Postoperative Care after Mastectomy
Immediately following surgery, the patient is taken to the post-anesthesia care unit (PACU) and is closely monitored by the nursing staff until the anesthesia wears off. When the patient awakens fully from the anesthesia and the vital signs stabilize, they are taken to their room.
After the anesthesia wears off, there is pain in and around the incision and pain medication is prescribed. Most mastectomy patients have a drainage tube placed in the breast or under the arm to drain blood and fluid that accumulates during healing. The tube is usually removed within a few days, depending on recovery; however, sometimes it must remain in place for a week or two.
The IV remains until the patient can tolerate fluids taken by mouth. Clear liquids are offered the day of the surgery or the morning after. Once liquids are tolerated, the diet progresses to solid food. If medication such as antibiotics has been prescribed, the intravenous remains in longer.
The length of hospitalization depends on the type of mastectomy performed, breast reconstruction, and complications. If a simple mastectomy has been performed, the patient may be discharged the same day. Most patients remain in the hospital for 1 or 2 days, but if reconstruction is done, the stay is longer.
If discharge is the same day as surgery, the patient must be accompanied home. Patients require assistance for several hours after the anesthesia wears off.
The drain may still be in place when a patient is discharged. Sponge baths instead of showers should be taken until the incision begins to heal and the stitches are removed. Redness or swelling at the site may indicate an infection and should be reported to the surgeon.
Muscle soreness and tightness on the side of the surgery may make it difficult to move the arm. After the drain is removed, simple exercises may be performed to relieve the tightness. A physical therapist can explain the best type of exercise to do. Keeping the arm elevated helps prevent edema (swelling).
After the stitches are removed and the incision is healing, stretching and increased range of motion exercises can be done to regain full movement in the affected arm. A physical therapist or other practitioner can recommend the most appropriate and effective types of exercise. If the patient's job requires lifting and strenuous physical activity, they may need to stay out of work, or temporarily transfer to another position. Complete healing generally takes about 6 weeks.
Most patients recover from mastectomy without any problems, but complications such as infection, lymphedema, and seroma can occur.
Infection usually manifests as redness and swelling of the incision with pus or foul-smelling drainage. Fever may also indicate infection.
Lymphedema may occur when the lymph nodes are removed. The arm on the affected side sometimes becomes swollen when the lymph system is damaged by lymph node removal or radiation. Sometimes it resolves on its own, but the condition can become chronic.
Seroma occurs when blood or fluid accumulates in an area of the body that has just undergone surgery. Sometimes the body absorbs it, but if it becomes painful or infected, it must be removed.