After-surgery instructions, by topic

After anesthesia and while taking narcotic pain medicine

• Do not drive or operate heavy machinery for 24 hours.
• You may eat your regular diet, but do not drink alcohol.
• Do not smoke.
• Do not sign legal documents for 24 hours.
• If you are taking narcotic pain medicine, do not drink alcohol, drive, or operate hazardous machinery while you are taking it.

Looking after the incision

• The day after surgery, you may shower or take a sponge bath to wash off the skin prep used in surgery. This may lower the chance of a rash.
• Keep the incision clean and dry between showers. After a shower, gently pat it dry.
• Skin glue (Dermabond) usually starts to peel away after 7 to 10 days. Let it fall off on its own. Do not pull it off.
• Ice packs can ease discomfort. Wrap an ice pack in a towel or cloth first, because ice placed directly on the skin can burn it.

• Most incisions are closed with stitches under the skin that dissolve on their own, so there is nothing to remove.
• A little pink or clear drainage on the gauze in the first day or two is normal. Bright red bleeding that soaks through, or drainage that is thick, yellow, or smells, is a call.
• Bruising and a firm ridge under the incision are part of healing and soften over weeks to months.
• After a mastectomy: the incision runs across the chest and the skin over it is numb. Check it in a mirror once a day, since you may not feel a problem starting.
• With a port: the port incision sits below the collarbone. Keep it dry for the first day and do not let a seatbelt or a bag strap rub across it until it has healed.

Your binder, compression, and sleep

• You will have a surgical binder put on you before you wake up after surgery. You will have another one of the same size to take home and change into after showering.
• Wear the binder 24 hours a day, 7 days a week, except when you are in the shower, at least until your follow-up appointment. Your surgical team will tell you when you are healing well enough to switch to a tight sports bra.
• After your shower, put fresh gauze inside the binder. It gives gentle compression against the breast.

• After a mastectomy: sleep on your back, propped on pillows, for the first week or so. A pillow under the arm on the surgery side helps. Side sleeping returns when the drains are out and it is comfortable.
• After a lumpectomy, re-excision, or surgical biopsy: sleep in whatever position is comfortable, with the binder on. Many people prefer their back for the first few nights.
• After a mastectomy: once you have healed, a soft breast form can be worn in a bra. The reconstruction page covers prostheses.

Showering and bathing after breast surgery

• You may shower or take a sponge bath from the day after surgery.
• No hot tubs, pools, or baths until your surgical team clears you.
• If you have drains: take off your binder, but leave the dressing in place. Tie a lanyard around your waist and tuck the drain under it, so it is held while you shower. Never let a drain hang by its tubing.
• If water gets into the dressing over a drain, call the office.

• Let water run over the incision. Do not aim the spray at it or scrub it.
• Do not put lotion, ointment, or powder on the incision unless you were told to.

Pain medicine after breast surgery

Unless you have an allergy or another reason you cannot take them, you will take both acetaminophen (Tylenol) and ibuprofen (Motrin). Taken together, these medicines are more effective for pain relief.

• For the first 3 days, take two regular strength acetaminophen 325 mg tablets four times a day: at breakfast, lunch, dinner, and bedtime.
• Dr. Perkins or the nursing staff will tell you when to start taking ibuprofen.
• After the first 3 days, take acetaminophen when you need it for pain.
• Take these medicines with food, so they do not upset your stomach.
• Do not take more than 4,000 mg of acetaminophen in 24 hours, and do not take more than 3,200 mg of ibuprofen in 24 hours. If you follow these instructions, your doses stay within those limits.
• For more severe pain, take the narcotic pain medicine as directed, when you need it.
• Constipation is common after surgery, especially with narcotic pain medicine. Make sure you drink enough fluids and eat fruits and vegetables.

• Pain that is getting worse instead of better after day three is a call, whatever the cause.

Activity, lifting, driving, and going back to work

• Be as active as you feel able.
• Walk several times a day. Walking helps prevent a blood clot.
• Do not lift more than 10 pounds for 2 weeks after surgery.
• Gently move the arm on the side of your surgery, slowly and as comfort allows. It lowers the chance of a frozen shoulder, a stiff shoulder that is hard to move.
• Driving: do not drive until you have been off narcotic pain medicine, including tramadol, for 24 hours. You also need to be able to turn the steering wheel all the way around and look behind you without pain.

• With a port placed on its own, with no breast operation: avoid heavy lifting and hard exercise on that side for about a week. If the port was placed along with breast surgery, follow the 10 pound, 2 week limit above.
• With reconstruction: your plastic surgeon’s activity limits apply and are usually stricter. Follow theirs.
• After a lumpectomy, biopsy, or port placement: desk work within a few days to a week; physical work when lifting is back to normal, usually two to three weeks.
• After a mastectomy: desk work in one to two weeks for many people; physical work in four to six weeks. Ask for a note if you need one.
• Exercise: walking and gentle stretching right away. Anything that bounces the chest or strains the arms waits until you are cleared, usually three to six weeks.
• Sex when you feel ready. There is no medical reason to wait once you are comfortable.

Caring for a Jackson-Pratt drain at home

If you go home with a Jackson-Pratt (JP) drain, these are Dr. Perkins’ instructions. The same instructions, and a place to record each drain, are in the drain log app.

• Always wash your hands with soap and water before you touch your drains.
• Strip, empty, and record each drain at breakfast, lunch, dinner, and bedtime.
• Keep the drain bulb squeezed flat. That creates the suction the drain needs. The drain will not work if the bulb is full of air.
• The drain is held in place with one stitch and a clear dressing. Pin the drain to your clothes or put it in your pocket. Never let it hang by its tubing.
• Wash your bedding before surgery, and regularly after.

How to strip the drain tubing

1. With one hand, hold and pinch the tube where it leaves your skin.
2. With the thumb and first finger of your other hand, pinch the tube just below where you are holding it.
3. Slowly and firmly slide your thumb and finger down the tubing toward the end of the tube. An alcohol swab helps your fingers slide smoothly.
4. Keep pinching and sliding your fingers down the tubing until you reach the bulb.

How to empty the drain bulb

1. Wash your hands with soap and water.
2. Open the drain plug. Do not touch the inside of the cap or the bottom of the plug.
3. Turn the bulb upside down and pour the fluid into a measuring container.
4. Clean the plug with an alcohol swab.
5. Squeeze the bulb to push out the air, and close the plug. The bulb should stay flat.
6. Write down the amount of fluid, in the drain log app, on the paper output record, or on a notepad.
7. Flush the fluid down the toilet.
8. Wash your hands with soap and water.

How to record drain output

• Record the amount in milliliters (mL) or cc. They are the same amount. Please do not measure in ounces.
• Record each drain separately.
• Use the drain log app, the paper output record, or a notepad.
• If the amount is less than 30 mL, a children’s liquid medicine cup makes it easier to measure. Pharmacies have these cups if you do not have one at home.

Keep your record on your phone The drain log app Record each drain at breakfast, lunch, dinner, and bedtime. The app adds up each drain, counts the days since surgery, and tells you when to call the clinic. Add it to your home screen and give it your own name. Get the drain log app →

When a drain can come out

A drain can come out when it has been in for at least 7 days and its output has been less than 30 mL in 24 hours for two days in a row. A nurse takes the drain out in the clinic. After it comes out, wait 24 hours before you take off the dressing and shower.

When to call the clinic about your drain

Please call the clinic at (208) 706-4650 if:

• Water gets into the dressing.
• The dressing is loose or falling off.
• The drain bulb will not stay squeezed flat.
• You think your skin may be reacting to the dressing, such as a rash or blisters.
• A drain’s output has been less than 30 mL in 24 hours for two days in a row, no sooner than 7 days after surgery. The nurse will go over your output with you and schedule a visit to take the drain out.
• You have had the drains in for more than 2 weeks.

Swelling, seromas, and numbness after surgery

• Some swelling and bruising is expected and peaks around day two to three.
• A seroma is a pocket of the body’s own fluid that collects in the space where tissue was removed. It feels like a soft, water-balloon fullness. It is common, it is not an infection, and most settle on their own over weeks. A large or uncomfortable one can be drained with a needle in the office.
• Numbness around the incision is expected. Some of it returns over months; some, especially across a mastectomy site or along the upper inner arm after node surgery, is permanent.
• Swelling that is tight, painful, and growing quickly, especially with fresh bruising, is different and is a call.

After lymph node surgery

• After a sentinel node biopsy: if only a radioactive tracer was used, you may not notice anything different as you recover. Sometimes a blue dye is needed. If it is, you will have blue or green urine for about a day, and a blue tinge to the skin where the dye was injected, which can take weeks to months to fade. Both are the dye, not a problem.
• Soreness and tightness in the armpit, and numbness or odd sensations along the upper inner arm from small skin nerves.
• Move the arm for daily tasks from day one, keeping it below shoulder height until the drain is out or the first week is over, then start the stretching exercises.
• Cording: a tight band you can feel or see from the armpit down the inner arm, appearing a few weeks after surgery. Harmless, treatable with stretching and physical therapy, and worth mentioning at your visit.
• After an axillary dissection: lymphedema precautions for the long term are on the arm and shoulder page.

If reconstruction was started

Two surgeons looked after you in the operating room, and two sets of instructions apply. Dr. Perkins’ cover the cancer operation. Your plastic surgeon’s cover the reconstruction, the expander or implant, any donor site, and the activity limits, and theirs are usually the stricter ones. When the two seem to differ, the plastic surgeon’s instructions govern the reconstruction, and a call to either office sorts it out.

• With an expander or implant: expect tightness and a stretched feeling over the chest muscle. Fills of the expander begin once the incisions have healed and continue every week or two.
• With a flap: expect a second incision where the tissue was taken, often the abdomen, and a longer hospital stay. Flap checks in the first days are about blood flow to the new tissue; call the plastic surgeon’s office right away for any color change, coolness, or sudden swelling of the flap.
• Drains after reconstruction often stay longer than after mastectomy alone. Record them in the same drain log app.

Living with a port

• The port is a small disc under the skin below the collarbone, connected to a thin tube into a large vein. You will feel and see a bump; that is the port, and it is meant to be there.
• Keep the incision dry for the first day, then shower normally. The site heals in about a week.
• The oncology team accesses the port with a special needle for each treatment and flushes it on a schedule between uses. Nobody else should use it.
• Call for redness, swelling, or pain at the port, swelling of the arm or neck on that side, or fever.

The pathology report and the follow-up visit

• Plan a follow-up visit two weeks after surgery. If you do not already have it scheduled, call the office at (208) 706-4650 to schedule it.

• The tissue removed goes to the pathologist, and the report usually takes about a week, sometimes two if extra tests are run. It sets the final stage, confirms the margins, and reports on the lymph nodes.
• The office calls when it is in, or Dr. Perkins goes through it with you at the follow-up visit. Bring someone with you, and bring your questions. The report decoder can help you make sense of the words beforehand.
• At the follow-up visit the incisions are checked and the next steps are laid out. Later steps, such as radiation planning, a medical oncology visit, or reconstruction stages, are booked from that visit onward.

When to call after breast surgery, and when to call 911

Call the office at (208) 706-4650 if you have a temperature over 101°F, chest pain, shortness of breath that is getting worse, or more drainage.

Also call the same day for shaking chills, redness spreading from an incision, an incision that opens, swelling that is tight and growing quickly, pain that is getting worse instead of better, or anything that worries you. Chest pain or trouble breathing that is sudden or severe, bleeding that does not stop with pressure, or fainting are 911. The full list, with what counts as which, is on when to call.

Call the office, (208) 706-4650

The instructions you were given when you left the hospital come first. This page is here to help you follow them, not to replace them. When something does not match, call the office and ask.

Where this comes from