Patient education: Mastectomy – Discharge instructions (The Basics)

What are discharge instructions? — Discharge instructions are information about how to take care of yourself after getting medical care for a health problem.

What is a mastectomy? — This is surgery to remove the whole breast (figure 1). The doctor might also remove 1 or more lymph nodes (glands) under the arm.

There are different types of mastectomies:

●Simple mastectomy – This involves removing the entire breast without removing lymph nodes in the armpit. It is also called a "total" mastectomy.

●Modified radical mastectomy – This involves removing the entire breast and lymph nodes in the armpit.

●Double mastectomy – This involves removing both breasts. It is also called a "bilateral" mastectomy.

●Skin-sparing or nipple-sparing mastectomy – In this type, the doctor removes the breast tissue, but "spares" or keeps the skin and/or nipple. This can help when reconstructing the breast.

People who have a mastectomy can also have surgery to rebuild or "reconstruct" the breast that is removed. Sometimes, this can be done at the same time as the mastectomy. Other people might choose not to have reconstruction.

How long it takes for you to recover, and what you need to do, depends on which type of mastectomy you had.

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

For the first 24 hours after surgery:

●Do not drive or operate heavy or dangerous machinery.

●Do not make any important decisions or sign any important papers.

●Do not drink alcohol of any kind.

You should also:

●Empty the drainage container as instructed. The doctor might want you to measure the amount of fluid and write it down each time. The amount of drainage should decrease each day.

●Take care of your incision – You might have stitches, skin staples, surgical glue, or a special skin tape on your incision. You might have more than 1 incision.

•Keep your incision dry and covered with a bandage for the first 1 to 2 days after surgery. Your doctor or nurse will tell you exactly how long to keep your incision dry.

•Once you no longer need to keep your incision dry, gently wash it with soap and water whenever you take a shower. Do not put your incision underwater, such as in a bath, pool, or lake. This can slow healing and raise your chance of getting an infection.

•After you wash your incision, pat it dry. Your doctor or nurse will tell you if you need to put an antibiotic ointment on the incision. They will also tell you if you need to cover your incision with a bandage or gauze.

•Always wash your hands before and after you touch your incision or bandage.

●Ask your doctor if you can wear a bra after your bandages are removed. Some people choose to use a prosthetic breast if they do not have reconstructive surgery right away.

●Increase your activity slowly – Start with short walks around your home, and walk a little more each day.

•Keep coughing and doing deep breathing exercises for 7 to 10 days after you go home. This will help prevent lung infections. When you cough, sneeze, or do deep breathing exercises, press a pillow across your incision to support the wound and ease pain.

•You can use your arm and hand after surgery. But avoid heavy lifting, sports, swimming, and other strenuous activities for at least a week or 2. (Your doctor or nurse will tell you exactly how long to avoid these or other activities.)

●Eat when you are hungry – If you have an upset stomach, it might help to start with clear liquids and foods that are easy to digest, like soup, pudding, toast, or eggs. You can eat other types of foods when you feel ready. If your doctor or nurse gave you specific instructions about what to eat or avoid, follow them.

●Use a stool softener to help prevent constipation, if needed. This is a common problem if you take opioid pain medicines. Follow all instructions for taking your pain medicines.

●Take non-prescription medicines to relieve pain, such as acetaminophen (sample brand name: Tylenol), ibuprofen (sample brand names: Advil, Motrin), or naproxen (sample brand name: Aleve). These can be used instead of opioids.

What else should I know?

●Some people choose to get an implant to rebuild their breast after mastectomy. If you chose this, you might have the final implant put in right away, or your surgeon might inert something called an "expander" after your breast is removed. This is a device that gradually stretches your skin and muscle so that you can have an implant put in later. If you get an expander, you will get instructions about what to do.

●Some people choose to have breast reconstruction using tissue from other parts of their own body. If you had immediate reconstruction, your surgeon will tell you exactly what was done, and give you more specific instructions.

●After mastectomy, some people notice feelings of pain, soreness, itching, or tingling where their breast used to be. This can continue even after you have healed from surgery. It does not mean that there is a problem, but it can feel strange. Try not to scratch, especially if you have had immediate reconstruction.

What follow-up care do I need? — The doctor will want to see you again after surgery to check on your progress. Go to these appointments. Your doctor might also want you to have other treatments like chemotherapy or radiation. You might also need to see other experts like a radiation or medical oncologist, or physical therapist. Some people need extra care to help reduce or prevent swelling in their arm.

If you have stitches or staples, you will need to have them taken out. Your doctor will usually want to do this in 1 to 2 weeks. Some stitches absorb on their own and do not need to be removed. If the doctor used skin glue or skin tape, it will fall off on its own. Do not pick at it or try to remove it yourself.

When should I call the doctor? — Call for advice if:

●You have a fever of 100.4°F (38°C) or higher, or chills.

●You have redness, bleeding, drainage, or swelling around the incisions from your surgery.

●You have nausea or vomiting for more than 2 days after going home.

●The drain seems clogged.

●The stitches holding the drain in place are loose or missing.

●You have redness, warmth, swelling, or hardness in the arm or hand on the side where your breast was removed.

●You feel depressed or have trouble adjusting after surgery.

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