What is post-operative care for breast cancer like?

Wound and Drain Care

Wounds are often closed with absorbable stitches, hence stitch removal is not needed.

Wound care is simple and patients will be taught and given specific instructions in the management of various types of wound coverage.

Patients are recommended to shower 2 days after most surgeries such as breast-conserving surgery and simple mastectomies.

Soft flexible tube drains are placed under the skin at the time of surgery. These help to remove blood and other fluids that accumulate at the site of surgery. Patients without breast reconstruction surgery are usually discharged from the hospital with the tube drain on the day after surgery.

The nurse in the ward will teach the drain care and provide a chart to keep a record of the drainage, to be reported to the Breast Care Nurse (BCN) daily. The drain will be removed in the clinic when the drainage is minimal and this usually takes 1 to 2 weeks.

Patients are recommended to see a doctor if there is:

• Fever (temperature of 38°C and above)
• Redness/swelling around the opera-tion site
• Discharge from the wound or around the drain site
• Increased pain at the operation site
• Wound breakdown i.e. the skin separates at the wound site

Medication and Diet

Routine medications prescribed by doctors are usually resumed immediately after surgery and there are diet restrictions unless otherwise advised by the doctor.

Activity and Rehabilitation

Patients are encouraged to resume normal mobility and function as soon as it is suitable after surgery.

Most patients with breast-conserving surgery (BCS) and simple mastectomies will be able to resume usual daily activities immediately after surgery, with special precautions for those with breast reconstruction surgery, where management will differ according to their surgeries.

Arm Exercise Programme

Our Arm Exercise Programme conducted by our Occupational Therapists or Physiotherapists on the day after surgery aims to prevent shoulder and arm stiffness. This will enable you to use the arm as you had before surgery in activities at home, work and in recreation.

The exercises also promote circulation of the lymphatic system, thus preventing swelling of the affected arm. Over-strenuous activities are to be avoided in the first few weeks after discharge.

These exercises are to be done once daily, and each set of exercises is to be repeated 5 times. Instructions from the Occupational Therapist or Breast Care Nurse on the limitations will be advised as needed.

Arm and Hand Care

Following axillary surgery, lymphoedema and increased risk of infection of the arm may occur as lymph nodes also contain cells which fight infection.

Therefore, extra care to protect the hand and arm on the operated side from injury is recommended.

Patients will be referred to a physiotherapist or occupational therapist specially-trained in treating lymphoedema. They will recommend programmes which include skin care, exercise, manual lymphatic drainage (a special massage technique), and compression garments to help reduce the swelling.

Preventive measures include:
You will be referred to an occupational or physio therapist for rehabilitation advice and arm exercise. Exercises may begin as early as the first post-operative day. The following basic steps can greatly reduce the risk of arm swelling:

Good skin care is essential in preventing an infection and subsequent swelling

• Use body lotion regularly to keep your skin moisturised.
• Avoid getting an injection or have blood taken from the arm on the operated side, whenever possible.
• Be extra careful to avoid cuts and wounds to your hands and fingernails, especially during activities like sewing, food preparation, gardening and manicure.
• Wear protective gloves prior to contact with chemicals or when immersing your hand in water for prolonged periods.
• Wear long sleeves when outdoors to avoid prolonged direct sunlight. Use sunblock with SPF of at least 30 to protect your skin from sunburn.
• Use insect repellent to prevent insect bites.

Avoid extreme heat on affected arm pathway

• Do not apply hot oil or heat-producing products (e.g. heat rub cream) on the arm, neck and back of the operated side.
• Avoid prolonged exposure to heat e.g. hot springs, saunas and steam baths.

Care for wounds, cuts or burns, and recognizing the symptoms of infection

• Cleanse the area with sterile normal saline or antiseptics. Dry the area and apply a simple, sterile dressing over the wound.
• Observe for symptoms of infection such as redness, swelling, warmth, pain and fever. Consult your GP early, as oral antibiotics may be needed.

Avoid any constrictions to the arm as this might restrict the flow of lymph fluid

On the operated side,

• Do not wear tight jewellery or clothes with tight sleeves.
• Do not hang handbags or shopping bags over your forearm.
• Avoid blood pressure taking.
• Avoid acupuncture.
• If you do go for a deep tissue body massage, request for the masseur not to exert deep pressure.

Maintain exercise to maximize lymph flow

• Use your affected arm, as you would normally do when combing your hair, bathing, dressing, and eating.
• Build up the duration and intensity of exercise or strenuous activity gradually over time.
• Obesity increases the risk of lymphoedema. Reduce weight through exercises and change of dietary habits.
• Continue to exercise your arm after surgery / radiation until you regain normal range of shoulder and arm movements.

Avoid overuse or fatigue of your arm muscles

• Avoid using the arm on the operated side to carry very heavy items, for prolonged periods of time.
• Take more frequent rest breaks when scrubbing, mopping, cleaning, or while doing other vigorous or repetitive activities, especially if your arm feels tired, heavy, or achy.

Physical Appearance

With a mastectomy, physical appearance can be maintained by wearing a prosthesis (called a breast form), or by undergoing breast reconstruction.

There are women who choose not to have breast reconstruction after mastectomy. Some make this decision because they want to avoid extra surgery. For others, it is because they are comfortable with their appearance and body image.

Breast forms or prostheses are used to maintain appearance and a sense of balance, as well as to relieve the strain on posture that may occur after a mastectomy. They are available in a variety of sizes, shapes and colours. Some are designed to fit into a special bra. Others can be attached securely to your chest using a special adhesive.

• Our BCN will give you an appointment for prosthesis-fitting about 6 weeks after the surgery. In the meantime, you may use soft padding underneath your bra while your wound heals.
• When choosing a breast form, it is important that it has the same size and weight as your other breast. This will help maintain your posture and prevent back strain.