Recovering from surgery

Surgery is a very common local therapy for breast cancer. Most people with an early-stage diagnosis will have breast surgery at some point. Some may even have multiple surgeries, whether to remove more cancer or to rebuild the breast after lumpectomy or mastectomy. And, though surgery is less common for those with metastatic (stage IV) breast cancer, there are still some situations when surgery may be used to relieve pain or ease other side effects.

After surgery, it’s likely you’ll feel pain, fatigue, and muscle tightness, as well as general whole-body soreness or nausea that anesthesia can cause. You may also have issues with range of motion, or limits to how well you can move your arms, because of how close the shoulder joint is to the breast area.

Everyone recovers in their own time. It can take from weeks to months to feel fully recovered. The type of surgery you have can affect your recovery time, and your experience may differ even from others who had the same surgery. You may feel better quickly, or you may continue to feel limited and have side effects for longer than expected.

Be sure to communicate with your providers about how you are doing as you recover. Notify your provider if you have:

• pain that is not well controlled or lasts longer than expected
• decreased range of motion
• swelling in your arm or hand
• bleeding that does not stop (even after holding pressure for 10 minutes)
• fever (ask your doctor or nurse what temperature qualifies as a fever)

Recovery at the hospital

You will be moved from the operating room to a recovery room following surgery. You will still be under the effects of anesthesia so you may not be aware that you’re being moved. Once in recovery, nurses will monitor things like your heart rate and blood pressure as you wake up and until you are fully awake. Your surgeon will update any friends and family members at the hospital on the procedure. You may feel cold following surgery, and this is normal. Ask your recovery nurse if you need an extra blanket.

If you have a lumpectomy — also called breast-conserving surgery, where the tumor and a margin of healthy tissue around it are removed — the recovery room may be the last stop before you go home. Many lumpectomies are outpatient procedures, meaning you go home the same day you have the surgery. You should speak to your nurse or doctor about any pain you have at this point so they can give or adjust your pain medicines. Before you leave the hospital, make sure you, or someone with you, get and understand all instructions you need on how to care for the wound left by the surgery.

If you have a mastectomy, surgery that removes the entire breast or both breasts, you will likely stay in the hospital a night or two as you start to recover. Once you are fully awake from the anesthesia, you will be moved to a different room where you will stay for this time. Here you will get support and monitoring until you are well enough to go home. How long you stay in the hospital depends on the type of surgery you have and how your recovery is progressing.

Support at home

You may need support at home after surgery. That may mean help with your daily activities, caring for your wounds from surgery, or physical therapy to restore the full movement of your arm. If you have family and friends who are able to assist you, it’s OK to ask them for help. Let them know before you go in for surgery that you may ask for support after. You can even set up a schedule so people know when they should be available and specific dates or times they may be needed. Many people find it helpful to have someone who can drive them for errands, help with cooking, watch young children, or be nearby while they take a shower, in case they need assistance.

If you don’t have people who can support you at home, or you think you need help from someone with more training or experience, speak to your healthcare team before you leave the hospital. They may be able to refer you to local organizations or point you toward other resources in your community.

Side effects of breast surgery

As you recover from surgery, it is normal to have some side effects. Your healthcare team should discuss these and how you might manage them before you leave the hospital. They may recommend a prescription medicine to manage pain at first, and suggest over-the-counter medicines you can switch to as the pain eases. You may be able to manage other side effects with support and planning. Ask your healthcare team about these concerns before you leave the hospital:

• Pain and tightness in the breast and chest area, and anywhere else cut during surgery.
• Swelling that should go away as you recover.
• Scar tissue at the site of the operation. Tissue under the incision may feel firm. This is often called a “healing ridge”. The firmness may be present for several months but will soften over time.
• Limited range of motion.
• If you had lymph nodes removed, you may have an increased risk of developing lymphedema, a buildup of fluid in your hand, arm, breast, or torso, on the side you had surgery. This is different from regular swelling after surgery and tends to show up later. Ask about ways to lower your risk of developing it.

For all these side effects, consider asking:

• How long should it last?
• What can I do to manage it or to feel better?
• When should I call you to report changes in how I feel, or how the wound or swelling looks?

In some cases, pain is caused by damage to the nerves. This may feel like burning or shooting pain that doesn’t go away. If the medicine your doctor recommended does not ease the pain, or if the pain doesn’t get less intense over time, speak to your healthcare team. Be as specific as possible. Consider keeping a pain journal to track when pain happens and how intense the pain is. Nerve pain does not react to the same medicines as other kinds of pain, and your healthcare team may recommend another medicine for you if you learn the pain you’re feeling is from nerve damage.

There are some practical things you can do to help lessen or manage pain after surgery:

• Wear a supportive bra during recovery. This may even be worn while sleeping.
• You may find ice helpful to ease some discomfort. Check with your provider for instructions on if and when you can use ice; it is not recommended for some procedures.
• If your treatment center provided a special bra, camisole, or other garment to wear after surgery, you should bring this to the hospital and wear it as instructed.

Your team will instruct you to watch for other side effects such as redness, swelling or bleeding where your skin was cut during surgery, which may be signs of infection or other problems. Ask your providers what kind of redness or bleeding is a normal part of recovery and when it can be a sign of something more.

A Note on Pain Medicines: If you have a history of problems with opioids or addiction, or have other concerns about pain medicines, speak to your surgeon before going in for the operation. They can work with you on a strategy that works for your needs. Be sure to follow directions for all pain medicines, including over-the-counter medicines such as acetaminophen (Tylenol). If your pain medicine is not enough for your comfort, speak to your doctors. It may be a sign that there’s a problem.

Surgical drains

In many cases, people who have breast surgery have drains left in the surgical wound that let blood and other fluid escape from the site where the cancer was taken. Someone from your healthcare team will discuss how to use the drains to measure the fluid released, how to keep them clean and clear of infection, and when you will return to have them removed.

Wound care

When you leave the hospital, you should have been given instructions about what you need to do to care for the site of the incision and drains left after the surgery, and how to care for yourself during recovery. You and anyone helping care for you should read over the instructions and ask any questions before you leave.

If you don’t have help at home, speak with your healthcare team about getting a nurse or nurse’s aide. Some major insurance providers now offer coverage for a home care nurse to check in on you once or twice after you go home.

Your doctor’s instructions may cover how to

• clean the wound and replace the bandage
• care for and empty drains (if you have any)
• bathe and shower during recovery
• limit your activity and exercise, such as lifting, running, and general housework
• take medicine for pain, whether prescription or over-the-counter
• recognize signs of infection

You should also get instructions on activities you should do to help your body heal. Doing certain movements may help keep the muscles in your chest from tightening too much. Moving your arm is important in improving your range of motion so that you will be able to move your arm as you had before the surgery. This may be as simple as stretches you can do at home, but ask your healthcare team if you would benefit from physical therapy.

Self-care

Your healthcare team will provide important information on how to care for the site of the surgery, but you may face other practical challenges. You will likely have pain and some limits on what you can lift and how high you can reach. Even if you find you can do some activities when you first get home, you may tire more quickly or develop discomfort by doing too much in a given day.

It can help to put your daily tasks in order of importance. Focus on the most important things first and, if there is more than you think you can or should handle in a day, don’t be afraid to ask others for help. Find ways to conserve your energy whenever and however you can.

One idea is to prepare a comfortable space to spend your recovery days that allows you to avoid having to get up too frequently:

• Choose a comfortable chair that is easy to get in and out of.
• Find a pleasant spot, with sunlight and easy access to the restroom and any other needs.
• Keep a table or tray within reach for items you need during the day, like medicines and activities.
• Have straws handy for sipping drinks while reclined.

While you don’t want to spend all your energy getting up for small items, movement is important to recovery. Follow your healthcare team’s guidance. If you have physical therapy, ask what stretches or activities you can do at home. Ask friends to join you on walks.

Bathing

You may have to protect the wounds and drains from water during recovery. You may not be able to shower for several days after surgery, and when you are cleared to shower, you may still have to arrange to keep water away from the surgery site and the drains. Speak with your provider for their recommendations on bathing after surgery.

Having a caregiver, aide, or friend around can be very helpful. In addition to keeping the wound dry, you may have pain that limits how well you can move. This person can help you with changing in and out of clothes, help you step into or out of your shower or bathtub, and stay nearby in case you need help.

A shower bench can also be helpful and provide security while you wash.

Sleep

Getting rest is important to your recovery, but finding a comfortable sleeping position may be difficult. Your usual sleeping arrangement may not allow you to protect the wound or drains, or may simply be uncomfortable if you’re sore. Prepare ahead of time with these tips:

• Consider sleeping on a recliner for the first few nights, if you have one. This will keep you from rolling onto the surgery wounds.
• In your bed, use extra pillows to support a comfortable position and keep you from rolling onto your wounds during the night.
• Sleep in a room without noise or distraction. Since your sleep may be disturbed by pain from the surgical wounds, limit other interruptions. Some people find it helpful to sleep separate from their partners for some time.