Mastectomy with Sentinel Lymph Node Biopsy (with immediate reconstruction) Post-Surgery Guide

The following information is intended to guide you through your postoperative recovery. Please note that your plastic surgeon will also provide you with postoperative instructions, as well.

Note:

  • Discuss with your doctor how and when to increase your activity level and lymphedema prevention (if appropriate) after surgery.
  • 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: Pain management and medication refill requests should be requested through your plastic surgeon’s office.

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 and drain care

  • You will have several 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.
  • Your plastic surgeon will decide when the drains should be removed. Please contact your plastic surgeon’s office with questions regarding dressings or drain removal.
  • 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.
  • Contact your plastic surgeon’s office with any concerns about your incisions and/or drains.

Physical activity

Your plastic surgeon can advise you regarding your activity level.

Bathing and showering

Please check with your plastic surgeon regarding when you may shower. Typically, you are not allowed to shower with the drains in place.

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 plastic surgeon can inform you of when you might return to work.

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

Your initial follow-up appointments will be with your plastic surgeon. You will need a follow-up appointment with your general surgeon after the drains have been removed at your plastic surgeon’s office (usually 2-3 weeks postoperative).

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 our office after your surgery to schedule this appointment.

Call your plastic surgeon’s 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 your plastic surgeon’s office with further questions. To schedule a follow-up appointment with your general surgeon, call 541-868-9303.