Post Surgery
Recovery from Surgery
You will be discharged from hospital with a dressing around your chest and abdomen. You may also have a drain in place. Please leave the dressing on until your first post op visit with the Dr. Van Laeken approximately 7 days following the procedure. An additional appointment will be booked 2 weeks post operatively.
Drain Care
A drain may have been inserted in the operating room to prevent the collection of blood and fluid in the wound area. Your nurse in the hospital will teach you how to empty and reactivate it.
How to empty and activate the Jackson Pratt Drain
To Empty
- Wash hands
- Unplug the capped drainage plug at the top of the bulb.
- Squeeze the drainage from the device into a clean measuring container. Keep track of the fluid amounts on a piece of paper and bring it with you to your first appointment.
To Reactivate
When the drain is emptied, simply reactivate by depressing or flattening the bulb and then reapplying the cap.
Please keep 24 hr. totals of the drainage emptied and bring it with you to the first appointment, unless, your homecare nurse has removed it beforehand. The drain will be removed when the output is less than 50cc/24hrs. Do not be alarmed if you notice drainage from this site on the day the drain is removed. Use a light dressing to cover the site. This can be changed if it becomes soiled. Typically, the drainage should settle by the next day.
Occasionally, a pocket of fluid can build up after the drains are removed, this is called a seroma. The body is capable of reabsorbing the fluid over time if the seroma is small enough, large volumes of fluid need to drained using a needle and syringe in the office. Please inform us if you experience a seroma accompanied by a fever.
Medications
Take all prescriptions according to instructions on the label. This will include an analgesic (pain medication) and an antibiotic. If you find your pain is only minimal after a few days, try taking extra strength Advil or Tylenol.
For constipation, Dr. Van Laeken recommends a stool softener called Colace or a laxative called Senokot.
For nausea, Dr. Van Laeken recommends Gravol.
If you are suffering any serious side effects from these medications please call our office.
Shower
You may only shower after the drain is removed.
Wound Care
Dr. Van Laeken will arrange for a homecare nurse if required. These nurses can assist you with your drains and dressings. They can also asses any other health problems you may be experiencing or answer any questions you may have regarding your post operative recovery.
You can expect bruising and swelling to the operative site. Also, some slight bleeding may be noticeable around the incisions. Try to keep your arm elevated on pillows on the operative side to minimize swelling. Do not use heating pads or hot water bottles on the operative site as sensation will be decreased. Activities of daily living such as grooming, eating and light housework are encouraged.
Dressing
After your initial dressing is removed by Dr. Van Laeken, steri strips will be left in place. These are small tapes that are not to be removed until your following visit. If one or two come off when you have been given the approval to shower, you do not need to replace them. Do not intentionally remove them. Most of the sutures are absorbable, but with a balancing procedure, non-absorbable sutures will be used. This means that they will need to be removed 10-14 days post op. After the stitches are removed, Dr. Van Laeken recommends 3M Paper tape to cover the incisions. This can be purchased from your local pharmacy. It can be left on for up to a week at a time. It does not need to be changed every day as that may result in irritated skin. The application of Vitamin E to the incisions is not recommended for the first 6 weeks as it is believed it may actually widen the scars.
Call our office if you notice the following:
- A temperature of 38.5 degrees C (orally)
- Increased pain and swelling of the breast not controlled with analgesic
- Yellowish or green drainage from the incisions or drain sites
- Increased heat, pain or redness to the site
- Bright red blood coming through the dressing
- Any allergic reactions to medications or tapes characterized by hives, rashes ,irritation or swelling
Bra Recommendations
Following removal of the initial dressing, you will be able to wear a comfortable bra for support. Initially, a light jog bra is recommended. One month following surgery, an underwire bra can be worn. For assistance with bra sizing, Dr. Van Laeken recommends visiting Diane’s Lingerie in Vancouver for service and selection.
For the full line of Ameona and Trulife Prosthetic and Mastectomy Bras, visit Burnaby Orthopaedic and Mastectomy or phone (604) 436-6092. A certified fitter provides service in English and Mandarin. Home visits arranged if necessary.
Activity/Exercise/Physiotherapy
Get plenty of rest following your procedure. It is not uncommon to feel fatigued for a number of weeks following your surgery. Take short walks but avoid strenuous activities and heavy lifting for 6-8 weeks or until recommended by Dr. Van Laeken.
The physiotherapists will instruct you how to do the recommended exercises to increase the movement of your shoulder and arm following the mastectomy. This will be challenging at first but it will become more tolerable as time goes on. www.eduhealth.ca
Exercises after lumpectomy/partial mastectomy and axillary node dissection
Do 3-5x/day with repetitions of 10. See Physio Excercises (148K pdf)
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It is natural to be protective the surgical site, however, try to avoid holding your shoulder up towards your neck on the affected side as this will contribute to back, shoulder and neck discomfort.
Driving should not be attempted for approximately 2 weeks or more. The lap portion of the seat belt should be worn at all times when travelling by car.
Post Operative Mastectomy – Physiotherapy Group Program
Purpose:
- To prevent secondary complications following breast surgery - Education about follow up care, wound management, arm movement & strength.
- To learn how to safely exercise following breast surgery - Education about posture, increasing arm range of motion and muscle strength.
- To learn about community & educational resources to support you during your recovery.
Please attend the first available Physiotherapy Session one week after surgery:
1st Wednesday of the month 10:30-11:30 |
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2nd Thursday of the month 9:00-10:00 |
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3rd Thursday of the month 10:00-11:00 |
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4th Tuesday of the month 10:30-11:30 |
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Breast Massage
To prevent capsular contracture and maintain mobility in the breast pocket, breast massage should be performed twice/day. This controls the scar tissue that forms around the implants. Massage techniques are commenced 2-3 weeks after the tissue expander is exchanged for the breast implants. You will be taught how to perform these techniques by Dr. Van Laeken or her nurse on one of your post operative visits. This will become part of your daily routine for as long as you have the implants.
Expansion Procedure for Tissue Expanders
The expansion process commences 4 weeks after the mastectomy.
Infiltration of the tissue expander is performed in office every 2 weeks for approximately, 3-4 months or until desired size is achieved.
Approximately, 50-100 cc of normal saline (salt water) is infused using a small needle through the skin via a valve in the expander to fill the sac, thereby stretching the skin and muscle.
The procedure takes about 5 minutes. Most patients find the procedure unremarkable.
Occasionally, following the fill procedure, patients can experience some mild muscle discomfort. This will often last a day or two and can be minimized by using anti-inflammatory/analgesic medications such as Tylenol or Advil.
During the expansion process the tissue expander may be positioned high on the chest or laterally out toward the axilla. This can create asymmetry in regular clothing. It is important to be aware that this is not the position that the breast implant will reside in permanently.
Women can get creative with scarves and prints to help camouflage any asymmetry during the expansion phase. Some women will opt to wear a prosthesis in their bra also.
For dry flaky skin to the breast, apply moisturizer daily once the incision is completely healed. Dr. Van Laeken recommends a simple Lanolin moisture cream without perfumes.
Special Considerations for a Tissue Expander
- The tissue expander houses a metal port that provides protection for the sac when infiltrating with normal saline. The metal potentially will activate the metal detector at domestic and international airport screening centers. Please inform our staff, if you intend to travel via air and we will provide you with a doctor’s note.
- No MRI’s while tissue expander is in. Please check with your radiologist regarding CT Scans.
Chemotherapy or Radiation’s Impact on the Expansion Process
These adjuvant therapies may be recommended by the oncologist caring for you. We work with these agencies and doctors to tailor a plan to provide the best care possible. It may, on occasion mean that the tissue expansion process can take longer.
Chemotherapy treats cancer by inhibiting cancer cells from growing, multiplying or spreading to other parts of the body by using specific drugs. These medications may be prescribed orally or intravenously. Occasionally, a port-o-catheter will be inserted into the neck and tunneled to the upper chest for venous access.
If you are starting chemotherapy, we recommend timing the expansion fills within 1-2 days prior to the next cycle of chemotherapy. This will often extend the interval between injections from 2 to 3 weeks. This is timed accordingly as to minimize any potential risk of infection. This slight delay does not affect your overall result.
Patients receiving radiation will not be injected with normal saline during the typical 5 week radiation cycle. We will ask that you return for a follow up visit during the mid cycle (2.5-3 weeks) of your treatment regime. Radiation therapy can cause skin changes and inflammation where the energy is delivered. The skin in this area may become red, irritated, dry, swollen or itchy. Occasionally, the skin can get moist and break down. It is important that Dr. Van Laeken monitors the side effects of your treatment and its impact on your skin. Most skin changes will dissipate over the space of a few weeks following the completion of the treatment.
The long term effects of radiation on this reconstruction option may interfere with shape, size, or firmness of the breast mound. Infection rates are higher in radiated skin and overall healing may be compromised. Dr. Van Laeken may recommend an alternative reconstructive option if you are informed that radiation will be required.
Nipple Areola Reconstruction
A skin graft from the breast mound, groin or the opposite nipple is used to create the nipple areola complex. This is done as a daycare procedure and recovery time is minimal. A local anaesthetic will likely be used, however, if a general anaesthetic is required, you will remain in hospital for 2-4 hours after your procedure.
This procedure is done at a minimum of 3 months after the exchange of the tissue expander for the implant.
Dressing
Dr. Van Laeken will apply a “tie-down dressing “. This means that dressing material will be sutured on to the skin for protection of the site. Do not attempt to remove the dressing until you are seen in our office approximately one week after the procedure. A lighter protective dressing will be applied at this time. There may be some minimal bruising and tenderness to the graft site and/or the newly constructed areola. You may shower after this appointment as a waterproof dressing will be in place.
A second appointment will be booked two weeks post operatively to reassess the site and remove any necessary sutures. Following this appointment, you should use the 3M paper tape to cover the graft harvest site. This taping procedure is for scar management purposes and should be carried out for a period of 3 months. You can shower with the tape in place and simply pat dry. The tape can stay on for one week at a time. If you choose to change it daily, the skin can become irritated. This is Dr. Van Laeken’s method of scar management. Please call our office if you notice the following:
- A temperature of 38.5 degrees C (orally)
- Increased pain or swelling of the breast not controlled with analgesic
- Yellowish or green drainage from the incisions or drain sites
- Increased heat, pain or redness to the site
- Bright red blood coming through the dressing
- Any allergic reactions to medications or tapes characterized by hives, rashes, irritation or swelling.
Tattoo
Several months following the nipple graft procedure, tattooing is performed by Dr. Van Laeken in the outpatient department at the hospital. The areola/nipple is matched with the appropriate skin tone pigments and tattooed for permanent results.
This takes less than 1 hour and you can resume your normal activities following. If you opt for a local anaesthetic, the area will remain “frozen” for approximately one hour following the procedure.
Caring for your Tattoo
Leave your dressing on for 5 -7 days then it may be removed. You may shower with the dressing in place. You may notice some of the pigment and a small amount of blood through the dressing, this is normal. Do not aggressively rub the area. After the dressing is removed the skin will appear dry with some scabbing. Do not pick at these areas as it could result in pigment loss. Use a gentle moisturizer such as Lanolin cream on the area. Avoid soaking in the bathtub, a hot tub or swimming pool (chlorine may contribute to fading of the tattoo). Also, avoid tanning beds and watch your exposure to sunlight. Use sunscreen as necessary. The tattoo may appear somewhat dark at first and will lighten over the next 3 months.
This is considered the final stage of the reconstructive process.
Lymphedema
Large groups of lymph nodes are located throughout the body, specifically, in the groin, neck and underarm region. The role of the lymph nodes is to act as a filter for body fluids, abnormal cells and bacteria. In an axillary dissection, often performed in conjunction with a mastectomy, lymph nodes are removed . Consequently, the lymph fluid drainage can become impaired and excessive build up of fluid in the arm may become evident. This is known as lymphedema. It can become evident months or even years following treatment.
Watch for signs of lymphedema and inform your doctor:
- swelling, fullness or heaviness in the arm
- problems fitting into your sleeves, jewelry etc even though your weight hasn’t changed
- redness, tenderness or warmth of the arm
- Feeling of tightness in the skin or joints
To avoid the risk of infection, it is important to protect the skin and arm on the affected side. The following are recommendations to minimize or manage lympendema:
- Avoid cuts, scratches, burns and bites. Treat the previous afflictions by washing wounds promptly, and using antibiotic ointment.
- Avoid blood pressure cuffs and venopunctures on the affected arm
- Use an electric razor for shaving
- Avoid caring heavy bags over the shoulder or arm
- Wear work gloves when gardening
- Wear sunscreen to avoid burns to the skin
- Note: Activities which demand the use your arms, such as swimming, dragon boat paddling, yoga and other activities of daily living will help to stimulate the lymphatic drainage.
- Your doctor may recommend the use of a compression sleeve if the lymphedema is remarkable or problematic. Varying degrees of compression are available with a prescription:
-Low (10-20mmHg)
-Med (20-30mmHg)
-High (30-40mmHg)
Visit the Burnaby Orthopaedic and Mastectomy website or phone (604) 436-6092 for a full line of Lymphedema Sleeves. They have certified fitters providing service in English and Mandarin. Home visits arranged if necessary.
Mammograms and Breast Self Exam Post Breast Reconstruction
Following reconstruction, it is recommended to continue with both breast self exams and mammograms on the unaffected side. Patients with a previous breast cancer diagnosis or with current breast problems post reconstruction will be referred for diagnostic mammograms.
www.bccancer.bc.ca (1-800-663-9203)
If you have never been taught how to perform breast self examination or if you want additional information call the Cancer Society line at 1-888-939-3333 or email info@cis.cancer.ca.
Emotional Adjustments
“Women often grieve the loss of a breast,” confirms Dr. VanLaeken. “Long after the breast is removed they have as constant reminder of what they went through. Many women, especially young women, are very concerned about living with the deformity of a missing breast, but with today’s reconstruction options, we can remove the day-to-day reminder of the life-threatening surgery and follow up procedures.”
The loss of a breast can be an emotionally challenging ordeal for some patients. The grieving that Dr. Van Laeken refers to can be represented by feelings of anger, sadness, fear, depression and then eventually some form of acceptance. Each patient will journey through this process at different rates. It is normal to experience these emotions as a natural part of the mental healing process. Many women cope by sharing their story with family or friends, while other women prefer support groups of other women going through a similar circumstance.
Support Services
The Canadian Cancer Society offers telephone support in which information about cancer or available services in your community. They can also connect you with volunteers willing to share their story who may have experienced a similar type of cancer. 1-888-939-3333 or email info@cis.cancer.ca.
Willow Breast Cancer Support Canada is the only breast cancer support organization of its kind that provides free information and emotional support for those impacted by breast cancer. 1.888.778.3100 or email
info@willow.org.
Other Useful Links
BC Cancer Agency Library Services
www.bccancer.bc.ca
(604) 877-6000 local 2690
1-888-675-8001
BC Cancer Agency Patient & Family Counseling Services
www.bccancer.bc.ca
1-800-663-3333 (Vancouver)
1-888-563-7773 (Kelowna)
(604) 930-4000 (Fraser Valley)
1-800-670-3322 (Victoria)
Screening Mammography Program of BC
www.bccancer.bc.ca
1-800-663-9203
Abreast in the West Newsletter
www.abreastinthewest.ca
1-888-939-3333