of surgery, you’ll change into a hospital gown and wait in a
preoperative holding area. Some hospitals will allow you to have one or two
friends or family members with you in the room.
Your surgeon or
a nurse may draw markings on your breast that show where the incision will be
made. Usually this is done with a felt-tip marker. You’ll be sitting up while
this happens so that the natural crease of your breast can be marked.
You will be
taken into the anesthesia room, where a nurse will insert a needle connected to
a long tube — an intravenous infusion (IV) line — into your hand or arm and
tape it into place. Soon after this, you’ll be given relaxing medication
through the IV line. Once you are wheeled into the operating room, you will be
given general anesthesia.
During
mastectomy surgery
Mastectomy with
axillary dissection (modified radical mastectomy) can take 2-3 hours. If
reconstruction is performed at the same time, surgery will take longer.
Most mastectomy
incisions are in the shape of an oval around the nipple, running across the
width of the breast. If you are having a skin-sparing mastectomy, the incision
will be smaller, including only the nipple, areola, and the original biopsy
scar.
After the
incision is made, the breast tissue is separated from the overlying skin and
from the chest wall muscle underneath. All of the breast tissue — which lies
between the collarbone and ribs, from the side of the body to the breastbone in
the center — is removed. If you are having a full radical mastectomy, some of
your chest muscle may be removed as well. Your breast surgeon will also perform
axillary lymph node
dissection if it is part of your surgery plan.
When your
breast surgeon has removed your breast tissue — and if immediate breast reconstruction
is part of your plan — your plastic surgeon will perform the reconstruction.
In the final
stages of the surgery, your breast surgeon will check the surgery areas for
bleeding and insert surgical drains. Drains are long tubes that are inserted
into your breast area or armpit to collect excess fluid that can accumulate in
the space where the tumor was. The tubes have plastic bulbs on the ends to
create suction, which helps the fluid to exit your body. After the drains are
inserted, your surgeon will stitch the incision closed. The surgery site will
then be covered by a bandage that wraps closely around your chest.
After
mastectomy surgery
You’ll be moved
to the recovery room after mastectomy surgery, where staff will monitor your
heart rate, body temperature, and blood pressure. If you are in pain or feel
nauseous from the anesthesia, let someone know so that you can be given
medication.
You’ll then be
admitted to a hospital room. Hospital stays for mastectomy average 3 days or
less. If you have a mastectomy and reconstruction at the same time, you may be
in the hospital a little longer.
The morning
after your surgery, your surgeon or nurse will show you an exercise routine you
can do to prevent arm and shoulder stiffness on the side where you had the
mastectomy and to help prevent the formation of significant scar tissue. Some
exercises should be avoided until drains are removed. Ask your surgeon any
questions you may have to make sure the exercise routine is right for you. Your
surgeon should also give you written, illustrated instructions on how to do the
exercises.
Before you
leave the hospital, your surgeon or nurse will give you information about
recovering at home:
- Taking pain medication: Your
surgeon will probably give you a prescription 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 as soon as you are
home so that you have it available.
- Caring for the bandage (dressing)
over your 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: If you
have a drain in your breast area or armpit, the drain might be removed
before you leave the hospital. Sometimes, however, a drain stays inserted
until the first follow-up visit with the doctor, usually 1-2 weeks after
surgery. If you’re going home with a drain inserted, you’ll 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.
- Stitches and staples: Most surgeons
use sutures (stitches) that dissolve over time, so there's no longer any
need to have them removed. But occasionally, you'll see the end of the
suture poking out of the incision like a whisker. If this happens, your
surgeon can easily remove it. Surgical staples — another way of closing
the incision — are removed during the first office visit after surgery.
- Recognizing signs of infection: Your
surgeon should explain how to tell if you have an infection in your
incision and when to call the office.
- Exercising your arm: Your
surgeon or nurse may show you an exercise routine you can do to prevent
arm and shoulder stiffness on the side where you had surgery. Usually, you
will start the exercises the morning after surgery. Some exercises should
be avoided until drains are removed. Ask your surgeon any questions you
may have to make sure the exercise routine is right for you. Your surgeon
should also give you written, illustrated instructions on how to do the
exercises.
- Recognizing signs of lymphedema: If you
have had axillary dissection, you will be given information on taking care
of your arm and being alert to signs of lymphedema.
- When you can start wearing a prosthesis
or resume wearing a bra: The site of mastectomy surgery, and especially
mastectomy with reconstruction, needs time to heal before you can wear a
prosthesis or bra. Your doctor will tell you how long you may need to
wait.
At-home
recovery from mastectomy
It can take a
few weeks to recover from mastectomy surgery, and longer if you have had
reconstruction. It’s important to take the time you need to heal.
In addition to
your surgeon’s instructions, here are some general guidelines to follow at
home:
- Rest. When you get home from the
hospital, you will probably be 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 will
probably feel a mixture of numbness and pain around the breast incision
and the chest wall (and the armpit incision, if you had axillary
dissection). 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.
- Take sponge baths until your
doctor has removed your drains and/or sutures. You can take your first shower
when your drains and any staples or sutures have been removed. A sponge
bath can refresh you until showers or baths are approved by your doctor.
- 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, don’t feel you should take on more than you can handle.
In the months
after mastectomy
Your body will
continue to adjust to the effects of the surgery over a period of months. Here
are some things to keep in mind:
- You may have “phantom sensations”
or “phantom pain” in the months after mastectomy: As nerves regrow, you may feel a
weird crawly sensation, you may itch, you may be very sensitive to touch,
and you may feel pressure. Your discomfort may go away by itself, or it
may persist but you adapt to it. Analgesics and NSAIDs (pronounced
EN-seds) such as acetaminophen and ibuprofen usually can address the pain
related to this type of nerve injury. Opioids (pronounced OH-pee-oydz)
also can be used to treat this type of pain. Read more about managing phantom pain.
- Continue doing regular arm
exercises: Stay with your arm exercise routine to keep your
arm limber.
- You may experience fatigue from
time to time in the early months after surgery: If you’re having trouble with fatigue, ask your doctor
about things you can do.
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