Recovery after breast surgery, one day at a time

What is normal today

• Grogginess, a sore throat from the breathing tube, and feeling washed out. Sleep is the right thing to do with today.
• Nausea from the anesthetic. Small sips and plain food. If you cannot keep fluids down by tomorrow, call.
• Soreness at the incision that is worst on days one to three and then eases. A firm, sometimes tender area under the incision is the healing tissue, not a new lump.
• Tightness and pressure across the chest, as if a band were around it. Soreness under the arm on that side. Numbness over the chest wall, which is expected and may be permanent in part.
• A sore, bruised spot below the collarbone where the port sits. It settles over a week or two.
• If only a radioactive tracer was used to find the sentinel node, 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 a day and a blue tinge to the skin at the injection site, and the skin color can take weeks or months to fade.
• Soreness and a tight feeling in the armpit. Numbness or odd sensations along the upper inner arm, which happens when small skin nerves are disturbed and often improves over months.
• Tightness from the expander or implant, and a feeling that the chest muscle is being stretched. That is what an expander does.
• A second sore site where the tissue was taken, and a longer hospital stay. Your plastic surgeon's instructions govern the flap and the donor site.
• Bruising that spreads and changes color over the week. Yellow and green edges mean it is fading.
• Swelling and some firmness at the site. A soft, squishy fullness is usually a seroma, a pocket of fluid the body makes while it heals. It is common and it is not an infection.
• Drain fluid that is turning from red to pink to straw colored, and less of it each day. Record each drain in the drain log app.
• Tiredness that lasts longer than the pain. Most people need a nap in the afternoon for the first week or two.
• Itching along the incision as it heals. Do not scratch it; a cool cloth over the dressing helps.
• A hard ridge under the scar. Scar tissue firms up before it softens, over several months.
• Odd sensations in the chest: burning, pins and needles, or feeling as if the breast were still there. Those are healing nerves and they fade.
• A tight cord you can see or feel running from the armpit down the inner arm, sometimes to the wrist. It is called cording, it is harmless, and stretching and physical therapy settle it. Mention it at your visit.
• Energy returning in steps rather than all at once. A bad day after a good one is normal.
• Expander fills, if you have one, usually start once the incisions have healed and continue every week or two. Each fill brings a day or two of tightness.
• Scars that are still pink and slightly raised. They flatten and fade over a year or more.

What you can do

• Rest, and have someone with you tonight. For 24 hours after anesthesia, do not drive or operate heavy machinery, and do not sign legal documents. You may eat your regular diet, but do not drink alcohol, and do not smoke.
• While you are taking narcotic pain medicine, do not drink alcohol, drive, or operate hazardous machinery.
• For the first 3 days, take two regular strength acetaminophen (Tylenol) 325 mg tablets four times a day, at breakfast, lunch, dinner, and bedtime, unless you have an allergy or have been told not to. Take them with food.
• Do not take more than 4,000 mg of acetaminophen or 3,200 mg of ibuprofen in 24 hours.
• Walk several times a day. Walking helps prevent a blood clot.
• You will have a surgical binder put on you before you wake up after surgery, and 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 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.
• Sleep on your back, propped up on pillows, for the first week or so.
• Strip, empty, and record each drain at breakfast, lunch, dinner, and bedtime. Pin the drain to your clothes or keep it in a pocket. The drain log app keeps the record for you.
• 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.
• Use the arm for everyday things such as eating, brushing your hair, and dressing. Keep it below shoulder height until the drain is out or the first week is over. The arm and shoulder page has the gentle exercises for this week.
• The day after surgery, you may shower or take a sponge bath to wash off the skin prep used in surgery. That may lower the chance of a rash. After your shower, put fresh gauze inside the binder, and gently pat the incision dry. Keep it clean and dry between showers.
• Showering with drains: take off your binder, but leave the dressing on. Tie a lanyard around your waist and tuck the drain under it. If water gets into the dressing, call the office.
• No hot tubs, pools, or baths until your surgical team clears you.
• After the first 3 days, take acetaminophen (Tylenol) when you need it for pain. Dr. Perkins or the nursing staff will tell you when to add ibuprofen (Motrin). Take these medicines with food. For more severe pain, take the narcotic pain medicine as directed.
• Constipation is common after surgery, especially with narcotic pain medicine. Drink enough fluids and eat fruits and vegetables.
• Go back to desk work or light activity when you feel up to it, often within a few days to a week.
• Do not drive until you have been off narcotic pain medicine, including tramadol, for 24 hours, and you can turn the steering wheel all the way around and look behind you without pain.
• Do not lift more than 10 pounds for 2 weeks after surgery. Otherwise, be as active as you feel able.
• Use the arm normally. Avoid heavy lifting or hard exercise on that side for about a week. The port can be used once the incision has healed, on the schedule your oncology team sets.
• Start the full stretching exercises once the drain is out and Dr. Perkins has cleared you, usually around a week after surgery. The goal is a full reach overhead by about four to six weeks.
• Walk further every day. Light exercise that does not bounce or strain the chest is fine; hold off on running, swimming, and weights until you are cleared.
• Return to most normal activity. Swimming, hot tubs, and baths wait until your surgical team clears you.
• Build back to full exercise. Scar massage, once cleared, softens the scar; ask about it at your visit.
• Keep an eye on the arm for the long term. Heaviness, tightness, or swelling that does not settle overnight is worth a call, because lymphedema is easiest to treat early.

What is coming

• The pathology report from the tissue removed usually takes about a week, sometimes two if extra tests are run. The office calls when it is in, or goes through it at your follow-up visit.
• A drain can come out once 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. Call the clinic then: the nurse will go over your numbers with you and schedule a visit to take it out. Call as well if your drains have been in for more than 2 weeks.
• After the nurse takes the drain out, wait 24 hours before you remove the dressing and shower.
• A follow-up visit two weeks after surgery. If it was not scheduled before you left, call the office at (208) 706-4650 to schedule it.
• If the margins were clear, the next step is usually radiation planning a few weeks after healing, and a visit with the medical oncologist if medicine is part of the plan. If a margin was not clear, a short second operation is discussed.
• Visits with the medical oncologist and, when radiation is part of the plan, the radiation oncologist, usually within a few weeks of the pathology report.
• Expander fills with the plastic surgeon once the incisions have healed, then the exchange to the final implant months later.
• Your first infusion appointment, when the port is used for the first time. The oncology team flushes it on a schedule between uses.
• 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.
• A lasting scar, some permanent numbness, and a body that feels different. Those are expected, and there is help for each one on the support page.

For your drain 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 →

Daily check-in

Six quick questions. This does not diagnose anything. It sorts what you describe into three answers: carry on, call the office today, or call now. Nothing you answer here is saved.

Print my plan

One printout with your operation and today's plan. The instructions by topic print from their own page, and the drain log app prints your drain record. Bring it to the follow-up visit, or leave it on the fridge for whoever is helping you.