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

You had a mastectomy, the surgical removal of the entire breast. This surgery was done 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 chest wall 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 with implants or natural tissue.

Full recovery may take 4 to 8 weeks. You may have shoulder, chest, and arm stiffness. This stiffness gets better over time and can be helped with physical therapy.

You may have swelling in the arm on the side of your surgery. This swelling is called lymphedema. The swelling usually occurs much later and it can be a problem that lasts. It can also be treated with physical therapy.

You may go home with drains in your chest to remove extra fluid. Your surgeon will decide when to remove these drains, usually in a week or two.

You may need time to adjust to losing your breast. Talking to other women who have had mastectomies can help you deal with these feelings. Ask your health care provider about local support groups. A mental health care provider can help as well.

When sitting, keep your arm on the side of your surgery up as high as your heart. Doing so helps 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 surgeon.

• Your doctor, 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 for which you will need to use the arm on the side of your surgery, or that make you keep your arm raised.
• You may drive only if you are not taking pain medicines and you can easily turn the steering wheel without pain.

Ask your surgeon when you can return to work. When and what you can do may vary, depending on the 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.

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. This usually takes place 7 to 10 days after surgery.

Care for your wound as instructed. Instructions may include:

• If you have a dressing, change it every day until your doctor says you do not need to.
• Wash the wound area with mild soap and water.
• Do not wash or scrub the strips of surgical tape or surgical 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.
• You may shower after all of your dressings have been removed.

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

Try using an ice pack on your chest and armpit if you have pain or swelling. Do this only if your surgeon says it is okay. Wrap the ice pack in a towel before applying it. This prevents cold injury of your skin. Do not use the ice pack for more than 15 minutes at a time.

Your surgeon 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.

Call if:

• Your temperature is above 101.5°F (38.6°C).
• 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.

Hunt KK, Green MC, Bucholz TA. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 36.

Khatcheressian JL, Hurley P, Bantug E, et al. Breast cancer follow-up and management after primarytreatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2012 Nov 5. [Epub ahead of print.]

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