5 Things to Expect After a Mastectomy

By Constance M. Chen, MD, MPH

There is no way around it: Mastectomy surgery—the surgical removal of one or both breasts—is a big deal. This major procedure is performed on more than 100,000 women in the United States each year. Despite its prevalence, however, many women do not know what to expect in the days and weeks afterward.

Whether performed by itself or combined with immediate breast reconstruction using implants or natural tissue flaps, mastectomy surgery can surprise women in both its complexity and what its recovery involves.The length of your hospital stay, the amount and duration of your pain, and how long you require surgical tubes called drains to collect post-surgery fluids all depend on your individual situation. Your expectations should also take into account whether you had one or both breasts removed, whether lymph nodes were also removed, and whether reconstruction is performed and if so, what type.Given that every woman’s experience after a mastectomy may differ for these reasons, Dr. Chen offers 5 tips on what most women can expect:

1. You’ll need to rest – but walking is even more important

You may feel sore and weak in the days after surgery, sensing a “pulling” or stretching sensation when you move your arm. You will almost certainly need surgical drains, which remove fluids that would otherwise build up in the surgical area, and these too will need attention. You’ll be told to avoid strenuous activities such as biking, jogging or weightlifting—which won’t even seem desirable anyway—for an average of 6-8 weeks. You will also need to skip repetitive motions with your affected arm, including vacuuming, cleaning or gardening. It is essential to walk after surgery, however, so that you avoid blood clots and breathing problems that can develop from lying immobile in bed after surgery. Ask your doctor for guidance on how long you’ll need to recuperate before you can go back to work. Much depends on what type of job you have.

2. You’ll want to keep pain medication handy.

Any type of surgery can be painful, and mastectomy surgery is no exception. Your doctor will probably give you a prescription for pain medication before you leave the hospital, which you’ll want to fill right away. Pain management will likely involve multiple types of medications—from over-the-counter products such as acetaminophen and ibuprofen to nerve medications to narcotics and benzodiazepines—and you should stay in close touch with your doctor to make sure your pain is managed both effectively and safely.

3. Your incision(s) will need tender loving care.

Adding to your need for caution, your incision(s) will be covered after surgery in protective bandages that will require extra care. You may also need to wear a special surgical bra to hold your dressings and drains in place. Your doctor may have you wait until your first follow-up office visit after surgery before the bandage is removed or changed. After you get a chance to see your incision area, keep a keen eye out for signs of delayed wound healing or infection, such as fever, or increased redness or pus draining from the incision.

4. You may be doing special arm exercises to regain range of motion.

Don’t confuse this rehabilitative exercise with the medical advice to avoid strenuous activities for several weeks post-surgery. Indeed, performing arm exercises—which your doctor or physical therapist may teach you—can be a helpful part of your recovery from mastectomy if you have also had lymph nodes under your arm removed. Movements such as “walking” your fingertips up a wall, light stretching, and other prescribed arm exercises can prevent stiffness, keep your arm flexible, and potentially hinder the development of lymphedema, abnormal swelling in the arm, hand, breast area or beyond. Ask your doctor for individualized advice on how long to perform these arm exercises, but many mastectomy patients continue them for several months or longer.

5. Your “new” chest profile will take time to get used to.

Whether you’ve chosen immediate breast reconstruction or not, the shape of your “new” chest will undoubtedly look different than before your mastectomy. Factors that influence the shape include choices such as size and placement of breast implants or tissue flaps, as well as things you don’t choose—such as how smooth or bumpy your scars are. Sensation in your chest and armpit area may also change, and there may be parts of your skin you can’t feel fully. It simply takes time to absorb and accept these changes.It’s also important to talk to your doctor if you’re having a tough time physically or emotionally coping after mastectomy surgery. Make sure you reach out for help if you need it.

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com