Your hospital stay for breast cancer surgery

The length of time you stay in hospital will depend on the procedures you have and how well you recover.

The following suggestions have been made by people who have had breast surgery and may make your stay a little more comfortable.

Practical considerations

Some practical tips to help with your hospital stay include:

• Front-buttoning pyjamas or nightshirts are easier to undo and make it easier for your doctors and nurses to check your dressings, saving you the embarrassment of uncovering more than you need to!
• Ask your breast care nurse to order a free My Care Kit for you. This contains a Berlei bra specially designed to be suitable after breast cancer surgery.
• If you are still waiting for your Berlei bra to be delivered or it has not been ordered yet, a soft old bra without underwire, or a sports bra that you don’t have to pull over your head could be used. Front opening bras with wide straps also tend to be more comfortable. You may not want to wear a bra at all until drain tubes have been removed.
• You might prefer to wear comfortable day clothes in hospital rather than nightwear after the first day of surgery.
• Hospitals sometimes have the air-conditioning turned up higher or lower than you’d like. Having multiple layers that you can take on and off as needed can help.
• Consider taking your own pillow and/or a blanket or shawl.
  Earplugs might be handy, especially if you’re in a shared ward.
• You might want to take your smartphone, iPad or laptop so you can listen to music, audiobooks, or podcasts, or watch movies.
• Some people find they can’t concentrate well enough to read a book. Short stories or magazines can be much less demanding.
• Don’t take valuables or too much money to hospital – you don’t need the extra worry of trying to keep your purse or wallet secure.
• If you’re having a mastectomy, you can be fitted for a temporary breast prosthesis by the breast care nurse. This is a pocket filled with a soft fluffy material that fits inside your Berlei bra or inside a firm singlet top. This will give you some shape to help match your remaining breast. You can use this until you’re ready for a permanent prosthesis.

Post-surgical cushions

The women’s service organisation Zonta provides free cushions that are specially made to tuck under your arm. They help ease the pressure and discomfort of any drain tubes on your chest and axilla (underarm) or from your arm leaning against your chest/axilla. They can also be useful in protecting your chest from the pressure of a seat belt when you are in the car following surgery.

In some places, local organisations such as the Country Women’s Association (CWA) also make these cushions.

Your breast care nurse might provide a cushion for you or you can visit Zonta's website or phone BCNA on 1800 500 258.

Visitors

Visitors can be wonderful when you’re in hospital and when you go home but it’s a good idea to ask them when they plan to arrive (and leave). You may also need to explain that people tire easily when they’re recovering from surgery - even if they look fine.

You may need some quiet time as you come to terms with the physical and psychological impact of your diagnosis and surgery. Some people prefer to restrict their visitors to family and close friends during their hospital stay.

Remember that you need to look after yourself at this time. Don’t feel obliged to accept more visitors than you can handle out of politeness. It’s okay to ask friends to wait until you’re ready for visitors.

Returning home

How long you stay in hospital will depend on a number of factors, though it’s usually only a few days or less. Sometimes, breast cancer surgery is day surgery.

If you have had an axillary dissection or mastectomy, you may go home with drain tubes in place. These are put in during your surgery to drain blood or fluid that would otherwise build up under your wound. The drain tubes are connected to a small bottle which usually has a low vacuum to help draw the fluid out of your wound, or sometimes a bag. The amount of fluid gradually decreases over a few days and, when there’s little being collected, the tubes are removed.

You may be referred to your local district nursing service or ‘hospital in the home’ service who will visit you each day to check the drain tube and wound dressings. When the drainage amount over a 24 hour period is low enough, as per the instructions of your surgeon, your drain tubes will be removed.

Before you leave hospital, make sure you understand how to take care of yourself after your surgery and what to do if you have any concerns or problems and the details of whom you can contact.

Here are some things to consider when planning your return home.

Take the time to ease back into your home life.

If your drain tubes are still in place make sure you know how to manage them. This might include changing the bottle or bag, or measuring the drainage amount. It is important that you know who to contact if you need help, day or night, before you leave hospital.

If you live with your family, make sure they understand that you need to rest. You might want to have jobs planned for them to do.

Accept offers of help with driving. The usual recommendation is that you don’t drive for 2–3 weeks after mastectomy or axillary dissection surgery to the armpit. Talk to your surgeon to find out what the best advice is for you.

Be sure to ask your family and friends for the help you need.

You may find it hard to accept offers of help but remember that this is a way for others to show they care about you. It can also take the pressure off you and your family for a while.

You can suggest that friends or family download BCNA's Helping a friend or colleague with breast cancer booklet for some useful tips and advice.

Before you leave hospital, a physiotherapist or your breast care nurse will give you some arm and shoulder exercises to do, with instructions on how to do them and how often. It is important to do these exercises as instructed because they will help to restore normal movement in your arm. BCNA’s Strengthen Your Recovery Pilates exercise program, is a series of four videos that have been designed specifically to provide information and exercises for the 10 weeks following surgery.

For more information, read: Exercise after breast surgery.

Some things you may notice after leaving hospital

Swelling and odd sensations

After surgery it’s normal for there to be some numbness in the armpit, the upper arm and the breast or chest wall, and there’s often some swelling.

As the nerves begin to repair, it’s also normal to experience odd and uncomfortable sensations, often described as tingling or a feeling that the skin is sunburnt or grazed.

These sensations can occur in the breast or chest wall, armpit, upper arm and upper back.The swelling and odd sensations usually settle down during the weeks or months after surgery.

Discuss your symptoms with your surgeon or breast care nurse at each visit, especially if they don’t go away or get worse.

Wearing your Berlei bra or a soft bra with wide straps and no underwire can also help you to feel more comfortable.

Seromas

A collection of fluid ( seroma) is quite common after breast surgery. It can occur:

• in the armpit where the lymph nodes were removed
• under the mastectomy scar if the breast has been removed
• in the area where the breast tissue was after breast conserving surgery.

In most cases this fluid will be slowly absorbed by the body over time. However, if it’s very uncomfortable, your surgeon, a breast care nurse, another health professional in the clinic or your GP can drain the fluid using a fine needle and a syringe. This is not usually a painful procedure.

In rare situations a seroma can keep re-accumulating over many months and need to be drained several times.
One strategy to try and keep seroma fluid from re-accumulating is to apply pressure on your chest (such as by wearing your prosthesis in your bra) or if you don’t yet have a prosthesis, putting padding in your bra to keep light pressure on the area. Your breast care nurse or surgeon will be able to offer suggestions about ways to apply effective pressure.

Sometimes your treating team may even consider applying a pressure dressing and will explain to you how to manage it. Very rarely, if the seroma doesn’t resolve, you may have to have another operation where your surgeon will put in a new drain tube.

For more information, read the article on seromas.

Cording

Cording, sometimes called axillary web syndrome (AWS), is the name given to the development of tender vertical cords in the armpit (axilla).  

These cords can develop anywhere from a few days to a few weeks after lymph node surgery, although there have been individual cases where they appeared many months later. Scar tissue from surgery to the chest area can also contribute to cording.

If you develop cording, you might see and/or feel a web of rope-like structures under the skin, or feel a pulling sensation in your inner arm, down to the elbow or even to the wrist. For most people cording resolves within around six to eight weeks.

Continuing with a range of moving and stretching exercises is the best way to resolve cording and stop the pain that it can cause. A warm (not hot) pack on the area may help to reduce the discomfort along with the use of pain-relieving medications. Occasionally, ultrasound is used to help ‘stretch’ the cords and reduce the pulling sensation.

Your breast care nurse may be able to teach you some massage techniques to help relieve the cording or a referral to a physiotherapist is sometimes needed to manage it. Talk to a member of your treatment team if you have any pain or symptoms that are concerning you.

A GP Chronic Disease Management Plan will give you access to 5 Medicare-subsidised visits to an ancillary health professional such as a physiotherapist.

For more information, read the article on cording.