After your Breast Cancer Surgery

This general fact sheet is for anyone who is going into hospital for breast surgery, so not all of the issues may be relevant to your particular circumstances. It discusses what to expect after your operation, including some of the short-term problems that can occur.

What happens after the operation?

After your operation you will wake up in the recovery room, probably feeling sleepy and you may have an oxygen mask over your mouth to help you breathe. You will have a transparent dressing over your wound. Unless advised to the contrary, this is to be left in place until removal is advised by Dr Gordon-Thomson (usually 7-10 days). You may shower as normal, as the dressing is splash proof, but try to avoid getting it soaking wet as it will tend to lift off. Simply pat it dry after your shower with a soft towel. The stitches in your wound are buried and dissolvable and do not need to be removed. Depending on the nature of your surgery you may have one or two fine plastic drain tubes coming out from near the wound which drain blood and fluid. The tubes are stitched in place and therefore quite secure. They are attached to small portable, plastic bottles which will be placed in a bag which you will need to carry around with you. You will have been advised prior to the operation as to whether it is likely that a drain tube/s will be required.

If you are staying in the hospital it is likely when you wake up that you will have a small, plastic tube in one of the veins in your arm connected to a bag of liquid (a drip). This gives your body fluid until you are able to drink, and medications e.g. antibiotics and painkillers can be given via this route. After your operation you will be able to eat as soon as you are wide awake and the drip can often come out the next day. Sometimes people feel sick after breast surgery and may vomit. If this happens medication will be given to stop the vomiting. If you have had a sentinel node biopsy there will be some blue staining of the skin around the injection site on the breast. This fades gradually, but may be visible for some months.

Visiting is allowed on the day of surgery, and a relative is welcome to phone the ward.

Will I have any pain or discomfort?

You are likely to have some discomfort after surgery but everyone’s experience will be different. Before your operation, the anaesthetist will talk to you about different types of pain control and what is likely to be useful in your particular case. You should be able to get up and out of bed the next day. You will be offered painkillers regularly whilst in hospital to ensure that you are comfortable and pain-free and able to move your shoulder and arm adequately.. Your breast care nurse, physiotherapist or ward staff will monitor your progress. Following discharge home, continue to take prescribed painkillers as required. Depending on your individual circumstances you may be encouraged to start gentle arm/shoulder exercises a few days after surgery. The physiotherapist will be able to advise on appropriate exercises.

Post-Operative Problems After Breast Surgery

Some of the following post-operative problems are not specific to breast surgery and others are directly related to the type of surgery you have had. Some will have been discussed with you preoperatively as part of the routine "informed consent" process.

Bruising and Haematoma

Bruising is common after all forms of surgery. It can be mild, moderate or even severe but will gradually disappear with time. Occasionally, blood/blood clot collects within the tissues under the wound, causing swelling, hardness and discomfort. This can sometimes occur even if a drain tube is in place. If the swelling is pronounced and occurs rapidly, especially in the first few hours after the operation, it may sometimes be necessary to consider returning to the operating theatre to explore the wound, remove the blood clot and to check that there is no ongoing bleeding. If it occurs more gradually, it is often left for the body to re-absorb which can take a few weeks.

Wound Infection

A wound infection can develop at any time from a few days after surgery until the wound is completely healed, which usually takes 2-3 weeks. Any of the following symptoms could possibly indicate a wound infection

  • The wound feels tender, swollen or warm to touch (this can sometimes be difficult to distinguish from normal post operative bruising and swelling)
  • Redness in the area
  • Discharge from the wound
  • Feeling generally unwell with fever

Seroma

It is common for women who have had some or all of the lymph glands removed from under the arm to develop a collection of clear, straw coloured fluid under the wound called a “seroma”. You may experience fullness under the arm, which is often described as like having a ball fixed in the armpit. If you have had a mastectomy, similar fluid can also build up on the chest wall. As with haematoma, this fluid is re-absorbed by the body over time but if it causes discomfort, as it is watery in nature, it can be easily drained (aspirated) using a small needle and syringe. This is a very simple and almost painless procedure. In some cases, the fluid may collect again on several occasions requiring repeated aspiration.

Change in Sensation

If you have had lymph glands removed from under your arm, you may experience a loss or change in sensation running down the inner side of your upper arm. This occurs because the nerves running across the armpit to the upper arm, which supply sensation to the skin in that area, often have to be disturbed to reach the lymph glands. This can cause trauma to the nerve, which can lead to a variety of symptoms:

  • Numbness or reduced sensation
  • Sensitivity to touch or pressure
  • Burning or tingling sensations

These symptoms are usually temporary and improve or completely disappear about 3 months after surgery. In some cases you may be left with a degree of permanent loss or altered sensation in your upper arm (e.g. if the nerve had to be divided at the time of surgery in order to properly perform the operation).

Cording

Occasionally following surgery to the glands under the arm (either sentinel node biopsy or axillary node clearance) you may develop a tender cord running across your armpit. A pulling sensation can sometimes be felt down to the elbow or wrist. This is called "cording". It is due to hardened lymph vessels. You may even be able to see and feel raised cord-like structures that "bow-string" across your armpit, and it can significantly restrict your arm movement. You may need physiotherapy to maintain your shoulder movement and to stretch the cords. Cording ALWAYS gets better although it can sometimes take a few months.

Pain

Persistent minor discomfort and swelling in the breast after the initial post-operative recovery period is not uncommon, especially when you have also had radiotherapy.

Activity Guidelines

The exact nature of your breast surgery will obviously influence when you can resume your usual activities. After a breast biopsy or removal of a small breast lump most people can return to day-to-day activities within a couple of days. You should avoid vigorous exercise, but other activities can be undertaken as pain permits. After a larger operation such as a mastectomy, getting back to normal will take longer. At what time it is safe to resume driving depends on the extent and nature of your surgery and your personal recovery. Usually you can start driving again once your wound has healed and you have regained full movement of your arm. If the area is still sensitive you may need extra padding around your seatbelt. Ask Dr Gordon-Thomson or our breast care nurse for guidance if necessary.

When can I leave the hospital?

The length of time you spend in hospital will depend on the nature and extent of your surgery and how quickly you recover. A lot of breast surgery these days is able to be done as “day case” surgery or as on overnight stay only. We are usually able to give you a fairly accurate estimate of the likely length of your hospital stay before the operation.

When can I expect to recover from surgery?

Recovery after surgery involves healing both on a physical and emotional level and the time taken varies from individual to individual. The length of time you spend in hospital will depend on the extent of your surgery and how quickly you recover. Going home can arouse mixed emotions. You may feel enormous relief that the operation is over. You may feel isolated or insecure because you no longer have the immediate support of the nurses, doctors and the hospital team. Feel free to contact our breast care nurses if you have any queries or just need some psychological support if you feel a bit “down” after discharge.

Miscellaneous Post-op Issues

Deodorant – if you have a wound under the arm you should avoid using deodorant until it is completely healed (approx 1 month). During this time the area can be cleaned in the shower or sponged. When you resume using deodorant, a roll-on may be easier than a spray to avoid the wound.

  • Shaving – If you have a wound under the arm you will need to stop shaving for a while. After surgery in which some of the lymph glands have been removed you may have altered /decreased sensation of the skin in the area and so you need to be very careful when shaving (it may be advisable to get someone else to do it for you or to do it under vision using the bathroom mirror).

Discharge

You must have an adult accompany you home on discharge. It is not safe for you to drive yourself or to use public transport.

  • Confirm that a follow up appointment to see Dr Gordon-Thomson has been arranged
  • Take any x-rays which are on the ward home with you
  • Request a medical certificate if required
  • Make sure your regular medications and any new ones started during your admission have been given to you
  • If you have drain tubes, check that the appropriate arrangements for their care at home have been made

Contact us prior to your planned post-op appointment if you have any of the following

  • Excessive pain not relieved by medication
  • Excessive swelling in the region
  • Discharge or bad odour from the wound
  • Fever or chills

Useful Contact Numbers

  • Breast Care Nurse (Gill Neil) – or
  • Ward 6 North – or
  • University of Cape Town
  • King Edward VII's Hospital
  • Royal Australasian College of Surgeons
  • Royal Hospital for Women
  • prime wales hospital
  • BreastScreen Australia