Below are general instructions for post-operative care after surgery. Please consult with your own personal physician for additional information.

• Wound Dressing and Drain Care After Your Surgery
• Activities After Surgery
• First Aid for Your Arm Following Surgery
• Lymphedema

Wound Dressing and Drain Care After Your Surgery

When you go home, you will have a dressing over your incision or wound where the surgery was done. If you had a mastectomy or reconstructive surgery, you may also have Jackson-Pratt drains (JP drains) for a few days or week after your surgery. Below are some general care guidelines. Your surgeon will give you more specific instructions on how to care for your dressing and drains. (If these instructions differ from what your individual surgeon recommends, follow the directions from your surgeon.

• Make sure that the dressing stays clean and dry. The dressing should not become saturated with blood or clear fluid. If it does, apply an extra dressing and contact your surgeon.
  
  
• Your surgeon will let you know when you can take a shower.
  
  
• Your surgeon will tell you when to remove or change the dressing. He or she may want you to leave on the original dressing until your first post-surgery doctor’s visit. When your surgeon tells you it is OK, it is often easiest to remove the dressing by wearing it in the shower and using the warm water to help loosen it. After a shower, pat the incision dry and apply another dry dressing to keep the wound clean.
  
  
• Check the incision or wound to make sure it is healing properly. The wound should be dry without a lot of redness or pink surrounding it. It is normal to have some swelling, tenderness and numbness in the area. Symptoms to watch for include:
  • Redness around the wound
    
    
  • Leakage of fluid
    
    
  • Large amounts of swelling
    
    
  • Excessive warmth around the wound
    
    
  • Fever
  If you develop any of these symptoms, contact your surgeon. You may have an infection at the wound that requires treatment.
  
  
• The JP drains need to be emptied regularly. Your nurse will show you how to empty them before you leave the hospital. It may be easier to have someone help you empty the drains. To empty the drain, pull the stopper out of the top of the drain and pour the liquid into a container. After the drain is empty, squeeze the drain flat with one hand and push the stopper back into the top of the drain. The collapsed drain will create suction and help pull the excess fluid out of the wound. Record the date, time and amount of fluid collected for each drain. The amount of fluid coming out of each drain will decrease over time.
  
  
• The JP drains can develop infections so it is important to watch the area around the tube for redness, warmth, drainage and fever. Call your surgeon if you have any of these symptoms. Sometimes fluid may drain around the tube instead of into the drain. If this occurs, you can apply a small dressing around the tube. Change it frequently if it becomes wet. Call your surgeon if there is a lot of drainage around the tube.
  
  
• Occasionally, a JP drain may fall out on its own. If this happens, call your surgeon and do not panic.
  
  
• Sometimes after the JP drain is removed, or if you did not have a JP drain, fluid may collect under the skin and in the tissues under your arm. This may feel like a fluid-filled ball and look visibly swollen. If it is uncomfortable, you can contact your surgeon, and the fluid can be drained very easily. It is also important to stay alert to signs of infection.

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Activities After Surgery

The time it takes to return to normal activities after surgery depends on the type of surgery performed. In general, lumpectomies require the least amount of recovery time, while a mastectomy with a tissue flap reconstruction takes the longest. Always check with your breast and reconstructive surgeons to determine when it is safe for you to resume specific activities.

General Guidelines

• When you first return home, you will be able to do much of your own personal care, such as bathing, dressing and preparing simple foods.
  
  
• You may find that you need to take rest breaks between activities, but you should not need to stay in bed for prolonged periods during the day.
  
  
• A short walk each day will help your recovery.
  
  
• You can resume light household and work activities, such as simple meal preparation, folding laundry, using your computer and completing paperwork, as you feel ready.
  
  
• Avoid activities that require moderate to heavy lifting (grocery shopping) or pushing/pulling (vacuuming) and repetitive motions (such as washing windows or long hours at the computer).
  
  
• A good rule during your recovery period is to listen to your body, do what is comfortable, and stop and rest when you feel tired.

Driving

If you had a lumpectomy or a single mastectomy without having lymph nodes removed, you may be able to resume driving within a few days. If you had lymph nodes removed and/or reconstructive surgery, you may need to wait several days or weeks before you feel comfortable driving. You should not be driving as long as you are on pain medications. A pillow or seat belt positioning device may help cushion or adjust the seat belt to a more comfortable position when you drive.

Exercising

You will gradually be able to resume all of your pre-surgery activities over the course of the first several weeks and months after your surgery. Again, the best rule is to listen to your body, do what is comfortable, and stop and rest when you feel tired or sore. If you participated in vigorous sports before your surgery, check with your doctor to determine when it is safe to return to these activities.

Returning to Work

Most women are ready to return to work within several weeks after their surgery. Again, this timeframe depends upon the extent of the surgery and the type of work performed. Some may choose not to return to work while they undergo additional treatments, such as radiation therapy or chemotherapy. Another option may be to return to work part-time, gradually adding additional hours as you feel ready. Your doctor will help you determine what is best for you.

Stretches

During your early recovery period, you need to maintain the range of motion in your arm and shoulder. At your first post-surgery check-up, ask your surgeon if you can start some of these simple stretches and exercises.

• Shoulder shrugs: With your arms at your sides, pull your shoulders up towards your ears and hold for a few seconds. Repeat several times.
  
  
• Raise your arms in front and to the side.
  
  
• Wall walks
  
  
• Broomstick/Yardstick behind the back or climbing
  
  
• Hands-behind-the-head stretch
  
  
• Arm-away-from-the-body stretch (broomstick/yardstick to the side)
  
  
• Overhead stretch

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First Aid for Your Arm Following Surgery

Despite all the planning and care you take with your arm following surgery, sometimes you may find yourself with an injury that requires treatment. Be prepared to handle any of these minor emergencies by keeping the following supplies on hand: bandages, antibiotic ointment, antihistamine cream and lotion without dyes or fragrance.

Cut or Scratch to the Hand or Arm

1. Apply pressure gently to stop any bleeding.
   
   
2. Wash the cut with warm water and soap.
   
   
3. Dry the area.
   
   
4. Apply an antibiotic ointment to the cut.
   
   
5. Cover the area with a bandage.
   
   
6. Clean and reapply antibiotic ointment once a day or more often if the area becomes wet and/or soiled. Do not leave a wet bandage on to dry.
   
   
7. Watch for signs of infection at the site and arm, including redness, warmth, and drainage and/or fever. Contact your doctor if you experience any of these symptoms.

Burn to the Hand or Arm

1. Rinse the area with warm water and pat dry.
   
   
2. If burned skin is open, contact your doctor. Otherwise, follow the steps below.
   
   
3. Apply an antibiotic ointment to the burn.
   
   
4. Apply a non-adhesive bandage.
   
   
5. Watch for signs of infection to the burned area and arm, including redness, warmth, and drainage and/or fever. Contact your doctor if you experience any of these symptoms.

Insect Bite to the Hand or Arm

1. Wash and dry the area.
   
   
2. Do not scratch the site. Apply an antihistamine cream, such as Benadryl, to the site to decrease itching. Applying a cool compress may also help decrease itching.
   
   
3. Watch for signs of infection at the site and on the arm, including redness, warmth, and drainage and/or fever. Contact your doctor if you experience any of these symptoms.

Sunburn to the Hand or Arm

1. Bathe in warm water.
   
   
2. Liberally apply lotion containing aloe vera, without fragrance or dyes, to the arm at least four times daily.
   
   
3. Expect some swelling in the arm, but the swelling should begin to decrease after 48 to 72 hours. When sitting or lying down, try to keep your arm elevated. If it is still swollen as the sunburn improves, contact your doctor.
   
   
4. Wear loose-fitting clothing.
   
   
5. Watch for signs of infection to the burned area and arm, including redness, warmth, and drainage and/or fever. Contact your doctor if you experience any of these symptoms.

Overuse of the Arm

1. It is OK to use the arm for everyday tasks, but try not to do any heavy lifting or repetitive motions with the arm.
   
   
2. Rest the arm if it is sore or tired.
   
   
3. Try to keep the arm elevated when sitting or lying down.
   
   
4. Contact your doctor if swelling does not improve within 48 hours.

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Lymphedema

Lymphedema is the collection of protein-rich lymph fluid in the tissues of the hand, arm and/or chest wall on the side of the breast surgery. Lymphedema causes painless swelling of the hand, arm and/or chest. The condition occurs when the normal lymphatic drainage system in the chest and arm is injured during surgery and/or radiation therapy.

Development and Prevention

Most women who undergo breast surgery and radiation therapy do not develop lymphedema. However, it is important to learn and follow a few prevention strategies to reduce your risk of developing lymphedema.

Lymphatic System

The lymphatic system is part of your immune system. It consists of a series of vessels that run alongside your circulatory system (veins) and lymph nodes, which are located around major organs and in certain tissues (under your arm for instance). The lymph system helps to filter out dead cells, protein and waste products in your veins. It also plays a role in mobilizing your immune system to fight off an infection.

During your breast surgery, the lymph vessels and nodes are usually cut and removed, especially if you have had a sentinel or complete axillary lymph node dissection. This damages and disrupts the flow of lymphatic fluid in that region. Radiation therapy may cause further scarring. Most of the time, your body can adapt to these changes without excess fluid accumulating in the arm on the side of the breast surgery. However, lymphedema can occur from overusing the arm or from an infection, bug bite, cut or some other type of injury that causes excess fluid to build up that the body cannot remove. The buildup of lymphatic fluid causes swelling in the arm.

Risk Factors and Occurrence

• Women who have had breast surgery (either mastectomy or lumpectomy) with a complete axillary lymph node dissection have the highest risk of developing lymphedema.
  
  
• Women who have only a sentinel lymph node procedure have a small risk of developing lymphedema.
  
  
• Women who have not had a lymph node dissection do not develop lymphedema.
  
  
• Lymphedema can be mild and only last a short time starting a few days after the lymph nodes are removed. The affected arm may be warm and slightly red, but usually not painful. It typically gets better within a week by keeping the arm elevated.
  
  
• Lymphedema can arise slowly and become noticeable 18 to 24 months after surgery or not until many years after finishing cancer treatment.

Some women will have very mild lymphedema that may fluctuate over time. However, most women with lymphedema will have chronic, constant swelling that requires regular management to prevent further problems. Physical therapists specially trained in lymphedema management techniques can help. They will teach you how to reduce swelling using a special type of self-massage, how to apply compression bandages and how to wear a compression sleeve to maintain the arm’s size. Treatment to manage lymphedema is also available in some locations through a lymphedema clinic.

Prevention

You can also take precautions to reduce the chance of developing lymphedema following breast surgery that includes a sentinel lymph node biopsy or a complete axillary lymph node dissection (with or without radiation therapy). The following are some suggestions to minimize your risk:

• Do not carry heavy objects with your affected arm, including heavy handbags.
  
  
• Avoid vigorous, repetitive motions with your affected arm that you are not used to doing. For example, clean only one or two windows at a time instead of all the windows in your house at the same time.
  
  
• Keep the arm raised above the level of the heart, whenever possible.
  
  
• Avoid needle sticks of any type in the affected arm.
  
  
• Avoid blood pressure readings, blood draws, regular injections and intravenous injections in your affected arm to reduce the chance of trauma.
  
  
• When taking a long plane flight (greater than two to three hours), wear a compression sleeve on your affected arm. You may also want to wear a sleeve when at high altitudes (greater than 5,000 feet) or while exercising.
  
  
• Keep the skin on the affected arm and chest clean and well lubricated. Healthy, intact skin is the best defense against infection. Use sunscreen with a SPF 30 or higher when outside.
  
  
• Avoid tight clothing or jewelry on the affected arm. Make sure bra straps fit comfortably. If you choose to wear a breast prosthesis, make sure it is a lightweight one.
  
  
• Avoid dramatic changes in temperature, such as long soaks in a hot tub.
  
  
• Wear gloves when doing housework or gardening to protect your hands.
  
  
• Avoid cutting cuticles on the hand of the affected arm. Push cuticles back gently instead.
  
  
• If you must shave, use an electric razor.
  
  
• Use thimbles when sewing.
  
  
• Treat cuts, burns and insect bites promptly. Be alert for signs of infection: redness (including a red streak up the arm), swelling, drainage, warmth and fever.
  
  
• Seek treatment immediately if an infection occurs. Alert your physician if swelling persists for longer than four days.

Lymphedema Signs and Symptoms

• Feelings of tightness in the arm
  
  
• Noticing that rings or other arm/finger jewelry has become tight
  
  
• Weakness in the arm
  
  
• Pain, aching or heaviness in the arm
  
  
• Redness, swelling or signs of infection

Treatment

Lymphedema is usually treated by physical methods and with medication.

• Physical methods:
  • Support the arm in a raised position.
  • Undergo manual lymphatic drainage (a specialized form of very light massage that helps to move fluid from the end of the arm towards the trunk of the body).
  • Wear custom-fitted clothes that apply controlled pressure around the arm.
  • Clean the skin carefully to prevent infection.
• Compression garments:
  • Compression garments should cover the entire area of swelling.
  • Compression pumps may be used with garments, but only under the supervision of a trained health care professional.
• Medication:
  • Antibiotics may be used to treat and prevent infections.
• Pain management:
  • Pain is caused by the swelling and pressure on nerves, loss of muscle tissue and function, or scar tissue causing shortening of muscles and less movement in joints.
• Dietary Management:
  • Blood protein levels and weight should be monitored regularly, and patients should be encouraged to eat protein-rich foods.

Support

Coping with lymphedema after breast cancer is especially difficult. Group and individual counseling can help by providing emotional support and information about ways to prevent lymphedema. Check with your health care provider to find a lymphedema support group near you.
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