Care after mastectomy (breast removal surgery). Mastectomy is one of the main treatments for breast cancer and is also called breast removal or breast clearance surgery.
Signs: a feeling that there is a lump; changes in the skin; dimpling; abnormal discharge in women who are not breastfeeding; pain, swelling or a sore on the breast. Diagnosis: physical examination of the breast, mammography, ultrasound, chest X-ray, biopsy, fine-needle aspiration. Treatment: the choice of treatment depends on the stage of the disease, the woman's age, her menopausal status and the disfiguring effects of surgery; drug therapy, chemotherapy, radiotherapy.
Care after surgery: once the nausea has passed and fluids are tolerated, and in coordination with the doctor and nurse, it is recommended that you get out of bed and start walking. To reduce temporary swelling (oedema) in the affected arm, rest the arms on a pillow three times a day for 45 minutes. Do not let the operated arm hang down. Do not sleep on the operated arm. From the second day after the operation, start hand, shoulder and arm exercises and breathing exercises. Exercises after mastectomy should usually be done 3 times a day for 20 minutes each time, and continued until the full range of movement has returned; this is usually recommended for 5–6 weeks after the operation.
Care of the hand and arm after removal of the underarm lymph nodes: avoid having your blood pressure taken, injections or blood samples taken from the arm on the operated side. Use sunscreen with a sun protection factor (SPF) above 15. To avoid insect bites, use insect protection (screens and insecticides). Avoid cutting the cuticles around the nails, and take care during manicures. Use only an electric razor to shave the armpit. Avoid lifting objects heavier than 2–4 kilograms.
If the skin in this area is injured or broken, wash it with soap and water and use an antibacterial ointment.
Nutrition: a high-calorie, high-protein diet, such as meat, pulses, eggs, etc., is recommended to meet energy needs, heal the wound and increase the body's resistance. To improve appetite, eat frequent small meals. Eat food that is rich in protein and low in salt, together with fruit and vegetables. Cut down on chocolate and caffeinated drinks such as coffee and tea.
Care of the Hemovac drain after mastectomy: after surgery, a drain is usually placed at the operation site to let fluid out, prevent fluid from collecting and help the surgical wound to heal.
Some drains are connected to a drainage collection bag; one of these is called a Hemovac. These drains are usually removed before the patient leaves hospital, but sometimes, for reasons such as heavy bloody drainage, the patient is discharged with the drain, and the treating doctor removes it at a later visit in the surgery or the hospital clinic (the underarm drain is usually removed 7 days after surgery). Drainage collectors are devices that are connected to the drains and work by continuous, low-pressure suction.
What helps to prevent lymphoedema (lymphatic swelling)? Exercise; wearing special elastic garments; moving the lymph with massage; bandaging; using a compression pump under a doctor's supervision. Exercises after mastectomy (removal of the breast lump): Wall climbing: stand close to and facing a wall. Place your hands on the wall at shoulder level and gradually slide them upwards.
Then slowly bring your hands back to the starting position. Arm swinging: rotate your arm in a circular movement; continue the circular movement until you feel pressure in your arm. Opening and closing the hands: open and close your hand.
Advice after discharge: avoid lifting heavy objects. The operation site should be dressed using a completely sterile technique. The dressing should be changed 5 times a day, as instructed by the doctor, and the stitches are removed 7–10 days after the operation. If you are discharged with a drain (plastic tubes running from the operation site to a plastic container), the drain area should be cared for and cleaned using a sterile technique.
Make sure the drain tube stays open and that fluid continues to be added to the drainage already collected.
The plastic container should be kept lower than the level of the body. If redness, a bad smell, pus-like discharge or a fever above 38°C occurs, inform the doctor. Take prescribed antibiotics on time and complete the course. See your doctor every 3 months for up to 2 years after the operation, then every 6 months until 5 years, and yearly after that. Because skin nerves are cut during breast surgery, patients may feel various sensations, such as tightness and burning, in the chest wall, the armpit and the inner part of the arm; these may last for several months to a year and then fade.
Hand and arm exercises are recommended, and the prescribed scans should be used. After full recovery, take warm showers with a mild soap to relieve muscle pain. Breast self-examination is recommended for the remaining breast (the breast from which the tumour was removed) or, after complete removal of the breast, for the chest wall. For screening, have a yearly mammogram, ultrasound and MRI as prescribed by your doctor.
Prepared and compiled by: Zahra Zahiri