Lumpectomy/Segmental Mastectomy/Partial Mastectomy, Sentinel Lymph Node Biopsy or Axillary Dissection Post-Surgery Guide

The following information is intended to guide you through your postoperative recovery.

Note:

  • If you had a sentinel lymph node biopsy, your urine may turn blue for approximately 48 hours after surgery. This is expected and considered normal.
  • Do not allow any blood pressure tests or lab/IV punctures on the arm of the affected side (surgery side). Discuss these restrictions with your surgeon at your postoperative appointment.

Medication and pain management

Follow the directions on any new prescriptions that your doctor has given you. Prior to your discharge, you will be instructed about which daily medications to take at home.

Pain management is an important part of your post-surgery care. You may be sent home with a prescription for pain medication. It is important to take your pain medicine before your pain becomes more severe.

Side effects from narcotic pain medications include nausea and constipation. If you experience nausea or vomiting related to your pain medications, you should stop the medication and take ibuprofen or acetaminophen for pain management.

PLEASE NOTE: No pain medication refills will be authorized on the weekends. If a refill is needed, the request must be made BEFORE 12:00 PM (noon) on Friday.

Diet

For the first few days following your surgery, eat foods that you easily tolerate normally.

Bowel care

To prevent constipation, drink plenty of fluids and take a stool softener, such as docusate (Colace) daily. Walking is often helpful to stimulate bowel movements.

If you have not had a bowel movement within 48 hours after your return home, increase your fluid intake. You may take one single dose of Milk of Magnesia if you do not have abdominal distention. Or, you may start over-the-counter Miralax, once daily; stop this medication when you reestablish your normal bowel habit.

Incision care for patients WITHOUT drains

  • You may remove the gauze and/or plastic dressing over your incision 3-4 days after surgery, then resume showers.
  • If your clothes irritate the incision or if you have some drainage after the dressing is removed, you may place a clean, dry gauze dressing over the incision; change it daily.

Incision care for patients WITH drains

  • You may have one or two drains in place after surgery. Empty the bulb(s) at least twice a day, and keep a record of the output for each drain, per day. Hospital staff will provide instructions. However, despite the discharge instructions from the hospital, you do NOT need to clean the drain bulb caps with alcohol. This is unnecessary and may make them too slippery to stay capped.
  • Do NOT shower while the drains are in place.
  • Leave your dressings in place until your first office visit. You may re-tape any part of the dressing that becomes loose, before it falls off.
  • Drains are typically removed once the output is less than 15-30cc for each drain in a 24-hour period. If you have questions about when the drains can be removed, contact us and talk with your surgeon’s nurse.
  • If your dressing becomes extremely soiled or comes off prior to your first office visit, you may replace it with a dry sterile dressing and tape. Then call our office to arrange a nurse visit for a dressing change.

Incision care for ALL patients

  • Once the dressing is removed, check your incision daily for signs or symptoms of infection. Such signs would include: increased swelling, redness or wound drainage with odor. It is normal, however, to have some swelling and bruising around your incision.
  • When your outer dressing is removed, you will see steri-strips (tape) across your incision. Leave the strips in place 5-14 days, or until your postoperative appointment. The strips may gradually loosen and come off; any that remain will be removed at your postoperative appointment.
  • You will likely be given a compression garment (breast binder) immediately after your surgery; continue to wear it until your postoperative appointment or until your surgeon instructs you to discontinue.
  • If the material from the compression garment irritates your skin, you may wear a thin shirt or camisole under the garment. A pad placed under the arm may prevent irritation at the site of the incision, caused by the compression garment.

Physical activity

  • Minimize your activity level for the first few days at home, then resume non-vigorous, normal activities.
  • Avoid repetitive movements with your arm on your surgical side. If you’ve had lymph nodes removed under your arm, avoid lifting your elbow above your shoulder for 1-2 weeks after surgery.
  • Discuss with your doctor how and when to increase your activity level and lymphedema prevention (if appropriate) after surgery.
  • Before returning to exercise, get approval from your physician.

Bathing and showering WITH drains

  • Do NOT shower while the drains are in place.
  • Once your drains are removed, wait 48 hours before taking a shower.
  • When you are released to shower, you may do so with your steri-strips and stitches in place.
  • Do not scrub across your steri-strips or incision.
  • Do not bathe in a tub for 14 days after your surgery; this includes a hot tub.

Bathing and showering WITHOUT drains

  • Gauze dressing: If you have a gauze dressing held in place with a woven or fabric tape, you may take a shower when you have been instructed to remove your dressing (usually 3-4 days after surgery).
  • Plastic dressing: If you have a plastic dressing covering the entire incision: you may shower 24 hours after surgery. Plastic dressings may be removed 4 days after surgery.
  • All patients without drains: When you are released to shower, you may do so with your steri-strips and stitches in place. Do not scrub across your steri-strips or incision. Do not bathe in a tub for 14 days after your surgery; this includes a hot tub.

Driving

You may drive only when you are no longer taking narcotic pain medications AND when you feel you can quickly respond to situations that will not place yourself or others at risk.

Returning to work

Your doctor can tell you when you can return to work. Please notify us if you need a return-to-work letter for your employer. It may take up to 48 hours for the letter to be completed. Please provide a fax number for your employer, so we can fax your letter of release.

As a general guideline:

  • Light lifting or no lifting-type jobs: You may return to work within 1-2 days after surgery.
  • Heavy lifting or physical-type jobs: You may return to work within 3 days to one week after surgery.

Pathology results

Your pathology results will normally be available within 4-5 business days, following your surgery. You can call our office the afternoon of your fifth postoperative day if you have not heard from us and would like to check on the results. Please note that your doctor may not be available to discuss your results when you call.

If you choose not to call, your provider will discuss the results with you in detail at your first postoperative appointment.

Follow-up appointments

You will be given instructions about your postoperative follow-up the day of your surgery; please follow the instructions. If you have not already done so, please call the office after your surgery to schedule this appointment.

Call our office for the following:

  • Fever > 101°F
  • Uncontrolled pain; on a scale of 1-10 (10 being the worst pain imaginable) your pain is a level 7 or above
  • Nausea and/or vomiting that continues for 12-24 hours
  • Diarrhea that continues for 12-24 hours
  • Signs of a wound infection
  • Chest pain or difficulty breathing
  • Your incision separates or opens
  • Significant drainage leaking around the drain

Questions

Please contact us at 541-868-9303 if you have questions.