Mastectomy Health Article

Aftercare

In the past, women often stayed in the hospital at least several days. Now many patients go home the same day or within a day or two after their mastectomies. Visits from home care nurses can sometimes be arranged, but patients need to learn how to care for themselves before discharge from the hospital. Patients may need to learn to change bandages and/or care for the incision. The surgical drains must be attended to properly; this includes emptying the drain, measuring fluid output, moving clots through the drain, and identifying problems that need attention from the doctor or nurse. If the drain becomes blocked, fluid or blood may collect at the surgical site. Left untreated, this accumulation may cause infection and/or delayed wound healing.

After a mastectomy, activities such as driving may be restricted according to individual needs. Pain is usually well controlled with prescribed medication. Severe pain may be a sign of complications, and should be reported to the physician. A return visit to the surgeon is usually scheduled 7 to 10 days after the procedure.

Exercises to maintain shoulder and arm mobility may be prescribed as early as 24 hours after surgery. These are very important in restoring strength and promoting good circulation. However, intense exercise should be avoided for a time after surgery in order to prevent injury. The specific exercises suggested by the physician will change as healing progresses. Physical therapy is an integral part of care after a mastectomy, aiding in the overall recovery process.

Emotional care is another important aspect of recovery from a mastectomy. A mastectomy patient may feel a range of emotions including depression, negative self-image, grief, fear and anxiety about possible recurrence of the cancer, anger, or guilt. Patients are advised to seek counseling and/or support groups and to express their emotions to others, whether family, friends, or therapists. Assistance in dealing with the psychological effects of the breast cancer diagnosis, as well as the surgery, can be invaluable for women.

Measures to prevent injury or infection to the affected arm should be taken, especially if axillary lymph nodes were removed. There are a number of specific instructions, all directed toward avoiding pressure or constriction of the arm. Extra care must be exercised to avoid injury, to treat it properly if it occurs, and to seek medical attention promptly when appropriate.

Additional treatment for breast cancer may be necessary after a mastectomy. Depending on the type of tumor, lymph node status, and other factors, chemotherapy, radiation therapy, and/or hormone therapy may be prescribed.

Risks

Risks that are common to any surgical procedure include bleeding, infection, anesthesia reaction, or unexpected scarring. After mastectomy and axillary lymph node dissection, a number of complications are possible. A woman may experience decreased feeling in the back of her armpit or other sensations including numbness, tingling, or increased skin sensitivity. Some women report phantom breast symptoms, experiencing itching, aching, or other sensations in the breast that has been removed. There may be scarring around where the lymph nodes were removed, resulting in decreased arm mobility and requiring more intense physical therapy.

Approximately 10% to 20% of patients develop lymphedema after axillary lymph node removal. This swelling of the arm, caused by faulty lymph drainage, can range from mild to very severe. It can be treated with elevation, elastic bandages, and specialized physical therapy. Lymphedema is a chronic condition that requires continuing treatment. This complication can arise at any time, even years after surgery. A new technique called sentinel lymph node mapping and biopsy, which may eliminate the need for removing many lymph nodes, is being tested.

Normal results

A mastectomy is performed as the definitive surgical treatment for breast cancer. The goal of the procedure is that the breast cancer is completely removed and does not recur.

Abnormal results

An abnormal result of a mastectomy is the incomplete removal of the breast cancer or a recurrence of the cancer. Other abnormal results include long-lasting (chronic) pain or impairment that does not improve after several months of physical therapy.

BOOKS

Berger, Karen J., and John Bostwick III. A Woman's Decision: Breast Care, Treatment and Reconstruction. St. Louis, MO: Quality Medical Publishing, 1998.

Robinson, Rebecca Y., and Jeanne A. Petrek. A Step-by-Step Guide to Dealing With Your Breast Cancer. New York: Carol Publishing Group, 1994.

Zuckweiler, Rebecca. Living in the Postmastectomy Body: Learning to Live in and Love Your Body Again. Point Roberts, WA: Hartley and Marks, 1998.

PERIODICALS

Frost, Marlene, et al. "Long-term Satisfaction and Psychological and Social Function Following Bilateral Prophylactic Mastectomy." Journal of the American Medical Association (20 July 2000): 319-24.

Lynden, Patricia. "Your Breasts or Your Life." American Health for Women (16 June 1997): 29-31.