After Your Breast Cancer Surgery (The James)

After Your Breast Cancer Surgery (The James)

 

This handout gives you information about what will happen during and after your surgery. If you have more questions after reading this information, talk to your nurse or doctor. This handout gives you information about what will happen during and after your surgery. If you have more questions after reading this information, talk to your nurse or doctor. This handout gives you information about what will happen during and after your surgery. If you have more questions after reading this information, talk to your nurse or doctor.

 

Day of Surgery

  • A nurse practitioner or surgical resident will talk with you about your health and your surgery. This may be done during pre-admission testing or in the Ambulatory Surgery Unit (ASU).
  • You and one family member or friend will be taken to the pre-surgical area. Other family and friends will be directed to the waiting area. Your doctor will call or come to the waiting area after your surgery to talk with your family and friends.
  • When you arrive in the pre-surgical area, a nurse will talk with you. The nurse will check your identification (ID) band and ask if you have any allergies. You will also meet the anesthesiologist and the other staff who will be with you in surgery. Tell the staff if there is anything special you want them to know. Your surgeon will also talk with you before your surgery and answer any questions you have.
  • Your hair will be covered with a paper net and your vital signs (blood pressure, temperature, pulse and breathing rate) will be checked.
  • The nurse will put an intravenous (IV) catheter in your arm opposite of your surgery site. An IV catheter is a long, thin, flexible tube placed in a vein in your arm to give you fluid and medicines. You will be given medicine to help you relax and make you sleepy.

 

During Surgery

  • The staff in the operating room will wear special gowns, caps and masks. The room has bright lights and is kept cool.
  • You will see special equipment and tables with supplies and instruments. The staff will tell you what will be done before each step in the process.
  • You will be made comfortable on the operating table. You will be covered with an extra blanket if you are cold and your arms may be tucked in at your sides or put on an arm board.
  • Your vital signs will be closely checked. You will be hooked up to a monitor to count your heart rate. A small clip (pulse oximeter) will be put on your finger to check your pulse and the amount of oxygen in your blood.
  • The time it takes for your surgery is an estimate. If your surgery takes longer than you were told, it does not mean that anything is wrong.

 

After Surgery

  • After your surgery you will be taken to the Post Anesthesia Care Unit (PACU).
  • A nurse will watch you closely and take your vital signs during this time. Your pulse and the amount of oxygen in your blood will be checked. If you need oxygen, you will feel a tube on your face with little prongs in your nose.
  • When you first wake up, you may feel cold and you may shiver. This is normal when you have had general anesthesia. Warm blankets can be given to you. The PACU is a busy area with a lot of activity.
  • If you have pain, ask your nurse for pain medicine. When you are awake and your vital signs are normal, you will be moved to the Ambulatory Surgery Unit (ASU). At this time, your family and friends will be able to visit.

 

Recovery from Surgery

  • When you are taken to your room you will be put in the bed and made comfortable. Your arm may be elevated on 1 to 2 pillows to help with comfort and circulation. It is important to follow the directions you were given about the use of your arm(s).
  • You may have compression wraps on your lower legs. These wraps are attached to a pump and are used to prevent blood clots. You should wear these wraps when you are in bed or in a chair.
  • The nursing staff will get you up to the bathroom the day of your surgery and will help you walk in your room.
  • To help keep your lungs clear after surgery, your nurse will ask you to cough and to take 10 deep breaths every hour. Your nurse will show you how to use a breathing exerciser (incentive spirometer) to help you take deep breaths.
  • Until you are fully awake, you will only be given ice chips to help with your thirst. Once you are awake, you can have fluids. If your stomach is upset (nausea) you can be given crackers or toast. When you can take medicine by mouth, it is best to take it with food to help prevent nausea.

 

Pain Control

You are encouraged to take your pain medicine so you will be comfortable when you turn, cough, deep breathe and walk. Pain medicine works best if you take it before the pain gets out of control. Ask your nurse for pain medicine before your pain becomes severe. Pain medicine may be given through your IV or as a pill that you take by mouth.

Before you leave the hospital, your doctor will give you a prescription for pain medicine (opioids). It is important to take pain medicines with food to prevent nausea. Do not drive, operate machinery or drink alcohol while taking opioid pain medicine.

Your doctor may order one of the following opioid pain medicines for you:

  • Hydrocodone (Vicodin, Norco, Lortab)
  • Morphine (MSContin, MSIR)
  • Oxycodone (OxyContin, Percocet, OxyIR, Roxicodone)
  • Hydromorphone (Dilaudid, Exalgo)
  • Fentanyl (Duragesic)
  • Oxymorphone (Opana)
  • Methadone

If the pain medicine your doctor ordered is too strong or you no longer need it, you may take:

  • Ibuprofen/Advil/Motrin (200 mg). Take 2 tablets every 4 to 6 hours as needed for pain. Do not take this medicine if you have stomach problems, a history of ulcers or are taking blood thinners such as Coumadin.
  • Acetaminophen/Tylenol (325 mg). Take 2 tablets every 4 to 6 hours as needed for mild pain. Do not take this medicine if you have liver disease. Do not take more than 3,000 mg each day. Do not take this medicine if you are taking other acetaminophen pain medicines such as Percocet, Vicodin or Norco.

Talk to your doctor if you have questions about using over-the-counter pain medicines.

 

Constipation and Pain Medicine (Opioid) Use

Constipation is when you are not able to have a bowel movement (BM) for several days or have stools that are hard or difficult to pass without straining. Constipation is a common problem. Even if you are not eating, you still need to have a bowel movement at least every 2 days.

Taking pain medicine (opioids) will make you constipated. This problem will not go away as long as you are taking opioids. To decrease constipation caused by taking opioids:

  • Drink fluids - Unless you are told otherwise, drink 8 to 10 cups of non-caffeinated, fluid each day. Do not drink alcohol.
  • Physical Activity - Walk if you are able. Check with your doctor before you start any new exercises.
  • Use Laxatives and Stool Softeners - While you are on opioids, you may need to take medicine each day to control your constipation. See the following guide for how to use laxatives and stool softeners. Check with your doctor for other ways to control constipation.
StepMedicineDirections
1

You should start taking these medicines the same day you start taking opioids (pain medicine).

 

Senna 8.6 mg tablets

Take 2 tablets at bedtime each day.

This medicine will help prevent constipation.

Take this medicine every day that you take opioids.

 

Docusate (Colace)

100 mg capsules

Take 1 to 3 capsules by mouth, two times a day.

This medicine is to help soften your bowel movements.

If your bowels become loose, you may need to take fewer pills.

2

If you have not had a bowel movement in 48 hours, CALL YOUR DOCTOR. Your doctor may tell you to use of the medicine listed below.

 

Polyethylene glycol

3350 (Miralax)

Mix one capful (17 grams) of powder in 8 ounces of water, juice, sports drink, coffee, or tea.

Use Miralax every 12 hours until you have a bowel movement.

3

Call your doctor again if you have not had a bowel movement for 24 hours after following these steps.

When should I call my doctor about my constipation?

You should call your doctor if you have any of the following symptoms:

  • Watery stools (this can be a sign of severe constipation or too much bowel medicine)
  • No bowel movement in 48 hours
  • Small stools
  • Hard stools
  • Pain with bowel movements
  • Straining with bowel movements

 

Care at Home

Your nurse will go over care instructions with you before you leave the hospital. Here are some things to remember as you recover from your surgery.

 

Incision Care

  • You will have 1 to 2 incisions, depending on your type of surgery. If you had a lumpectomy, you will have an incision on your breast. If you had your lymph nodes removed with your lumpectomy, you will have a second incision below your armpit. Your stitches will be on the inside.
  • If you had a mastectomy you will have an incision from the middle of your chest across to your armpit. Your stitches will be on the inside. If you have a drainage tube(s), there will be a stitch on the outside to hold the tube(s) in place.
  • The nurse will put a check (√) by the information about how your incision was closed:

Special tape (steri-strips) - If you have steri-strips, leave the steri-strips on until they fall off by themselves. If the strips have not come off 2 weeks after your surgery, you may remove them.

Surgical glue (Dermabond) - If your incision was closed with surgical glue (Dermabond), do not use any creams, lotions, rubbing alcohol, moisturizers or Neosporin on the incision area.

  • The nurse will put a check (√) by the information about your dressing:

☐ A dressing will be put over the incision(s). The dressing can be removed 2 days after surgery.

☐ A surgical bra may be put on you after surgery. This should be kept on for 24 hours a day, except while bathing or showering, until your first post-operative clinic visit or until your provider says you may remove it. 

  • Leave your incision(s) open to air and keep it clean and dry.
  • Check your incision(s) each day and call your doctor if you see any signs of infection including:
    • Redness
    • Increased amount of drainage
    • Drainage that smells bad
  • Call your doctor if you have a fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.
  • You may shower __________ days after surgery. Stand with your back to the showerhead to keep water from spraying directly on your incision(s) or drainage tube(s). Do not scrub your incisions. You may want to cover your incision(s) with plastic wrap to keep water out. It may help to wear a surgical drain apron in the shower and clip your drain to it. Your surgery nurse will give you an apron. For your safety, have someone nearby to help you if needed.
  • Your drain dressings should only be changed if you are instructed to do so. Your nurse will give you instructions.
  • Do not use deodorant or powder until your incision(s) have healed. Do not use any products that may cause a rash or irritate your skin.
  • Do not shave your armpits until you have healed. If you had lymph nodes removed, it is important to only shave with an electric razor. This helps prevent infection and lymphedema by reducing the risk of cuts to your skin.

 

Drains

If you had a mastectomy or if you had all your lymph nodes removed with your lumpectomy, you will have 1 or 2 drains. Drains help remove fluid and blood from the area to help with healing. A tube will come out of your skin below your armpit on the side of your surgery. A small collection device at the end of each tube gently suctions and collects the fluid. These will be emptied and measured every 4 hours while you are in the hospital. The drainage can range from a few teaspoons to a few ounces.

You and your caregiver will be taught how to care for your drain(s) before you leave the hospital. The drain(s) will remain in place as long as they are needed (normally 2 to 3 weeks). You will need to empty and measure your drains when you are at home.

If needed, your Patient Care Resource Manager (PCRM) will arrange for a home care nurse. You will be sent home with enough dressing supplies to last until supplies arrive at your home. Your doctor may order an antibiotic medicine for you to take until your drains are removed.

You may take a sponge bath while you have drain(s). If you want to take a tub bath, the water level must be kept below the area where the tube comes out of your skin.

Detailed directions about home care for your wound drain is included later in this book.

 

Activity

  • You can use the arm on the side of your surgery to eat, comb hair and do light activities. The nurse will put a check (√) in the box for how high you can raise your arm:

☐ 45 degrees

☐ 90 degrees

  • Until the drain(s) are removed, do not lift anything with your arm that weighs more than:

☐ 1 pound (A gallon of milk weighs 8.6 pounds)

☐ 2 pounds

  • Do not drive until your drains are removed.
  • Do not drive or drink alcohol if you are taking opioid pain medicines.
  • Elevate your arm on pillows when you sit or at night for one week after your surgery.
  • You may have sex whenever you feel comfortable, but do not put pressure on your incision(s) or breast.
  • You may be told to wear a bra. Choose a soft, tight fitting bra like a sports bra with a front closure. If you had a lumpectomy, a bra will give you added support. If you had a mastectomy, you may use a temporary prosthesis or soft padding in your bra about 1 month after your surgery.

 

Your Feelings

It is normal to have a range of emotions after your surgery. A common concern for patients is how they will look after breast surgery. It often takes several months for your skin and tissues to relax and soften. Your nurse will tell you what changes may happen, so you will know what to expect. If you would like to talk with someone about your feelings or to teach you relaxation exercises, ask your doctor or nurse for information about these services.

If you had a mastectomy, a permanent prosthesis can be fitted about 3 months after surgery. You will be given a prescription for a permanent prosthesis once you are completely healed (about 12 weeks after your surgery). Hope’s Boutique has caring, trained professionals to help you look and feel your best. This specialty store is located at The Stefanie Spielman Comprehensive Breast Center (1145 Olentangy River Road, Columbus, OH).

 

Follow-up Appointment

It is important to schedule an appointment with your doctor 1 week after your surgery. If you have any questions after you leave the hospital, call your doctor’s office.

 

Helpful Phone Numbers

  • James Emergency Services Unit at the Ohio State University Wexner Medical Center Emergency Department (614) 293-8333
  • Department of Surgical Oncology (614) 293-4040

 

 

© January 25, 2024. The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.