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Mastectomy - Breast Removal Information

After Surgery

After mastectomy, patients generally spend two to three days in the hospital, although some may stay up to eight days. Most modified radical mastectomy patients spend an average of three days at the hospital, and those who have breast reconstruction in addition to mastectomy may spend three to six days, depending on the body’s rate of healing.

Major soreness from mastectomy usually lasts two to three days, although many mastectomy patients do not experience soreness after surgery. A linear scar at the mastectomy site is probable. Many patients do experience a pulling sensation near or under their arm after mastectomy.

Patients should receive instructions before leaving the hospital concerning:

  • care of the wound and dressing
  • type of pain/sensations to expect
  • use of pain medications
  • how to monitor the drainage tube
  • how to recognize signs of infection
  • any restricted activities
  • emotional feelings to expect
  • proper diet
  • when to begin arm exercises to reduce stiffness
  • when to wear a bra
  • when to begin wearing a prosthesis (if chosen)

Source: American Cancer Society Online: Surgery: What to Expect

Physicians will normally schedule follow up exams seven to 14 days after mastectomy. At the follow up exam, the results of the pathology report are usually shared with patients. Radiation treatment may or may not be necessary after mastectomy. Patients with problems or concerns after surgery should contact their surgeon right away.

Click here for information on exercising after mastectomy.

Phantom Breast Pain

Studies have shown that many women experience phantom breast sensations after mastectomy. In a recent study conducted at Johns Hopkins Hospital, more than one third of 279 mastectomy patients experienced phantom breast pain after mastectomy. The incidence of phantom breast pain was similar, regardless of whether or not the women had breast reconstruction after breast cancer surgery. Symptoms of phantom breast pain may include:

  • Unpleasant itching
  • Pins and needles
  • Pressure
  • Throbbing

Physicians believe that phantom breast pain occurs after mastectomy for the same reasons as phantom pains occur after limb amputations. According to Srinivasa Raja, MD of Johns Hopkins, during mastectomy, small nerves are cut between the breast tissue and skin area. This causes the neural connections in the brain to undergo neural plasticity (reorganization). This process, as well as the spontaneous firing of electrical signals from the ends of cut or injured nerves, causes phantom sensations, said Dr. Raja. Women who experience breast pain prior to mastectomy are most likely to have sensations of pain in the breast area after surgery.

Physicians recommend that patients who experience phantom sensations in the breast area after surgery report their symptoms to their physicians immediately so that the pain can be properly managed. In some cases, exercise or breast massage may help alleviate phantom breast pain, although patients should first discuss these options with their physicians. In more severe cases, medications may be prescribed to reduce phantom breast pain. Phantom breast pain does not indicate that cancer cells are still present in the breast area or that cancer may return.

Exercising After Mastectomy and Lymph Node Removal

It is important that a patient ask her physician when it is safe to begin exercising and using the surgery-side arm again after a mastectomy. While there are no contraindications to performing any number of exercises after full recovery from mastectomy, there are certain precautions that should be taken by any person who has undergone a mastectomy, especially those who have had accompanying lymph node dissection.

Any minor injury to the skin on the side of the mastectomy may become infected more easily than an injury on the other arm. This is because the lymphatics have been disrupted and lymph nodes have been removed, leaving the arm more vulnerable to invading organisms such as bacteria. The lymphatics normally serve to drain fluids from the limb and the lymph nodes act, in some sense, as a filter, removing harmful substances from the lymph fluid.

Up to 20% of women who have undergone mastectomy and axillary lymph node dissection experience some edema (swelling) in the arm and report a higher incidence of irritation to minor skin trauma for this reason. Click here for more information on lymph nodes and breast health.

In addition, there may be a higher chance of axillary vein thrombosis (a clot in the deep vein in the armpit) in women who have undergone surgery in that area; especially if a more complete axillary dissection with the removal of 30 or more lymph nodes is performed. This is because the lymph nodes are normally located near blood vessels, and (unavoidable) scarring at or near the axillary vein may result from surgery. This scarring may tether, kink, or narrow the blood vessel and make it more susceptible to further injury.

While an increased incidence of deep vein thrombosis has not been reported in the medical literature after axillary surgery, it has been, in rare cases, associated with strenuous upper body exercise, since overdeveloped musculature may affect nearby nerves, veins, and arteries (thoracic outlet syndrome). Therefore, many physicians recommend tempering upper extremity exercise after surgery with periods of rest and keeping the arm elevated above the level of the heart for a few hours, to avoid undue swelling. Mastectomy patients should be careful not to exercise too intensely in order to avoid preventable injury.

On a positive note, regular use of the muscles after mastectomy will keep joints limber, stretch and soften scar tissue, help recruit (open up) new lymphatics, and promote blood flow and actually help reduce clot formation. These benefits generally outweigh the risks of a careful exercise program after mastectomy.

Recurrence of Breast Cancer

Occasionally breast cancer can return (recur) after mastectomy or other treatment. There are three types of breast cancer recurrence: local, regional, and distant. With local recurrence, cancerous tumor cells remain in the original site, and over time, they grow back. A regional recurrence of breast cancer is more serious than local recurrence because it usually indicates that the cancer has spread past the breast and the axillary (underarm) lymph nodes. A distant breast cancer recurrence, also known as a metastasis (spread), is the most dangerous type of recurrence. With this type of recurrence, breast cancer spreads to distant regions of the body, such as the bone, lung, liver, or brain.

Treatment will depend on the type and severity of the breast cancer recurrence. Breast cancer recurrences may be treated with additional surgery, chemotherapy, radiation, or other drug therapies (such as tamoxifen).

Additional Resources and References