Recovering from breast cancer surgery

In 2000, Charron Walker, now 49 years old, from Jacksonville, Florida, had a lumpectomy and lymph nodes taken out. She felt relieved the cancer had been removed. But she was in pain and uncomfortable.

She’s not alone. Surgery is a common part of breast cancer treatment. Though it’s effective, the recovery that comes with it can be tough. Sore, tight, painful muscles, sensitive skin and fluid buildup in the surgery site can all be part of recovery.

You may have a lumpectomy, where the cancer is removed but the rest of the breast is left. Or you may have a single or double mastectomy, in which one or both of the breasts are removed. You may also have surgery to remove lymph nodes under your arm.

With lumpectomy, you may be able to go home the same day as your surgery. And many doctors say you’ll be able to go back to work and your normal routine within just a few days. For mastectomy, the hospital stay may be a few nights, and your doctors may tell you to expect up to 6 weeks of recovery. But your own experience can vary: It’s common for recovery to take longer or to come with more or worse side effects than your doctor estimates. Depending on who you talk to, doctors or peers, you can also get different advice on coping with recovery.

Before you go home, your healthcare providers should talk to you about what to expect. They may recommend you see a physical therapist to help with healing and range of motion, how well you can move the arm and shoulder on the side you had surgery. If you have questions about recovering from surgery after reading this article or at any point in the future, contact your healthcare providers.

Treat the pain

After breast surgery, it’s normal to feel pain and discomfort where your skin, muscles or lymph nodes were cut or removed. If you are in pain, your doctor will give you medicine after surgery and suggest over-the-counter medicines like acetaminophen (Tylenol) or ibuprofen (Advil), prescription medicines like opioids, or both to use while you heal.

You may also be interested in pain relief that doesn’t involve taking medicine. Talk to your providers about complementary therapies, including acupuncture, meditation and gentle yoga, that may help reduce pain.

Charron took prescription pain medicine for the first week or two after surgery, until she felt she no longer needed it.

F. Lynette Walker, 50, from Kansas City, Missouri, was diagnosed with breast cancer in 1993. Lynette, who is not related to Charron, has had three local recurrences. Her treatment has
included a lumpectomy with radiation therapy, two mastectomies and breast reconstruction.

“I had to rely on the [prescription] pain medication for a while to get through [the mastectomies],” she says, adding, “You can make it through the pain. Don’t be afraid to take the medicine to get through it.”

Watch for problems

If the discomfort you feel includes increasing redness or warmth around your surgical incision or drains, you should call your doctor right away, says Margaret Rinehart Ayres, PT, PhD, because you could have an infection, a serious but treatable problem. Dr. Rinehart Ayres specializes in homecare physical therapy, is an advocate for oncology rehabilitation and is an associate editor for the American Physical Therapy Association’s Rehabilitation Oncology journal.

Some swelling is normal after surgery. It doesn’t necessarily mean you have lymphedema, a long-term condition that causes swelling under the skin of your hand, arm, breast or torso, on the same side as the cancer. But if you feel heaviness or fatigue in your arm or if your jewelry or clothing start to feel tighter on that side, tell your doctor so he or she can check you for lymphedema, Dr. Rinehart Ayres says.

Get comfortable

Prioritizing your own comfort is important after breast cancer surgery, Dr. Rinehart Ayres says. This includes choosing the right clothing. Because your range of motion can be impacted by surgery, and your arm may be sore or stiff, she suggests wearing shirts or nightgowns that button or zip in the front so you don’t have to raise your arms above your head or reach behind your back to get them on or off.

Ronda Henry-Tillman, MD, a surgical oncologist specializing in breast oncology at the University of Arkansas for Medical Sciences, in Little Rock, asks her patients who have a lumpectomy to wear a bra for at least the first 48-72 hours after surgery, even at night, to ensure the breasts have enough support. She says if a woman has a mastectomy and feels most comfortable wearing a bra, she can do so right after surgery. Choose a bra that is comfortable and easy to get on and off: Sports bras that close in the front or mastectomy bras designed to be soft may be best. Mastectomy bras are specially made for surgical recovery, and some have pouches to hold breast prostheses. Prostheses make your chest look more natural underneath clothes.

Rest is an important part of recovery. But you may need to change your normal sleep positions as they may be uncomfortable after breast surgery, Dr. Rinehart Ayres says. Sleeping on your stomach or on the side where you had surgery may cause pain and discomfort, which makes getting good sleep more difficult.

Charron had to get used to sleeping on her back, she says, to keep pressure off her arm and chest. A friend sewed a C-shaped pillow that fit around Charron’s waist and supported her head, chest and arm, which helped.

Take care of drains

After major surgery, fluids can build up in the space where tumors, breast tissue or lymph nodes were removed. This is normal. But if the fluid is left in the body, it could cause swelling and pain. To prevent that, your surgeon will place drains to help those fluids leave the body. You may have one or two drains on each of the sides on which you had surgery. The drains consist of a tube from the inside of your body near your surgery scars, leading to a bulb on the outside that collects fluids, including blood.

Your providers should teach you or a caregiver how to empty the drains every day and measure and write down how much liquid comes out. Once the amount is under a certain level specified by your doctor, your providers can remove the drains. You may want to pin the drains to clothing to keep them secure, or buy special clothes with pockets for the drains.

To avoid dirty water getting inside the drains and causing infection, many doctors recommend against showering while the drains are in. Instead, they suggest taking sponge baths or regular baths if you can to avoid getting the drains and incision areas wet.

“I didn’t like that part,” Lynette says. “Just the smell and the inconvenience of the drains. It’s uncomfortable. I didn’t want to go anywhere.”

Some doctors say it’s OK to shower as long as you keep the drains dry and out of the way. And some women shower, even if their doctors recommend against it. Some women attach the drains to belts, pouches, strings or jewelry around their waists or necks to keep them dry and out of the shower stream. If you want to shower while your drains are in, talk to your healthcare providers and to others who have had drains after breast cancer surgery for ideas.

When it’s time for your drains to be removed, usually 1 or 2 weeks after surgery, your doctor will pull them out during a quick outpatient procedure. Some people experience pain or discomfort, but others don’t.

Charron called getting the drains taken out, and then being able to take a shower on her own, the best part of recovery.

Move your body

After surgery, your chest and arms can feel tight and painful. It may be hard to reach toward a high shelf or carry light groceries. If you’ve had a mastectomy, reconstruction, or both, Dr. Rinehart Ayres recommends avoiding lifting heavy objects for the first week or two. Your doctor can tell you what “heavy” means in your situation. Many recommend not lifting more than 10 pounds.

But carefully using your body, rather than avoiding moving it, can help you recover faster.

“It’s important to try to be involved in an exercise routine to try to get back to your normal function as soon as possible,” Dr. Rinehart Ayres says.

Most healthcare providers encourage their patients to do arm exercises that can help improve their range of motion. Charron’s team recommended daily mobility exercises, like raising her arm or crawling her hand up a wall. The exercises helped her feel stronger faster than she thinks she would have otherwise.

“It showed me, when I could lift my arm a little higher, that I was healing,” she says.

If you’re interested in starting or returning to a fitness routine, talk to a physical therapist or other healthcare provider so you don’t do too much too fast.

Accept help from others

Surgery can limit your normal activities in unexpected ways, and having others there for you, to do things like bring you food, care for your kids or remind you to take medicine, can help. For example, many doctors recommend against driving for a week or two after breast surgery because holding your arms out to grab and turn the steering wheel can be painful, and driving while taking prescription pain medicine is unsafe. Ask a loved one to drive you home after surgery and elsewhere until you feel comfortable.

Carol Jacobs, 82, from Chestnut Ridge, New York, had a mastectomy without reconstruction in 2013. That surgery, plus fatigue caused by other breast cancer treatments, led her to stop driving for a couple of months. Instead, family members, neighbors and friends did the driving.

“I am known for preferring to do things myself,” she says, “so people recognized if I [did] ask for help I really needed it, and they were quite responsive.”

Carol calls her recovery “uneventful,” largely because of a home care nurse, who checked in on her for 2 or 3 weeks until her drains were out. When the nurse left, Carol felt confident she could handle the rest of her recovery herself.

Still, Carol, who had radiation therapy after surgery, says it’s hard to consider yourself “recovered” from surgery while you’re still in treatment.

“But I do remember the very first time I went out dressed as I normally would dress and I was wearing my prosthesis for the first time,” she says. “I remember thinking ‘I look like everyone else. I look normal.’”