What to Expect During a Mastectomy

There are many potential treatment options for breast cancer, but a Mastectomy is a common treatment option that involves removing the entire breast.

It can take several weeks, months or sometimes years to fully recover from a Mastectomy. Still, during the early recovery stage, you may experience different things and take different speeds to return to your typical daily activities depending on your overall health, whether you had a breast reconstruction at the same time or used another treatment. However, a quick recovery from a mastectomy can take up to 4 weeks. You can get a sense of what to anticipate from your Doctor or nurse.

The four different sections in this guide will help you know what to expect during a Mastectomy and prepare your mind to adjust:

What you can expect…

• Before the Mastectomy Surgery
• During the Mastectomy Surgery
• After Mastectomy Surgery
• At-home recovery from Mastectomy

Before the Mastectomy Surgery

We are starting right from the day of the Mastectomy surgery. In the Hospital, you will change into a hospital gown and wait in the preoperative area. Depending on the Hospital, you can have a friend or a family member in the waiting room. There are three things you can expect at this point:

1. You should expect to meet your Anesthesiologist before your surgery to talk about your medical history, allergies you may have and the plan for administering Anesthesia before the surgery.
2. Your Surgeon will come in after your Anesthesiologist to draw markings on the breast to be operated on to show where the incision will be made. You will be sitting up while the markings are being made so the natural creases of your breast can be marked.
3. A Nurse will insert an IV (Intravenous Infusion) into your hand or arm, and it will be taped in place. Then, a relaxing medication, sometimes a Midazolam injection, is given to you through the IV line.

In the operating room, you will receive general anesthesia and a breathing tube placed over your mouth for easy breathing while you sleep.

Be ready with supplies before the Mastectomy day for a fast and comfortable recovery. For a start, you will need a sleep mask, soft foam slippers, Baby Wipes, and a Notebook. The notebook will be used to track your medicine times and drain-fluid amounts. It can also provide emotional support.

To help with recovery, you will need a Mastectomy pillow, a seat belt pillow, a neck pillow, functional clothing like a Front closure Bra, pink pockets, and a management robe.

During the Mastectomy Surgery

Just a complete Mastectomy without a breast reconstruction can take 1-3 hours. If your Doctor says you can perform breast reconstruction during the Mastectomy, the surgery will take longer. It could be approximately 3 to 4 hours for reconstruction with tissue expanders and 6 to 8 hours for reconstruction with tissue flaps. Your Doctor will discuss breast reconstruction before or after the Mastectomy, but here is what may happen during the surgery.

1. The Surgeon will separate breast tissue from the skin and muscle. All breast tissue seen from the collarbone to the ribs will be removed. Depending on your kind of Mastectomy, the Surgeon can remove other parts of the breast. A sentinel lymph node dissection is where one or five underarm lymph nodes are removed. An axillary lymph node dissection is where ten or more underarm lymph nodes are removed. This is done to prevent cancer from spreading to the lymph nodes. The Surgeon will remove additional lymph nodes if a pathologist discovers cancer cells in the excised lymph nodes. Depending on the kind of Mastectomy you are having, here is what your Surgeon could do:

• If you have a sentinel lymph node dissection, your Surgeon will use a lymphatic mapping procedure to find the sentinel lymph nodes. The process involves injecting a radioactive liquid, a blue dye or both under the nipple or near the tumour site. The fluid travels to the sentinel node or nodes allowing the Surgeon to see and remove them. A small handheld device could also be used to measure the radioactivity from the liquid and how much of it was absorbed.
• If you are having immediate breast reconstruction with tissue expanders, breast implants or tissue flaps, your Surgeon will perform the reconstruction using the same procedure explained above.
• If you are not having reconstruction, your Surgeon will perform a flat closure so your chest will be flat.

2. At the final stage of the surgery, the Surgeon checks for bleeding and inserts one or more thin, flexible tubes called surgical drains into your breast or armpit. The drains are three to collect the excess fluids that will accumulate in those areas after surgery. Each tube is outside your body and is attached to a soft plastic bulb that collects the fluid and must be emptied periodically. After the drains are inserted, the Surgeon will stitch the incision closed, and the surgery site will be covered with a bandage that wraps closely around the chest.

After the Mastectomy Surgery

After the surgery, you will feel weak and sore for the first 2 to 3 days. After that, stretching or pulling under the arm is normal, along with itching, tingling, and throbbing in the operated area, but it improves in a few days.

Your vital indicators, including your blood pressure, respiration, and oxygen levels, will be regularly monitored by medical staff in a recovery room while you are still in the hospital. If the pain worsens or you begin to feel nauseous, let a nurse know so you can get medication.

After you will be admitted to a hospital room and may be able to return home that day after the Mastectomy operation, especially if you had no lymph nodes removed, no reconstruction, or immediate reconstruction with a tissue expander or breast implant, or only a sentinel lymph node removed. Otherwise, you could stay in the Hospital for up to 5 days with your surgical team monitoring the blood flow to the flap.

Before leaving the Hospital, you might receive a Mastectomy pillow from a Nurse or Doctor and instructions about the following:

• Taking Pain Medication: You might get a prescription for pain medication when you leave the Hospital. You should file it before you leave or let a friend do it for you. Your surgical team might use an approach to pain medication called ERAS which means Enhanced Recovery After Surgery. These strategies control your pain for 3 to 4 days after the surgery without using drugs like Opioids. Drugs used during the ERAS protocol include Exparel, Gabapentin, and Tylenol.
• Side effects of the Lymphatic Mapping Procedure: If you had a lymphatic mapping procedure before a sentinel lymph node dissection and blue dye was used, your skin, pee, and poop will be bluish-green for 1 to 2 days after the surgery. The paint could also stain the site of injection temporarily or permanently.
• Caring for the Surgical Drain: Sometimes, the drain stays until the first follow-up visit to the Doctor, which is usually 1 to 2 weeks after the surgery. Other times, the drains are removed from the breast or underarm area before you leave the Hospital. If you are going home with the drains attached, you will need to empty the fluid from the detachable drain bag up to 3 times a day to more. Again, let your Surgeon give instructions for the drains before you leave.
• Recognizing Signs of Infection: Your Surgeon should explain how to tell if the operation area or incision is infected. Some signs to look out for include fever, redness, itching, and pus draining from the incision.
• Exercising Your Arm: You might be itching for a bit of action while you heal. Your Surgeon or Nurse will show you some exercises you can do to prevent arm and shoulder stiffness to avoid scar tissue from forming. Your Doctor will also give detailed instructions about the exercises that should be avoided until your drains are removed.

For the final section, you will see what to expect during recovery and how it can be made easier.

At-home recovery from Mastectomy

You may be able to recover and go back to your entire routine after some weeks or longer. This depends on the kind of Mastectomy (Single or Double) and if you had a reconstruction after. You can get a sense of what to anticipate from your doctor or nurse.

When recovering from a Mastectomy, it is important you find communities, forums or websites like www.zomaple.com to protect your mental health.

Here is how you can take care of yourself at home:

Activity

It is important you rest when you feel tired. After any activity, rest and raise your affected arm for a long period. A Mastectomy pillow with underarm support will make this easier for you as it will prevent pressure. You might want to rush back into your normal life but try to avoid strenuous activities like biking, lifting anything over 4.5 pounds, jogging, and aerobic exercise until your Doctor says it is okay.

You might probably be able to start these activities in 3 to 6 weeks, but even after, it is best you avoid some exercises and home chores like weed pulling, vacuuming, and window cleaning for six months. Ask your Doctor how soon you can drive or take a shower and bath. This limit to your activities might seem discouraging, but you will recover faster if you stick to what your Doctor says.

Diet

You may notice different bowel movements or stomach upsets. This is common. Avoid constipation by taking fibre supplements like Benefiber or Metamucil every day. If you have not had a bowel movement for a while, take a mild laxative like Milk of Magnesia or a stool softener like Colace.

Zomaple created this guide in hopes of making your Mastectomy easier for you. In addition, you can use some comfort items for faster recovery, like a Mastectomy, pair of slip-free cold/hot therapy socks and eye masks to sleep better. We wish you a safe surgery and a fast recovery with the support of a community.