MASTECTOMY AND/OR AXILLARY NODE DISSECTION POSTOPERATIVE INSTRUCTIONS

CARE OF THE INCISION – After the surgery, an ace bandage may be wrapped around your chest to prevent bleeding and swelling.  This can be removed in 48 – 72 hours.  The mastectomy incision will be covered with a gauze dressing.  This dressing may be removed after 48 hours and does not need to be replaced. Under the dressing you will find several thin paper tapes (steri-strips) covering the incision.  The steri-strips should be left in place. The stitches are underneath the skin and will dissolve.  You may notice bruising (black and blue) or mild swelling.  These changes will resolve as you heal.
 
DRAIN CARE – you will be instructed on how to empty your drain(s), strip or milk the tubing, and measure and record the amount of drainage before you are discharged from the hospital.  The drain(s) will need to be emptied between one and three times a day depending upon the amount of drainage.  Initially, the drainage will be dark red (bloody).  It will change in color over the next few days to a week, becoming a clear red and then a clear yellow.  There may be a few small blood clots in the drainage. This is normal.  If the drainage should become cloudy or look like pus, please call the office as this could indicate infection.  The drain(s) will be removed in the office when the drainage amount decreases to one ounce (30 cc) a day or less.  A Visiting Nurse may see you in your home to change the dressing, assess for infection, and monitor your progress after surgery.  While the drain is in place, you will find that it is easiest to wear loose fitting shirts that button down the front.  The drain bulb can be pinned to the underside of your shirt or pants.
 
MEDICATION –
            Antibiotics – You may be given a prescription for antibiotics to be taken after you are discharged from the hospital or asked to apply an antibiotic ointment around the drain site when the dressing is changed.  It is very important to follow this therapy to prevent infection while the drain(s) is in place.  Some patients develop diarrhea or abdominal cramps while taking antibiotics.  This can usually be prevented by eating yogurt on a daily basis.  It is also not uncommon to develop a vaginal yeast infection while you are taking antibiotics.  This can be treated with an over the counter medication such as Monistat.
            Pain Medication – Most women have pain or discomfort for a few days up to a week after the surgery.  You should take ibuprofen (Motrin, Advil) or enteric coated aspirin (Ecotrin), two tablets three times a day with meals for one week after your surgery. You will also be given a prescription for narcotic pain medication such as Vicodin (hydrocodone).  These pills should be taken for any pain which is not relieved by the ibuprofen or aspirin.  Common side effects of narcotic pain medication are decreased appetite, constipation, and feeling tired or “blah.”
            Vitamins – We may also recommend that you take a multivitamin (any brand) once a day to help with healing.  You may be asked to take iron if you are anemic after your surgery.
            Usual Medication – You should continue to take any medication that was prescribed before your surgery such as thyroid medication, high blood pressure medication, etc.
 
ACTIVITY – Limit your activities and pace yourself for the first few weeks after surgery.  Your body needs rest to help heal and recover from the surgery.  You should not be doing any heavy housework – laundry, vacuuming, etc.  You may go out to eat, visit friends, or go for a drive in the car. Taking a walk at least once a day will also help to speed your recovery along.  Sexual relations may be resumed when you feel comfortable enough.
 
ARM CARE – You should limit use of your arm on the affected side to eating, brushing your hair and teeth, and sponge-bathing until the drain is removed.  Do not raise your arm above the level of your shoulder.  Elevate your arm on a pillow when you go to bed to prevent swelling for the first three months after your surgery.  You will be given information in the hospital about special precautions that must be taken after the removal of lymph nodes from your axilla (armpit).  This will be reviewed with you in the office after the drain is removed.
 
PATHOLOGY RESULTS – Information about your breast cancer and whether it has spread to your lymph nodes will generally be available within 7 to 10 days after your operation. You will be called at home with the results, usually in the evening.
 
FOLLOW-UP OFFICE VISITS – You will be seen in the office 1-2 weeks following your surgery.  You will be given this appointment when the date of your surgery has been set and it will be documented in the surgical paperwork mailed to you.
 
HYGIENE – You may not take a shower while your drain is in place.  A sponge bath is preferred.  It is very important that you keep the drain site dry to prevent infection.  Do not wash around the drain site until after the drain is removed.
 
DIET – you may resume your normal diet.  It is not unusual for your appetite to be decreased for a few days after the operation.  This is usually due to side effects of medication, especially the pain pills.  Drink plenty of fluids and eat lightly until your appetite returns to normal. Eating a well-balanced diet with extra protein will help with healing at the surgical site.
 
WHEN TO CALL THE OFFICE – Do not hesitate to call the office if you develop a fever (temperature greater than 101), shaking chills, nausea or vomiting, diarrhea, dizziness, bleeding or pus from your incision or around the drain site, persistent or increased pain, or with any other problem that concerns you.
 

Genesee Surgical Associates, PC
Linden Oaks Medical Campus
10 Hagen Drive, Suite 240
Rochester, NY 14625
Phone:(585) 383-8830
Fax:(585) 383-8901

Christopher B. Caldwell, MD, Surgical Oncologist
Robert J. Tripp, MD, General Surgeon
David E. Burns Jr., MD, General Surgeon
Brian P. Watkins, MD, General Surgeon
Victoria U. Nugent, NP Nurse Practitioner
Stephanie Yu, RPAC, Physician Assistant

REV 5.27.2009