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Patient Instructions

You had a mastectomy, the surgical removal of the entire breast, to treat or prevent breast cancer. Your procedure was one of these:

• For a subcutaneous mastectomy, the surgeon removed the entire breast and left the nipple and areola (the pigmented circle around the nipple) in place.
• For a total or simple mastectomy, the surgeon cut breast tissue free from the skin and muscle and removed it. The nipple and the areola were also removed. The surgeon may have done a biopsy of nearby lymph nodes to see if the cancer spread.
• For a modified radical mastectomy, the surgeon removed the entire breast along with the lining over some of the muscles. Some of the lymph nodes underneath the arm were also removed.
• For a radical mastectomy, the surgeon removed the overlying skin, all of the lymph nodes underneath the arm, and the chest muscles.

You may have also had breast reconstruction surgery.

Full recovery may take 3 to 6 weeks. You may have shoulder stiffness if lymph nodes were removed from your armpit. This stiffness gets better over time.

You may have swelling in the arm on the side of your surgery (called lymphedema). It can be a problem that lasts.

You may go home with drains in your chest to remove extra fluid. Your surgeon will decide when to remove these drains. This may take a few days to a week, or more.

You may need time to adjust to losing your breast. Talking to other women who have had mastectomies, and to their partners, can help you deal with these feelings. Ask your doctor or nurse about local support groups. A mental health care provider can help.

When sitting, keep your arm on the side of your surgery up as high as your heart to help prevent swelling. If swelling in your arm does not go away, talk to your doctor.

It is okay to use your arm on the side of your surgery. But do not overdo it until sutures (stitches) or staples and all drains are removed, and you have seen your doctor.

• Your doctor or nurse or therapist can show you some simple exercises to relieve tightness. Do only the exercises they show you.
• You can start doing most normal activities again 2 weeks after surgery. Avoid doing things that you will need the arm on the side of your surgery, or that make you keep your arm raised.
• You may drive -- if you are not taking pain medicines -- and you can easily turn the steering wheel without pain.

Ask your doctor when you can return to work. When and what you can do may vary, depending on work you do and whether you also had a lymph node dissection.

Wearing a loose-fitting bra may be more comfortable.

You may still have drains in your chest when you go home from the hospital. You will need to empty and measure how much fluid drains from them. See also: Jackson-Pratt drain

Stitches are often placed under the skin and dissolve on their own. If your surgeon uses clips, you will go back to the doctor to have them removed, usually 7 to 10 days after surgery.

Change dressings every day until your doctor says you do not need to. Wash the wound area with mild soap and water. See also: Surgical wound care

• You may shower after all of your dressings have been removed.
• Do not try to wash or scrub surgical tape (Steri-strips) or glue. Let them fall off on their own. Do not sit in a bathtub, pool, or hot tub until your doctor tells you it is okay.

Your doctor will give you a prescription for pain medicines. Get it filled when you go home so you have it available. Remember to take your pain medicine to help before your pain becomes too bad.

Try using an ice pack on your chest and armpit if you have pain or swelling.

Your doctor will tell you when you need to have your next visit. You may also need appointments to talk about more treatment, such as chemotherapy or radiation.

Even when you are finished with all treatment, you will need to see your doctor regularly for the rest of your life.

Call your doctor or nurse if:

• Your temperature is above 101.4 °F.
• You have swelling of the arm on the side you had surgery (lymphedema).
• Your surgical wounds are bleeding, are red or warm to the touch, or have a thick, yellow, green, or milky drainage.
• You have pain that is not helped with your pain medicines.
• It is hard to breathe.
• You have a cough that does not go away.
• You cannot drink or eat.

Breast removal surgery - discharge; Subcutaneous mastectomy - discharge; Total mastectomy - discharge; Simple mastectomy - discharge; Modified radical mastectomy - discharge

Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, et al.American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006 Nov 1;24(31):5091-7. Epub 2006 Oct 10.

Hayes DF. Clinical practice. Follow-up of patients with early breast cancer. N Engl J Med. 2007;356(24): 2505-13.

Riutta J. Post-mastectomy pain syndrome. In: Frontera, WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 107.

Iglehart JD, Smith BL. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 34.

Updated by: James Lee, M.D., Department of Surgery, Columbia Presbyterian Medical Center, New York, NY. Review Provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.