Health Information

Information for Patients & Families about Mastectomy HF#4395

Important Phone Numbers

To reach your doctor, call the UW Breast Center (608) 266-6400 Monday through Friday, 8:00 am to 5:00 pm.

UW Emergency Room - (608) 262-2398

After hours, weekends, or holidays, call the Hospital Paging Operator at (608) 262-0486 and ask for the surgery resident on call. Give your name and phone number with area code. The doctor will call you back.

If you live out of the area you may call: 1-800-323-8942

What is a Mastectomy?

It is the surgical removal of one or both breasts.

Simple Mastectomy – removal of the breast only.
Modified radical mastectomy – removal of breast and some of the lymph nodes under the arm. Underlying muscle is not removed.
Unilateral – one side
Bilateral – both sides

What happens during lymph node removal?

There are two types of lymph node removal.

1. Sentinel lymph node biopsy – The sentinel nodes are the first nodes that drain the lymphatic fluid from a tumor area. They are found in the armpit on the side of the breast with the tumor. These nodes are the first to show spread of cancer cells. If there is no cancer in the sentinel nodes, it is likely that cancer is not present in other lymph nodes. The removal of fewer lymph nodes with this biopsy results in fewer side effects.

This procedure begins in Nuclear Medicine where a tracer fluid is injected around the tumor area and in the skin of the breast. The tracer fluid travels from breast tissue to the lymph nodes. This may be done the day before or the day of surgery.
The biopsy itself is done at the same time as the breast surgery. The surgeon will inject blue dye around the tumor site while you are in the operating room. The dye and tracer are taken up by the first nodes or sentinel nodes. The surgeon will look for blue dye in the lymph nodes or use an instrument to measure the tracer in the lymph nodes. When the nodes are found (most often 1-5 nodes), they are removed.

If any sentinel lymph nodes come back as positive (cancer has spread to the lymph nodes) then an axillary dissection will be done at a later date.

Side Effects: The blue dye may cause the skin of the breast to stain blue for a few weeks or permanently. The dye may cause the urine to look green/blue for 24 hours. Very rarely, there may be an allergic reaction from the dye.

2. Axillary lymph node dissection – This procedure will be done if cancer is suspected or found in the lymph nodes. An incision is made in the armpit area on the same side as the breast cancer. A number of lymph nodes are removed. A drain is placed in the incision.

Planning Ahead

If you have a simple or modified radical mastectomy you will normally stay in the hospital overnight. You may go home earlier if your surgeon feels you are ready.
Plan to stay home from work for 1-2 weeks.
Avoid lifting objects that weigh more than 10 pounds with your involved arm until your first clinic visit.
Make arrangements for childcare if needed.
Bring a loose top that opens in the front to wear home.
You may have a home health nurse visit you after surgery; this is often arranged in advance of your surgery. You may also have a friend or family member help you with your care.

Emotional Changes

You may be feeling worried, sad, angry, or scared. These and many other feelings can occur. It takes time to deal with the diagnosis, treatment, and new changes they bring in your life. Every woman copes with breast cancer in her own unique way. Some have found it helpful to talk about their feelings with the people close to them and to ask for their support. If you feel you need help, talk to your doctor or nurse. There is staff to help you at UW Hospital and support groups in the community that you can be connected with.

Care Wear Visit

Care Wear is located just outside the Breast Center. They provide special products for use after breast surgery.

You will have a visit arranged with Care Wear before your surgery. Your nurse will help make this appointment.
Specially trained staff will fit you for a bra to take home after surgery.
You will also be given a special camisole to help hold drains (see drain section below).
You may be fitted at a later date with a permanent prosthesis.

During Your Hospital Stay

You will have an incision covered with gauze or a clear bandage.
Your incision will have dissolvable stitches underneath the skin. You may also have small strips of tape called steri-strips covering the incision. The length of your incision will depend on the type of surgery you have had.
You will have one or more drainage tubes in place based on the type of surgery you had.
You may have a post-operative bra in place.
You will have an IV and compression stockings or special leg pumps in place. The leggings maintain good blood flow until you are up and walking.
Nurses will be asking you to rate your pain level. They will take your vital signs often.
You will be able to have family or friends visit once you are in your hospital room.
You will be able to get the results of your surgery within one week. Your surgeon will call you with these results.

Going Home

You will be able to go home when you are eating, drinking, and your pain is under control.
You will be given pain medicine when you go home.
Make sure you have someone to drive you home.

Care of Your Incision

You do not need to remove the dressing, but you may do so at anytime if it becomes wet or bothers you. You will be given dressing supplies to take home. Look at the site daily for any problems or signs of infection. You may notice a slight redness and swelling along your incision. There may be a small amount of pink drainage coming from your incision. This is normal. Place a new gauze dressing over your incision. If you have steri-strips in place, these will fall off by themselves, most often in about one week. If they remain in place after that you may remove them.

When to Call Your Doctor or Nurse

Call your doctor or nurse if you have these problems with your incision or drains after surgery:

increase in swelling.
firmness or rapid bruising.
heavy bleeding or an opening in the incision.
sudden increase in pain.
drainage bulb(s) filling quickly with the need to empty them every 1-2 hours.

Call if you have signs of infection.

Fever of 100.4°F (38°C) or greater taken by mouth 2 times, four hours apart.
Increased tenderness, redness, warmth, or swelling of the incision or drain sites. (A small area of redness about the size of a dime is common where the stitch around the drain leaves the skin.)
Increased drainage from your incision or drain site.
Increased swelling under your arm.

Drain Care

You may go home with one or more drainage tubes that were placed during your surgery. The drains remove blood and fluid that may collect under the skin and delay healing. Your drains will most often be removed about a week after surgery. This is based on the amount of drainage you have. Your drainage container will be marked in mL (milliliters).

Drainage should be measured twice a day or more often if needed. Record the amounts on the chart at the back of this booklet. Call a Breast Center nurse when your drainage is less than 30 mL, per drain, in a 24-hour period to talk about having your drain removed. When you come to the clinic to have your drains removed, bring this booklet with you.

To Clean the Drain and Incision Sites

Remove the gauze dressing from the incision and from the drain
As you shower or sponge bathe, gently wash the drain site with soap and water. Pat dry
It may be helpful to use a cloth belt (from a robe, etc) around your waist or a towel placed around your neck to safety pin your drains in place while you shower.
You may take a tub bath if the incision and the area where the drains are can be kept out of the water.
You do not need to wash the incision site. You may let water from the shower flow over the site.

Emptying Your Drain(s)

Wash your hands.
Empty the bulb into the container provided (see diagram next page).
Reapply suction (see diagram next page).
Record the date and amount of drainage from the bulb on the chart at the back of booklet). Empty the bulb twice a day (in the morning and in the evening) or more often if you notice it is over half full.
After you record the amount of drainage, empty the drainage down the toilet and rinse your container with tap water.
Wash your hands.

You may want to have a family member or friend help you with this.

Signs of Seroma

A seroma is a fluid-filled bulge that forms under the skin of the chest and/or under the arm where surgery has taken place.

Some women may hear a "sloshing" noise in the breast with movement. This is fluid filling the surgical cavity.

You may develop a small seroma that your body will slowly absorb over time.

A seroma may sometimes occur after a drain is removed.

If you have a seroma that is getting larger and causing pain or discomfort, please contact your doctor. This is not an emergency. You may be asked to return to the clinic to have the fluid drained.

Pain Management

The amount of pain that women have after this surgery varies greatly. You will be given a prescription for narcotic pain medicine. Use it as needed and as directed.

Do not drive a vehicle while taking narcotic medicine.
Eat plenty of fiber (bran, oats, fruits and vegetables).
Drink 6-8 glasses of water each day to help prevent constipation.
Take stool softeners if needed.
If you have nausea, take your pain medicine with food.

Many women find that taking Extra-Strength Tylenol® 1-2 tablets every 4-6 hours is helpful to relieve pain. You may take up to a total of 8 tablets in a 24-hour period. Do not exceed this amount. If you have liver disease, check with your doctor before taking it. You may also take ibuprofen as directed.

Do not combine Tylenol® with pain medicine that contains Tylenol® (also known as acetaminophen, APAP) such as Vicodin® or Percocet®.

Activity and Exercise

Using your arm after your mastectomy may be painful. As your incision heals the pain will decrease.

The day after your surgery, use your arm during your daily routines, such as dressing and combing your hair.
Start the “first exercises” on page 9. Go slowly and stop if it becomes painful. You may have numbness and/or shooting pains in some parts of your arm or chest.
Start “advanced exercises” of your arm and shoulder 1 week after your drains have been removed in order to prevent a stiff or “frozen” shoulder.
Drive a car when you are able to stretch both arms straight above your head. Do not drive if you are taking pills that might make you drowsy.
Resume light household activities within the first few days after surgery. You may bowl, golf, play tennis, shovel snow, or do more vigorous activity when you have full arm motion and your doctor says it is alright to do so (about 4 to 6 weeks).
Let your partner know when you feel ready for sexual relations and what feels comfortable to you and what does not. Being open about the fears and desires you both have can make this adjustment easier.

First Exercises

While doing this program, avoid sharp pain, incision stretch, or pulling on your drains.

Do these exercises for about 1 week. Keep doing any of the exercises that provide a good stretch. Start with 3 repetitions of each twice a day. Slowly increase to 10 repetitions each time, by the end of the first week.

Warm Up

Do these exercises with your arm elevated above the heart: fist squeeze, wrist circles, elbow bends.

Lying on your Back

Forward Arm Lifts

Lie on your back with your arm at your side. Lift your arm forward and up. Keep your elbow straight until your hand is over your head. Return your arm slowly to your side.

Sideways Arm Lifts

Lie on your back with your arm at your side. With your elbow straight and palm up, raise your arm sideways. Keep your arm in contact with the bed. Return slowly to your side.

Windshield Wipers

Lie on your back with your arms straight out from your sides at shoulder level. Bend your elbows and point your fingers toward the ceiling. Roll your arms forward until your palms rest on the bed. Roll your arms back trying to rest the backs of your hands on the bed beside your head.

Either Sitting in a Chair or Lying on Your Back

Reach to the opposite shoulder. Push gently on your opposite shoulder.

Bend your knees. Reach for your opposite knee. Push gently on your opposite knee.

Sitting

Shoulder Shrugs

Sit with your arms relaxed at your sides. Shrug your shoulders as high as possible toward your ears. Take a deep breath while raising your shoulders. Exhale as you relax.

Shoulder Blade Squeezes

Sit up straight, tuck your chin, and relax your arms. Slowly pull your shoulders back, squeezing your shoulder blades together. Try to get your elbows as close together as possible behind your back.

Deep Breathing

Sit up straight with your hands on your hips. Take a slow deep breath, inhale through your nose and exhale through your mouth. Try to expand your chest and rib cage as you inhale. Limit this exercise to 3 repetitions.

Neck Stretch

Sit up straight; slowly turn your head to the left until you feel a stretch, hold for 10 seconds. Repeat turning your head to the right, hold for 10 seconds.

Neck Extension

Sit up straight, bend your neck backwards until you feel a good stretch, hold for 10 seconds.

Neck Side Bend

Sit up straight, tip your head towards your right shoulder without lifting your shoulder. Hold for 10 seconds. Repeat with left side.

Advanced Exercises

Move on to these exercises 1 week after your drains are removed.

Chicken Wings

Sit up straight. Clasp your hands behind your neck, keep your head erect. Slowly spread your elbows apart as far as you can. Then return your elbows to the starting position.

Apron Strings

Sit up straight. Clasp your hands together behind your back as though you were tying your apron strings. Slowly lift your hands toward your shoulder blades. Then relax your arms at your sides.

Forward Arm Lifts

Sit up straight. Raise both arms forward and overhead. Reach toward the ceiling. Lower your arms and relax them at your sides.

Sideways Arm Lifts

Sit up straight. Raise both arms out sideways to shoulder level. Turn palms up and raise arm further to touch your ears with your upper arms. Keep your head erect. Lower your arms and relax them at your sides.

Tree Sway

Stand up straight. Clasp your hands together and watch your hands as you stretch your arms above your head. Lean towards your affected side, getting an underarm stretch. Hold for 2 – 3 seconds and return to the starting position. Repeat this exercise, but lean towards the unaffected side.

Doorway Sideways Stretch

Stand in a doorway with your affected arm out sideways with your hand on the doorpost at shoulder level. Slowly, walk your hand up the doorpost until you feel a good stretch, and then walk it down again. Keep yourself evenly in the doorway by touching your other hand to the opposite doorpost.

Wall Forward Stretch

Face the wall. Stand with your feet about 4 inches away from the wall. Place your palms on the wall at shoulder level. Gently pushing into the wall, slowly walk your hand up the wall until you feel a good stretch, and then walk it down again.

You can check your progress by marking the highest level reached by your affected arm. Try to increase it each day.

Things to Keep in Mind

Please discuss any new concerns or questions with your doctor. If you receive treatment through UW Health, and need more help with exercise or movement, ask for a referral to one of our Occupational Therapists at the outpatient clinics.

University Of Wisconsin Hospital and Clinics

600 Highland Ave

E3/311

Madison WI 53792

Phone (608) 263-8060

Fax (608) 262-7679

UW Health Rehabilitation Services

Princeton Club East

1726 Eagan Road

Suite 100

Madison WI 53704

Phone (608) 265 1221

Fax (608) 263-2666

Axillary Excision and Lymphedema

Our bodies have a network of lymph nodes and lymph vessels that carry lymph fluid, similar to the way blood vessels carry blood to all parts of the body. The lymph fluid contains white blood cells, which help us fight infections. During breast surgery, the doctor may remove a number of the lymph nodes from the underarm area to see if cancer has spread. Some lymph vessels that carry fluid from the arm to the rest of the body are removed also because they are intertwined with the nodes. This changes the way the lymph fluid flows in that side of the upper body. If the remaining lymph vessels cannot remove enough of the fluid in the breast and underarm area, the excess fluid builds up and causes swelling or lymphedema.

Radiation treatment to the lymph nodes in the underarm can affect the flow of lymph fluid in the arm and breast area in the same way.

Swelling of the arm may be slight, making your rings feel tight on your fingers, or it may be severe, causing your entire arm to be very swollen. The swelling may come on quickly after surgery or radiation. In other cases, it appears years later. This swelling occurs in 2 – 15% of the patients.

As breast surgery and treatment continue to become more conservative and as research advances are made with procedures such as the sentinel lymph node biopsy, doctors expect that fewer women will develop lymphedema. There are ways that you can care for your arm and breast area to reduce your risk of having future problems. Right after surgery, some swelling may occur in the affected arm or breast area. This swelling is most often temporary. It will slowly go away over the next 6 – 12 weeks.

To Reduce Swelling after Surgery or Radiation

If swelling is present after surgery, raise your arm for short periods throughout the day and night. Place your arm on pillows so that your hand is higher than your elbow, and your elbow is slightly higher than your shoulder.
Exercise your affected arm while it is elevated by opening and closing your hand and bending and straightening your elbow 15 – 30 times. Repeat these 3 – 4 times a day. This will decrease swelling by pumping lymph fluid out of your arm.
Exercise regularly but try not to over tire or strain your arm with activity that you have not been doing. Before any strenuous exercise, talk with your doctor, nurse, or rehab therapist to decide what level of activity is right for you. Avoid unusual activity or extensive use of your arms which can result in injury.
During radiation and up to 18 months after, do simple stretching daily to maintain your range of motion.
If you have had an axillary lymph node dissection, have all shots, IVs, blood draws, or blood pressure tests done on the unaffected arm. If both arms are affected have these done on your leg when possible. Let your doctor or nurse know that you are at risk for lymphedema. This is not needed after most sentinel lymph node biopsies. Discuss this with your surgeon.
Wear watches or jewelry loosely on the affected arm to avoid constriction.
Use your unaffected arm to carry heavy things such as groceries, suitcases, or handbags with shoulder straps. Use both arms when you can to carry heavy packages or children.
Avoid spending time in saunas or hot tubs since heat can increase fluid build-up.
Try to avoid gaining weight because extra fat in the arm requires more blood vessels. It creates more fluid in the arm and places a greater burden on the lymph vessels that are left.

Try to Avoid Infection

Your body responds to infection by making extra fluid to fight the infection. If the lymph nodes and vessels are removed or damaged it is harder for your body to transport this extra fluid. You may be more likely to get an infection in the affected arm. This can trigger lymphedema.

To help prevent infection and swelling

Avoid burns. Protect your arm from sunburn by using sunscreen that is labeled “SPF 15” or higher. Use oven mitts. Avoid oil splash burns and steam burns from cooking.
Clean even small cuts promptly with soap and water. Use an over-the-counter antibacterial cream on any openings once they are cleaned. Cover them with a bandage.
Wear gloves when you are in the garden, using strong cleaning products, or cleaning up after pets.
Use a thimble when sewing.
Use an electric razor when shaving under your arm to prevent cuts or nicks or choose a shaver with rounded heads.
Use insect repellent when outdoors to avoid bug bites. If you get stung by a bee in the affected arm, clean and elevate the arm, apply ice, and contact your doctor or nurse if it becomes infected (warmth, redness, swelling, fever).
Use your washcloth to gently push back cuticles while in the shower instead of cutting them.

Call your doctor right away if

Your arm remains swollen and painful for several days.
You have any sign of infection in your arm.
Your arm feels heavy and tight.
The skin in your arm feels hard.
Your hand or wrist is less flexible.
You have less range of motion in the involved arm.
You have hardening or discoloration of the skin on your involved arm.

The sooner lymphedema is noticed, the better the outcome of treatment will be.

Changes in Sensation

Since some nerves may be injured during your surgery, you may have some numbness near your incision, or if lymph nodes were removed, in your arm and armpit. Although tingling, chafing, burning, and the feeling that there is a large lump under your arm often lessen within weeks, some numbness may never go away. Avoid placing hot packs or heating pads near these areas as a burn could occur without you knowing it.

Permanent Prosthesis

A breast prosthesis is an artificial breast form. They come in many sizes and shapes. The breast form will replace the weight of the breast so your body will be balanced. Back, shoulder, and neck aches may occur when the body is not balanced.

You will be given a prescription for a breast prosthesis and for bras with pockets on your first visit to the clinic after your surgery. You can be fitted for your prosthesis 4-6 weeks after surgery as long as the incision is healed. To find a prosthesis, visit Care Wear located next to the Breast Center. The American Cancer Society can also supply a list of stores in your area that carry them. You may find it helpful to check with your insurance for coverage.

Reconstruction

If you are interested in reconstruction, you will meet with a plastic surgeon. The plastic surgeon will explain the different types of breast reconstruction available and if reconstruction is recommended for you.

Breast Self-Exam (BSE)

You will still need to check your breasts for changes. Also, on the side of your mastectomy, feel along your incision line, the tissue above the line up to your collarbone and under your arm. Do breast self exam (BSE) 5-7 days after the start of your menstrual period each month. If you do not menstruate, set aside the same day each month to do BSE (for example, the first day of each month). Doing an exam each month will help you to notice any changes. If you do notice changes during your breast self exam, call your doctor.

Follow-Up

After your surgery, follow-up visits with your doctor may take place every three to twelve months. Please discuss your specific follow-up plan with your doctor.

Drainage Measurements

Date	Drain # (list the number of drains you have)	AM	PM	TOTAL: (24 hour goal for drain removal is 30 ml/per drain)
example 1/1/2010	Drain #1	25	15	40
1/1/2010	Drain #2	20	40	60

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 03/29/2010

Copyright © 03/29/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4395

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