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Mastectomy

AMBULATORY CARE:

What you need to know about a mastectomy:

A mastectomy is surgery to remove all or part of one or both breasts. Tissue, lymph nodes, or muscle near the breast may also be removed. A mastectomy may be done to treat breast cancer or prevent the cancer from spreading. The type of mastectomy used depends on the size of the tumor and if the cancer has spread. A mastectomy can also be done to prevent breast cancer. This may be a choice if you are at high risk for breast cancer.

How to prepare for a mastectomy:

  • Your surgeon will talk to you about how to prepare for surgery. He or she may tell you not to eat or drink anything after midnight on the day before your surgery. Arrange for someone to drive you home and stay with you after surgery. This person can help care for you and watch for complications from surgery.
  • Tell your surgeon about all medicines you currently take. He or she will tell you if you need to stop any medicine for the surgery, and when to stop. You may need to stop taking aspirin or blood thinners several days before surgery. He or she will tell you which medicines to take or not take on the day of surgery.
  • Tell your healthcare provider or surgeon about all your allergies, including allergic reactions to medicine, anesthesia, or antibiotics.

What will happen during a mastectomy:

  • You will be given general anesthesia to keep you asleep and free from pain during surgery. You may be given an antibiotic to help prevent a bacterial infection.
  • Your surgeon will make an incision over your breast. He or she will remove the tumor and breast tissue. The nipple and areola (area around the nipple) may be removed. Surgery that leaves these in place is called nipple-sparing mastectomy. Your surgeon may also remove muscle from behind your breast. If lymph nodes will be taken, a small incision will be made in your armpit. The lymph nodes will be removed and tested for cancer.
  • Your surgeon may leave extra skin if you are having reconstruction surgery. This surgery is called skin-sparing mastectomy. Reconstruction surgery helps make the breast look more natural. It is done right after the mastectomy.
  • One or more drains may be inserted near your incision. A drain removes extra fluid and helps your incision heal. Your surgeon will close your incision with stitches and cover it with a bandage. He or she may also wrap a tight-fitting bandage around both of your breasts. This may decrease swelling, bleeding, and pain.

What to expect after a mastectomy:

  • You will be helped to walk around after surgery to help prevent blood clots.
  • Healthcare providers will monitor you until you are awake. You may need to spend 1 to 2 nights in the hospital.
  • You may have trouble moving the arm closest to your mastectomy. This should get better in a few days.

Risks of a mastectomy:

You may bleed more than expected or develop an infection. Nerves, blood vessels, and muscles may be damaged during your surgery. Blood or fluid may collect under your skin. You may need other procedures to remove the fluid or blood. You may have swelling in the arm closest to the mastectomy or where lymph nodes were removed. This swelling is called lymphedema. Lymphedema may cause tingling, numbness, stiffness, and weakness in your arm. This may be permanent. You may get a blood clot in your arm or leg. The blood clot may travel to your heart, lungs, or brain. This may become life-threatening.

Call your local emergency number (911 in the US) for any of the following:

  • You feel lightheaded, short of breath, and have chest pain.
  • You have trouble breathing.
  • You cough up blood.

Seek care immediately if:

  • Blood soaks through your bandage.
  • Your stitches come apart.
  • Your bruise suddenly gets bigger.
  • Your leg or arm is larger than usual and painful.

Call your doctor or surgeon if:

  • You have a fever or chills.
  • Your wound is red, swollen, or draining pus.
  • You have nausea or are vomiting.
  • Your skin is itchy, swollen, or you have a rash.
  • Your pain does not get better after you take pain medicine.
  • Your drain falls out or stops draining fluid.
  • Your drain has pus or foul-smelling fluid coming out of it.
  • You have numbness, tingling, or swelling in your arm or hand.
  • You feel very sad or anxious, or are having trouble coping with changes from the mastectomy.
  • You have questions or concerns about your condition or care.

Medicines:

You may need any of the following:

  • Antibiotics help prevent a bacterial infection.
  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Care for your wound as directed:

If you have a tight-fitting bandage, you can remove it in 24 to 48 hours, or as directed. Ask your healthcare provider when your incision can get wet. You may need to take a sponge bath until your drain is removed. Carefully wash around the incision with soap and water. It is okay to allow the soap and water to gently run over your incision. Gently pat dry the area and put on new, clean bandages as directed. Change your bandages when they get wet or dirty. If lymph nodes were removed from your armpit, ask your healthcare provider when you can wear deodorant. Check your incision every day for redness, pus, or swelling.

Self-care:

  • Apply ice on your incision for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain.
  • Elevate your arm nearest to your incision above the level of your heart. Do this as often as you can. This will help decrease swelling and pain. Prop your arm on pillows or blankets to keep it elevated comfortably.
  • Rest as directed. Do not lift anything heavier than 5 pounds. Do not push or pull with your arms. You can use your arms to groom, eat, and bathe. Take short walks around the house. Gradually walk further as you feel better. Ask your healthcare provider when you can return to your normal activities.
  • Do not sleep on your stomach. This will put too much pressure on your incision. Sleep on your back or on the opposite side of your incision.
  • Empty your drain as directed. You may need to write down how much fluid you empty from your drain each day. Ask your healthcare provider for more information about how to empty your drain.
  • Wear a supportive bra as directed. Wait until you remove the tight-fitting bandage to wear a bra. You may be given a surgical bra or told to wear a sports bra. A supportive bra may help hold your bandages in place. It may also help with swelling and pain. Do not wear bras with lace or underwire. They may rub against your incision and cause discomfort.

Arm stretches:

Your healthcare provider may show you how to do arm stretches. Arm stretches may prevent stiff arms or shoulders. You may need to wait until after your drains are removed to begin stretching. Do not do arm stretches until your healthcare provider says it is okay. Ask your healthcare provider for more information about arm stretches.

Follow up with your doctor or surgeon as directed:

Write down your questions so you remember to ask them during your visits.

For support and more information:

You may have difficulty coping with the changes to your body. Talk to your family or friends about how you are feeling. Ask your healthcare provider about support groups. It may be helpful to talk with other women who have had a mastectomy.

  • American Cancer Society
    250 Williams Street
    Atlanta , GA 30303
    Phone: 1- 800 - 227-2345
    Web Address: http://www.cancer.org
  • National Cancer Institute
    6116 Executive Boulevard, Suite 300
    Bethesda , MD 20892-8322
    Phone: 1- 800 - 422-6237
    Web Address: http://www.cancer.gov

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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