About Your Mastectomy

This guide will help you get ready for your mastectomy at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.

Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery. You and your healthcare team will refer to it as you learn more about your recovery.

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About Your Surgery

This guide has information about several types of breast surgeries. You may be having a:

  • Total mastectomy
  • Total mastectomy and sentinel lymph node biopsy
  • Total mastectomy and sentinel lymph node biopsy with a possible axillary lymph node dissection
  • Total mastectomy and axillary node dissection (also called a modified radical mastectomy)
  • Other similar surgery

If you’re having breast reconstruction, your plastic surgeon will give you more information.

Total mastectomy

A total mastectomy is a surgery to remove all your breast tissue. It’s usually done through an incision (surgical cut) across your chest, but it can be done in different ways. Your breast surgeon will talk with you about which option is right for you.

During your surgery, your surgeon may also remove one or more lymph nodes from your armpit. A pathologist will examine the lymph node(s) to see if the cancer has spread to them.

Sentinel lymph node biopsy

A sentinel lymph node biopsy is when the first lymph node(s) in your armpit that receive drainage from the breast tumor are removed and checked for cancer cells. These lymph nodes are called sentinel lymph nodes. If cancer cells spread, the sentinel lymph nodes are usually the first place they go. Your surgeon will identify the sentinel node(s) by injecting a special dye into your breast.

If you’re having a sentinel lymph node biopsy, you may have lymphatic mapping as part of your surgery. More information about this procedure is included later in this guide.

Your surgeon may send the sentinel lymph node(s) to the pathologist during your surgery. If the pathologist sees any cancer cells, your surgeon may then do an axillary lymph node dissection.

Axillary lymph node dissection

An axillary lymph node dissection is when most or all of the lymph nodes in your armpit are removed. The number of lymph nodes removed varies from person to person.

About your lymphatic system

Understanding how your lymphatic system works can be helpful as you get ready for and recover from your breast surgery. Your lymphatic system has 2 jobs:

  • It helps fight infection.
  • It helps drain fluid from areas of your body.

Your lymphatic system is made up of lymph nodes, lymphatic vessels, and lymphatic fluid (see Figure 1).

  • Lymph nodes are small bean-shaped glands located along your lymphatic vessels. Your lymph nodes filter your lymphatic fluid, taking out bacteria, viruses, cancer cells, and other waste products.
  • Lymphatic vessels are tiny tubes, like your blood vessels, that carry fluid to and from your lymph nodes.
  • Lymphatic fluid is the clear fluid that travels through your lymphatic system. It carries cells that help fight infections and other diseases.
Figure 1. Your lymphatic system in your breast and armpit

Figure 1. Your lymphatic system in your breast and armpit

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Before Your Surgery

The information in this section will help you get ready for your surgery. Read this section when your surgery is scheduled and refer to it as your surgery date gets closer. It has important information about what you need to do before your surgery.

As you read through this section, write down any questions you want to ask your healthcare provider.

Getting ready for your surgery

You and your care team will work together to get ready for your surgery.

Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.

  • I take a blood thinner, such as:
    • Aspirin
    • Heparin
    • Warfarin (Jantoven® or Coumadin®)
    • Clopidogrel (Plavix®)
    • Enoxaparin (Lovenox®)
    • Dabigatran (Pradaxa®)
    • Apixaban (Eliquis®)
    • Rivaroxaban (Xarelto®)
    There are others, so be sure your healthcare provider knows all the medications you’re taking.
  • I take prescription medications (medications my healthcare provider prescribes), including patches and creams.
  • I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
  • I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
  • I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
  • I have sleep apnea.
  • I’ve had a problem with anesthesia (medication to make me sleep during surgery) in the past.
  • I’m allergic to certain medication(s) or materials, including latex.
  • I’m not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke or use an electronic smoking device (such as a vape pen, e-cigarette, or Juul®).
  • I use recreational drugs.

Preventing pregnancy

If there’s any chance you could become pregnant before your surgery, be sure to use a form of birth control (contraception) that doesn’t have hormones. For example, you can use a condom, a diaphragm, or a copper (Paragard®) intrauterine device (IUD).

If you have questions about birth control or want help choosing the type of birth control that’s right for you, talk with your gynecologist (GYN doctor).

Fertility preservation

Avoid becoming pregnant during your treatment. If your doctor told you to avoid getting pregnant for some time and you want to have children in the future, you may want to think about freezing your eggs. For more information, read the resource Fertility Preservation: Options for Females Starting Cancer Treatment.

About drinking alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

  • If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medications to help keep them from happening.
  • If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do before your surgery to keep from having problems:

  • Be honest with your healthcare providers about how much alcohol you drink.
  • Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea (feeling like you’re going to throw up), increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you can’t stop drinking.
  • Ask your healthcare provider questions about drinking and surgery. As always, all of your medical information will be kept confidential.

About smoking

If you smoke, you can have breathing problems when you have surgery. Stopping even for a few days before surgery can help. Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507.

About sleep apnea

Sleep apnea is a common breathing disorder that causes you to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes completely blocked during sleep. OSA can cause serious problems during and after surgery.

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing device (such as a CPAP device) for sleep apnea, bring it with you the day of your surgery.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal account. You can use MyMSK to send and receive messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to create their own account so they can see information about your care.

If you don’t have a MyMSK account, you can visit my.mskcc.org, call 646-227-2593, or call your doctor’s office for an enrollment ID to sign up. You can also watch our video How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal. For help, contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.

Within 30 days of your surgery

Presurgical testing (PST)

Before your surgery, you’ll have an appointment for presurgical testing (PST). The date, time, and location will be printed on the appointment reminder from your surgeon’s office. You can eat and take your usual medications the day of your appointment.

During your PST appointment, you’ll meet with a nurse practitioner (NP) who works closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.

Tell your NP if you’re breastfeeding or pumping your breastmilk for your child.

Your NP will talk with you about which medications you should take the morning of your surgery.

It’s helpful to bring the following things to your PST appointment:

  • A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
  • The name(s) and telephone number(s) of your healthcare provider(s).

Identify your caregiver

Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home.

For caregivers

‌  Resources and support are available to help manage the responsibilities that come with caring for a person going through cancer treatment. For support resources and information, visit www.mskcc.org/caregivers or read A Guide for Caregivers.

Complete a Health Care Proxy form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. If you’ve already completed one or have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document that identifies the person who will speak for you if you can’t communicate for yourself. The person you identify is called your health care agent.

Talk with your healthcare provider if you’re interested in completing a health care proxy. You can also read the resources Advance Care Planning and How to Be a Health Care Agent for information about health care proxies, other advance directives, and being a health care agent.

Arrange for someone to take you home

You must have a responsible care partner take you home after your surgery. A responsible care partner is someone who can help you get home safely and report concerns to your healthcare providers, if needed. Make sure to plan this before the day of your surgery.

If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s usually a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you must still have a responsible care partner with you.

Agencies in New York Agencies in New Jersey
Partners in Care: 888-735-8913 Caring People: 877-227-4649
Caring People: 877-227-4649  

Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser (such as Hibiclens®)

4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser before leaving the Evelyn H. Lauder Breast Center or at your local pharmacy without a prescription.

Buy 325-milligram acetaminophen tablets (such as Tylenol® Regular Strength)

Acetaminophen is an over-the-counter pain medication. You’ll use it after your surgery to help manage your pain at home. It’s helpful to buy it ahead of time. You can get it at your local pharmacy without a prescription. Always follow the instructions on the container or from your healthcare provider when taking any medication.

7 days before your surgery

Follow your healthcare provider’s instructions for taking aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Don’t stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.

2 days before your surgery

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

Stop taking NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), 2 days before your surgery. These medications can cause bleeding. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

1 day before your surgery

Note the time of your surgery

A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you on the Friday before. If you don’t get a call by 7:00 pm, call 212-639-5014.

The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go.

Lymphatic mapping

If you’re having a sentinel lymph node biopsy, you may have a lymphatic mapping procedure the day before or the morning of your surgery. This will help your surgeon find the sentinel lymph node(s) during your surgery.

During your lymphatic mapping procedure, you’ll lie on a reclining chair for about 20 minutes. While you’re in the reclining chair, a healthcare provider will inject (give you a shot of ) a small amount of a radioactive liquid under your skin below the areola of your affected breast. You might feel stinging or burning during the injection.

After the injection, you’ll massage the area of the injection site for 10 minutes. This will help the radioactive liquid travel to the sentinel lymph node(s). Then, a technologist will measure the radioactivity in your breast and axilla (armpit) on your affected side to see how much of the liquid was absorbed. There are 2 ways they can do this:

  • Your radiation technologist might use a small handheld device called a Neoprobe®.
  • You might have an imaging scan using a larger machine that you lie down on. Read the section “Nuclear Medicine Scan” for more information.

Both ways work equally well. Your healthcare provider will tell you what to expect.

Nuclear medicine scan

If you’re having an imaging scan after your injection, your technologist will take you to the scanning room. You’ll lie on a table while the technologist takes pictures. Each picture takes 5 minutes to complete, and you must lie very still during this time. If you feel uncomfortable staying in any position for 5 minutes, ask your technologist to count down the time for you. The scan will take 10 to 15 minutes.

The pictures taken during your scan will show the flow of the radioactive liquid. They’ll also show which lymph nodes absorb the liquid. This creates a “map” of your lymphatic system. Your surgeon will use this map to find your sentinel lymph node(s) during your surgery.

If you’re having surgery the same day as your lymphatic mapping, a staff member will bring you from the scanning room to the operating room. If you’re having surgery at the Josie Robertson Surgical Center (JRSC), your care team will arrange for you to take an MSK van to the JRSC after your procedure. In most other cases, you’ll go home after your lymphatic mapping.

Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)

The night before your surgery, shower using a 4% CHG solution antiseptic skin cleanser.

  1. Use your normal shampoo to wash your hair. Rinse your head well.
  2. Use your normal soap to wash your face and genital area. Rinse your body well with warm water.
  3. Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth.
  4. Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Don’t put it on your face or genital area.
  5. Move back into the shower stream to rinse off the 4% CHG solution. Use warm water.
  6. Dry yourself off with a clean towel after your shower.
  7. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Instructions for eating before your surgery

‌  
Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
 

The morning of your surgery

Instructions for drinking before your surgery

‌  You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.

Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.

Take your medications as instructed

If your healthcare provider told you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.

Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)

Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.

Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things to remember

  • If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
  • Don’t wear any metal objects. Remove all jewelry, including body piercings. The tools used during your surgery can cause burns if they touch metal.
  • Leave valuable items at home.
  • If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.

What to bring

  • A button-down or loose-fitting top.
  • Your breathing device for sleep apnea (such as your CPAP device), if you have one.
  • Your Health Care Proxy form and other advance directives, if you completed them.
  • Your cell phone and charger.
  • Only the money you may want for small purchases (such as a newspaper).
  • A case for your personal items (such as your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles), if you have any.
  • This guide. Your healthcare team will use it to teach you how to care for yourself after surgery.

Once you’ve arrived for your surgery

Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or a similar name may be having surgery on the same day.

When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.

Meet with a nurse

You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight (including prescription and over-the-counter medications, patches, and creams) and the time you took them.

Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse doesn’t place the IV, your anesthesiologist will do it in the operating room.

Meet with an anesthesiologist

You’ll also meet with an anesthesiologist before surgery. They will:

  • Review your medical history with you.
  • Ask you if you’ve had any problems with anesthesia in the past, including nausea or pain.
  • Talk with you about your comfort and safety during your surgery.
  • Talk with you about the kind of anesthesia you’ll get.
  • Answer your questions about your anesthesia.
Marking your surgical site

Along with asking your name and birth date, staff members may also ask the name of your surgeon, what surgery you’re having, and which side is being operated on. Your surgeon or another member of the surgical team will use a marker to initial the site on your body that will be operated on. This is for your safety and to make sure all members of your surgical team understand the plan for your surgery.

Get ready for your surgery

When it’s time for your surgery, you’ll need to remove your hearing aids, dentures, prosthetic devices, wig, and religious articles, if you have them.

You’ll either walk into the operating room or a staff member will bring you there a stretcher. A member of the operating room team will help you onto the operating bed and place compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.

During your surgery

After you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe.

If you’re having a sentinel lymph node biopsy, your surgeon will inject a small amount of blue dye underneath your nipple or near the tumor. This dye will travel in your lymphatic fluid to the sentinel lymph node(s), staining them blue. If you had a lymphatic mapping procedure, your surgeon will also use a small device that measures radioactivity from the liquid injected during that procedure.

Once they locate the sentinel lymph node(s), your surgeon will make an incision and remove them. They may send them to the Pathology department to be checked for cancer cells during your surgery. If the pathologist sees cancer cells, your surgeon may remove more lymph nodes. This is called an axillary lymph node dissection. Your surgeon will discuss this with you in more detail, if needed.

Because blue dye was used during your sentinel lymph node biopsy, your skin, urine (pee), and stool (poop) may be bluish-green for 1 to 2 days after your surgery.

Once your surgery is finished, your incisions will be closed with sutures (stitches) under your skin. You may also have Steri-Strips (thin pieces of surgical tape) or Dermabond® (surgical glue) over your incisions. Your incisions may be covered with a bandage.

Your breathing tube is usually taken out while you’re still in the operating room.

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After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You’ll learn how to safely recover from your surgery.

As you read through this section, write down any questions you want to ask your healthcare provider.

In the Post-Anesthesia Care Unit (PACU) or recovery room

Figure 2. JP drain

Figure 2. JP drain

When you wake up after your surgery, you’ll be in the PACU or your recovery room.

A nurse will be keeping track of your body temperature, pulse, blood pressure, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose or a mask that covers your nose and mouth. You’ll also have compression boots on your lower legs.

Tubes and drains

You’ll have a surgical bra around your chest to cover your surgical site and at least 1 Jackson-Pratt® (JP) drain (see Figure 2) attached to the bra. The JP drain will help drain the fluid from your incision and prevent swelling. You’ll get supplies and an extra surgical bra to take home to help you care for your incision(s) and drain(s).

Managing your pain

You’ll have some pain after your surgery. To help you manage this:

  • You’ll get pain medication in your IV line.
  • Once you’re able to eat normal food, you’ll get oral pain medication (medication you swallow).

Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain will help you recover better.

You’ll get pain medication before you leave the hospital. Talk with one of your healthcare providers about possible side effects and when to start switching to over-the-counter pain medications.

Moving around and walking

Moving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around.

Read the resource Call! Don't Fall! to learn what you can do to stay safe and keep from falling while you’re in the hospital.

Exercising your lungs

It’s important to exercise your lungs so they expand fully. This helps prevent pneumonia.

  • Use your incentive spirometer 10 times every hour you’re awake. For more information, read the resource How to Use Your Incentive Spirometer.
  • Do coughing and deep breathing exercises. A member of your care team will teach you how.

Eating and drinking

First, you can drink water or juice. Then, you can start eating solid foods, such as crackers. After that, you can start eating your normal foods again as you’re able. If you have questions about your diet, ask to see a clinical dietitian nutritionist

Learning to care for your tubes and drains

You’ll go home with at least 1 JP drain in place. The drain(s) will usually be removed about 1 to 2 weeks after your surgery but may be left in longer.

One of your nurses will teach you how to care for the drain(s) before you leave the hospital. It’s helpful if your caregiver learns too. This will make it easier for them to help you at home.

For more information, read Caring for Your Jackson-Pratt® Drain.

Planning for your discharge

Your first appointment after surgery will usually be within 1 to 2 weeks after you leave the hospital. Your nurse will give you instructions on how to make this appointment, including the phone number to call.

Leaving the hospital

Before you leave the hospital, look at your incision with one of your healthcare providers. Knowing what your incision looks like will help you notice any changes later.

On the day of your discharge, plan to leave the hospital between 8:00 am and 11:00 am. You’ll need a responsible care partner to take you home once you’re discharged.

Before you leave, your healthcare provider will write your discharge orders and make sure you have all the prescriptions you need. You’ll also get written discharge instructions. One of your healthcare providers will review these instructions with you before you leave.

At home

Read the resource What You Can Do to Avoid Falling to learn what you can do to stay safe and keep from falling at home and during your appointments at MSK.

Filling out your Recovery Tracker

We want to know how you’re feeling after you leave the hospital. To help us continue caring for you, we’ll send questions to your MyMSK account every day for 10 days after you leave the hospital. These questions are known as your Recovery Tracker.

Fill out your Recovery Tracker every day before midnight (12:00 am). It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how you’re feeling and what you need.

Based on your answers, we may reach out to you for more information or ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions. For more information, read the resource About Your Recovery Tracker .

Managing your pain

People have pain or discomfort for different lengths of time. You may still have some pain when you go home, and you’ll have pain medication available for this if needed. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This doesn’t mean something is wrong.

Follow the guidelines below to help manage your pain at home.

  • Take your medications as directed and as needed.
  • Call your healthcare provider if the medication prescribed for you doesn’t ease your pain.
  • Don’t drive or drink alcohol while you’re taking prescription pain medication. Some prescription pain medications can make you drowsy. Alcohol can make the drowsiness worse.
  • As your incision heals, you’ll have less pain and need less pain medication. An over-the-counter pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) will ease aches and discomfort.
    • Follow your healthcare provider’s instructions for stopping your prescription pain medication.
    • Don’t take more of any medication than the amount directed on the label or as instructed by your healthcare provider.
    • Read the labels on all the medications you’re taking, especially if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medications. Taking too much can harm your liver. Don’t take more than one medication that contains acetaminophen without talking with a member of your care team.
  • Pain medication should help you resume your normal activities. Take enough medication to do your activities and exercises comfortably. It’s normal for your pain to increase a little as you start to be more active.
  • Keep track of when you take your pain medication. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.

Some prescription pain medications (such as opioids) may cause constipation (having fewer bowel movements than usual).

Preventing and managing constipation

Talk with your healthcare provider about how to prevent and manage constipation. You can also follow the guidelines below.

  • Go to the bathroom at the same time every day. Your body will get used to going at that time. If you feel like you need to go, though, don’t put it off.
  • Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. That’s when the reflexes in your colon are strongest.
  • Exercise, if you can. Walking is an excellent form of exercise.
  • Drink 8 to 10 (8-ounce) glasses (2 liters) of liquids daily, if you can. Choose liquids such as water, juices (such as prune juice), soups, and ice cream shakes. Avoid liquids with caffeine (such as coffee and soda). Caffeine can pull fluid out of your body.
  • Slowly increase the fiber in your diet to 25 to 35 grams per day. Unpeeled fruits and vegetables, whole grains, and cereals contain fiber. If you have an ostomy or have had recent bowel surgery, check with your healthcare provider before making any changes in your diet.
  • Both over-the-counter and prescription medications are available to treat constipation. Check with your healthcare provider before taking any medications for constipation, especially if you have an ostomy or have had bowel surgery. Follow the instructions on the label or from your healthcare provider. Examples of over-the-counter medications for constipation include:
    • Docusate sodium (Colace®). This is a stool softener (medication that makes your bowel movements softer) that causes few side effects. You can use it to help prevent constipation. Don’t take it with mineral oil.
    • Polyethylene glycol (MiraLAX®). This is a laxative (medication that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid. Only take it if you’re already constipated.
    • Senna (Senokot®). This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime. Only take it if you’re already constipated.
    If any of these medications cause diarrhea (loose, watery bowel movements), stop taking them. You can start again if needed.

If you haven’t had a bowel movement in 2 days, call your healthcare provider.

The healing process and new sensations

As you’re healing from your surgery, you may feel many different sensations in your arm, chest, or chest wall. You may feel sensations such as tenderness, numbness, twinges, or all 3. You may also feel the sensation of liquid going down your arm, when there is no actual liquid. This can happen because your nerves were cut during surgery.

After your mastectomy, you may also feel like your breast or nipple is still present. This is called a phantom sensation.

These sensations usually come and go and often get better within the first few months after surgery. Some sensations may last months, or even 5 years or longer. This is because the nerves are the slowest part of your body to heal. Most people say that the sensations aren’t severe or distressing.

Because of the change in sensation, don’t place anything hot or cold directly on your surgical site (such as hot water bottles, heating pads, or ice packs).

As you continue to heal, you may feel scar tissue along your incision site(s). It will feel hard. This is common, and it will soften over the next few months.

Caring for your incision

Your incision(s) will be closed with sutures (stitches) under your skin. These sutures dissolve on their own, so they don’t need to be removed. If you have small pieces of surgical tape (Steri-Strips) over your incision(s), your surgeon or nurse will remove them at your follow-up appointment. If you have surgical glue (Dermabond) over your incision, it will dissolve on its own over time.

Follow your healthcare provider’s instructions on how often to clean your incisions.

A week or two after your surgery, a pocket of fluid may form under the skin of your armpit or chest area where tissue was removed. This is called a seroma, and it’s harmless. The area may feel soft and puffy. It may also feel tender.

Seromas often go away on their own. If you develop a seroma that’s large or feels uncomfortable, call your healthcare provider’s office to discuss with your doctor or nurse.

Call your healthcare provider if:

  • The skin around your incision is very red.
  • The skin around your incision is getting more red.
  • You see drainage that looks like pus (thick and milky).

Eating and drinking

You can eat all the foods you did before your surgery, unless your healthcare provider gives you other instructions. Eating a balanced diet with lots of calories and protein will help you heal after surgery. Try to eat a good protein source (such as meat, fish, or eggs) at each meal. You should also try to eat fruits, vegetables, and whole grains.

It’s also important to drink plenty of liquids. Choose liquids without alcohol or caffeine. Try to drink 8 to 10 (8-ounce) glasses of liquids every day.

If you have questions about your diet, ask to see a clinical dietitian nutritionist.

Showering

If you’ve had breast reconstruction, talk with your plastic surgeon about when you can shower and if there are any special instructions.

If you haven’t had reconstruction, you can shower 24 hours after your surgery. Before you go home, your nurse will teach you how to secure your drains while showering.

When you’re ready to shower, remove your surgical bra and any gauze pads that are covering the incision(s). If you have Steri-Strips on your incision, don’t remove them. Gently wash your incision(s) with soap and water, letting the shower water run over them. After showering, pat your incisions dry with a clean towel. Put your surgical bra back on and secure the drains to your bra. If it feels more comfortable, you can place a clean gauze pad over your incision under the bra.

Avoid baths, hot tubs, saunas, and swimming pools until your doctor or nurse tell you it’s okay. Also, talk with your doctor or nurse before you use deodorant, lotion, powder, or perfume anywhere near your surgery site.

Wearing a bra

If you got a surgical bra, keep wearing it until your drains have been removed. After that, talk with your healthcare provider about what to wear. Your surgical bra will provide support, help keep you comfortable, and hold your drains in place. You should wear your surgical bra while you sleep but take it off it before you shower.

While you’re healing from your surgery or going through the different stages of breast reconstruction, your bra can be padded to help balance your appearance. One way to fill the bra is to use a soft breast form (temporary breast prosthesis). This breast form is a lightweight nylon pouch. You can adjust the size of the pouch to match your opposite breast by adding or taking out the cotton fluff inside. You can wash the nylon pouch using a mild soap such as Woolite® or Ivory®, then let it air-dry.

You can get the breast form from the Breast Boutique at the Evelyn H. Lauder Breast Center. The Breast Boutique is located at 300 East 66th Street, at 2nd Avenue. To reach the boutique, call 646-888-5330.

You can also line your bra with soft gauze, which you can get from your nurse. Replace the gauze often to make sure it’s always clean.

Breast prosthesis

A breast prosthesis is a more permanent breast form than the soft nylon pouch. If you’re interested in wearing a breast prosthesis, talk with your healthcare provider. If you haven’t had breast reconstruction, you can usually start wearing the prosthesis about 4 to 6 weeks after your surgery.

Your doctor can give you a prescription for a breast prosthesis during your follow-up appointment. Check with your insurance company to find out what’s covered for your breast prosthesis.

There are many types of breast prostheses. Mastectomy boutiques and lingerie stores sell them, and the boutique at the Evelyn H. Lauder Breast Center also carries a full range. A fitter will help you find the best prosthesis for you. If you prefer to shop closer to home, contact the Reach to Recovery program at the American Cancer Society by calling 800-ACS-2345 (800-227-2345) to get a list of stores in your area.

Physical activity and exercise

If you’ve had reconstruction, don’t lift objects heavier than 5 pounds (2.3 kilograms) until your doctor says it’s safe. This is usually about 6 weeks for people who had surgery with tissue transfers and 4 to 6 weeks for people who had surgery with tissue expanders. Your doctor will tell you how long you should avoid heavy lifting.

Avoid strenuous activities (such as jogging and tennis) until your doctor tells you it’s safe. Your physical therapist will give you written instructions on what exercises and movements you can do while your incisions are healing. Talk with your doctor or nurse before starting any heavy exercises, such as running, jogging, or lifting weights.

The scar tissue that forms around your surgical site can limit the range of motion of your arm and shoulder. If you have had reconstruction, you may also have muscle pain or tightness.

Review the information in Exercises After Your Mastectomy for examples of exercises that will help you regain motion in your arm and shoulder. If you’re having discomfort, you may find it helpful to take some pain medication 30 minutes before starting the exercises.

Sexual activity

You can start sexual activity again when you feel ready. Having sexual intercourse won’t harm your surgical area.

It may be helpful to let your partner see your incision soon after surgery. This may ease any worries you both might have. Let your partner know what is and isn’t comfortable. Avoid putting pressure on the surgical site in the first weeks after surgery. Try placing a small pillow or towel over the surgical area. If you have any questions, talk with your nurse.

You may have concerns about the effects of cancer and your treatment on how you look or on your sexuality. Our Female Sexual Medicine and Women’s Health Program is available to help you. For more information or to make an appointment, call 646-888-5076.

If there’s any chance you can become pregnant, be sure to use birth control. Don’t use any form of hormonal birth control. Your birth control options are:

  • Male condoms
  • Diaphragm
  • Copper T IUD. If you’re interested in this method, talk with your gynecologist. This type of IUD can be kept in place for a long as 10 years or can be removed earlier.

Keep using birth control during your treatment and until your doctor tells you it’s safe to try to get pregnant.

Going back to work

Talk with your healthcare provider about your job and when it may be safe for you to start working again. If your job involves lots of movement or heavy lifting, you may need to stay out a little longer than if you sit at a desk.

Driving

Don’t drive while you’re taking prescription pain medication. These medications can make you drowsy, making it unsafe for you to drive. Also, don’t drive until:

  • Your drain(s) have been removed.
  • You have recovered your full range of motion.
  • You can comfortably turn the steering wheel.

If you have questions about when it’s safe for you to drive, talk with your healthcare provider.

About lymphedema

Sometimes, removing lymph nodes can make it hard for your lymphatic system to drain properly. If this happens, lymphatic fluid can build up in the area where your lymph nodes were removed. This extra fluid causes swelling called lymphedema.

Lymphedema can develop in the arm, hand, breast, or torso on your affected side (the side where your lymph nodes were removed).

Most people don’t develop lymphedema, but some do. It’s hard to know a person’s risk of developing lymphedema because:

  • There’s no standard test for diagnosing lymphedema.
  • Removing or injuring lymph nodes affects people differently.
  • Lymphedema can develop soon after surgery, or it can develop years later.
  • Current cases of lymphedema can be caused by older treatment methods.
Figure 3. Approximate risk of developing lymphedema

Figure 3. Approximate risk of developing lymphedema

Your risk of developing lymphedema depends on how your lymph nodes are removed (see Figure 3).

During a sentinel lymph node biopsy, between 1 and a few lymph nodes are removed from your armpit and checked for cancer cells. The risk of developing lymphedema after a sentinel lymph node biopsy is low. About 0 to 7 out of every 100 people who have a sentinel lymph node biopsy develop lymphedema.

During an axillary lymph node dissection, more than a few lymph nodes are removed from your armpit. This is done to remove additional lymph nodes that may have cancer cells. The risk of developing lymphedema after an axillary lymph node dissection is higher than it is after a sentinel node biopsy. About 15 to 25 out of every 100 people who have an axillary lymph node dissection may develop lymphedema.

There’s no way to know for sure who will develop lymphedema.

Lowering your risk of developing lymphedema

Doing the following things may help lower your risk of developing lymphedema.

  • Stay at or safely work towards a healthy body weight.
  • Exercise and stretch your muscles regularly. Talk with your surgeon or nurse about which exercises are right for you.
    • When you resume exercise and activity, make sure to build up slowly and gradually. If you feel discomfort, stop and take a break. Exercise shouldn’t cause pain.
  • Try to minimize your risk of infection to your hand and arm. Ask your healthcare provider how best to care for cuts, scratches, and burns.

If you had a sentinel lymph node biopsy:

  • It’s OK to use your affected arm for blood draws, injections (shots), IV lines, and blood pressure measurements. Ask your healthcare providers to try to use your unaffected arm if it’s available.
  • If you start to notice any signs of lymphedema, always use your unaffected arm. If this isn’t possible, talk with your healthcare provider about which arm is safest to use.

If you had an axillary lymph node dissection:

Signs of lymphedema

Some mild swelling after surgery is normal. The swelling may last for up to 6 weeks. It’s often temporary and will gradually go away. You may also feel pain or other sensations, such as twinges and tingling, after surgery. These feelings are common and aren’t necessarily signs of lymphedema.

If you’re at risk of developing lymphedema, watch for these signs in your affected arm, hand, breast, and torso:

  • A feeling of heaviness, aching, or pain
  • A tight feeling in your skin
  • Less flexibility
  • Skin changes, such as tightness or pitting (skin that stays indented after pressing on it)

If you have any signs of lymphedema or aren’t sure, contact your healthcare provider.

Addressing your emotional needs

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200.

The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness.

When to call your healthcare provider

Contact your healthcare provider if:

  • You have a fever of 100.5 °F (38 °C) or higher.
  • You have drainage from your incision(s).
  • You have trouble breathing.
  • The skin around your incision(s) is warmer than normal.
  • You have increased discomfort around your incision(s).
  • The skin around your incision(s) is redder than normal.
  • The area around your incision(s) is starting to swell.
  • Swelling around your incision(s) is getting worse.
  • You have any questions or concerns.

Contact information

Monday through Friday from 9:00 am to 5:00 pm, call your healthcare provider’s office.

After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask to speak to the person on call for your healthcare provider.

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Support Services

This section has a list of support services that may help you get ready for your surgery and recover safely.

As you read through this section, write down any questions you want to ask your healthcare provider.

MSK support services

For more online information, visit the Cancer Types section of www.mskcc.org.

Admitting Office
212-639-7606
Call if you have questions about your hospital admission, including requesting a private room.

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for information if you’re interested in donating blood or platelets.

Bobst International Center
888-675-7722
MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.

Counseling Center
646-888-0200
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Female Sexual Medicine and Women’s Health Program
646-888-5076
Cancer and cancer treatments can have an impact on your sexual health. Our Female Sexual Medicine and Women’s Health Program can help if you’re dealing with cancer-related sexual health challenges such as premature menopause or fertility issues. Call for more information or to make an appointment. We can help you take action and address sexual health issues before, during, or after your treatment.

Food Pantry Program
646-888-8055
The food pantry program provides food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.

Integrative Medicine Service
646-888-0800
Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

Male Sexual and Reproductive Medicine Program
646-888-6024
Cancer and cancer treatments can have an impact on your sexual health. Our Male Sexual and Reproductive Medicine Program can help if you’re dealing with cancer-related sexual health challenges such as erectile dysfunction (ED). Call for information or to make an appointment. We can help you take action and address sexual health issues before, during, or after your treatment.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or speak with the library reference staff to find more information about your specific cancer type. You can also visit LibGuides on MSK’s library website at libguides.mskcc.org

Patient and Caregiver Education
www.mskcc.org/pe
Visit the Patient and Caregiver Education website to search our virtual library. There you can find written educational resources, videos, and online programs.

Patient and Caregiver Peer Support Program
212-639-5007
You may find it comforting to speak with someone who has been through a treatment like yours. You can talk with a former MSK patient or caregiver through our Patient and Caregiver Peer Support Program. These conversations are confidential. They may take place in person or over the phone.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or if you have concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nursing Office
212-639-6892
You may request private nurses or companions. Call for more information.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.

Social Work
212-639-7020
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment and can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs, as well as financial resources if you’re eligible.

Spiritual Care
212-639-5982
Our chaplains (spiritual counselors) are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call for information.

Virtual Programs
www.mskcc.org/vp
MSK’s Virtual Programs offer online education and support for patients and caregivers, even when you can’t come to MSK in person. Through live, interactive sessions, you can learn about your diagnosis, what to expect during treatment, and how to prepare for the various stages of your cancer care. Sessions are confidential, free, and led by expert clinical staff. If you’re interested in joining a Virtual Program, visit our website at www.mskcc.org/vp for more information.

External support services

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
A resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for people who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free cancer legal advocacy program.

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medications.

NYRx
www.nyrxplan.com
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides assistance with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medications that they have trouble affording.

Breast cancer support services

SHARE
www.sharecancersupport.org
866-891-2392
Offers support groups for survivors of breast, metastatic breast, and ovarian cancer in Manhattan, Queens, Brooklyn, and Staten Island.

Susan G. Komen for the Cure
www.komen.org
Provides information and support services for those with breast cancer.

Triple Negative Breast Cancer Foundation
www.tnbcfoundation.org
Provides information to help people understand triple negative breast cancer.

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Educational Resources

This section has the educational resources mentioned in this guide. These resources will help you get ready for your surgery and recover safely after surgery.

As you read through these resources, write down any questions you want to ask your healthcare provider.

For more information about lymphedema, you can also read the New York State Department of Health’s resource Understanding Lymphedema.

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