After the Knife

Surgery is mostly about what comes after. However, there are a few tips to share about preparing for surgery: 1) If the surgeon will

be taking lymph nodes, request a single incision for both breast surgery and accessing the lymph nodes; 2) request a nerve blocking procedure prior to surgery as it permits lower levels of anesthetic and lower dose pain (morphine) pills; 3) If you're not planning on reconstruction, direct your surgeon not to leave a flap of skin/tissue that is generally left for reconstruction purposes; 4) Obtain foam wedges for your bed. Having an elevated position will help you sleep better; and 5) Plan on not driving for a week or so after surgery.

Recovery

Pain

Without a doubt, you will have discomfort after surgery. I had no real pain. The idea is to “keep ahead of the pain” by taking prescribed pain medications even if you don’t feel pain(for me it was 1mg morphine pills). Wean yourself off them over the first 7-10 days.

Constipation

Another ‘inevitable’. RestoraLAX is gentle and effective that takes a day or so to kick in. Take from the first day you’re home. Don't wait until...

Dressings and Drainage

You may come home with a bandage covering your incision and at least one drain. The dressings need to be checked and changed every couple of days. Because I live in Quebec, this was done by the nurses at the closest CLSC (local community health centre). The hospital nurses will issue the requisition for this service for you. You need to call the CLSC Appointment Centre to set up your appointments. Get someone to drive you for the first week at least.

You look after your own drains, clearing them of accumulated fluid. Keep a log of the fluid that drains in each 12 or 24 hour period. When drainage drops to an amount designated by your surgeon, the drains can be removed (also at the CLSC). My surgeon would have been happy with 30ml/24h but I was more comfortable with 15ml/24h.

Both the incision and drainage area will be uncovered in due course to assist with healing.

Rehabilitation: Exercise and Stretch

This is the heart of the surgery experience - how to get back to normal. And it takes a fair amount of effort. Basic principle: Get moving but don't rush it.

It’s important to get moving again – right after surgery - to avoid stiffening up. You’ll likely leave hospital with a stretching and exercise protocol from the physiotherapy department. If not, you can find them online (eg. Canadian Cancer Society). The surgery involves your pectoral muscles and, in my case, my axilla area under my left arm. I found it impossible to raise my arm over my head (or put my forearm over the side of my head) for a while. And the advice is NOT to try to do so for a while! Same with weight – don’t carry anything more than 10lbs during the healing process. You really don’t want to tear the incision inside or out.

I was given an exercise protocol with (gentle) activity to start the day after surgery. Follow it. In the first four weeks, the key priority is to get moving. The next few weeks are about rebuilding your strength. Likely you will be called to an appointment with a hospital-based physiotherapist. This person was an excellent resource for me.

The Scar

Massage the scar when it’s sealed. It’s important to break up any adhesions so you’ll have full range of pain-free motion. Using pure vitamin oil on your scar will lessen the visual appearance of the scar. Any drug store should have it. An alternative is aloe vera gel (from the plant).I also found Glaxol Base to be very effective (I applied it during radiation and noticed that it also helped with my scar).

Lymphatic System

I developed lymphatic cording (axillar web syndrome or AWS) after surgery. It is quite common and it can be treated. It is like a webbing ‘catching’ in your underarm area. Or, think guitar strings. The hospital physiotherapist cleared this up in 2-3 sessions. Doing so made a huge difference in my range of motion.

If you have had tissue taken from your under arm area (axillar), your body will need to rebuild its lymph drainage. You can help: learn self-massage (see link at: http://www.lymphnotes.com/article.php/id/313/ and online YouTube videos. Have a friend (or physio with training in lymphatic management) measure key points on your arm to provide a baseline to tell if your arm is swelling so you can be proactive to avoid lymphedema.

The key point with the lymph area is prevention. You will most likely be given a brochure on lymphedema. Follow the advice. As with everything else in your treatment, be proactive if your arm seems to be changing. Mine is good so far. There are also qualified RMTs who specialize in lymphatic drainage/support. I plan to see one after radiation.

Note: My Surgery

I chose to have a mastectomy rather than a lumpectomy. Both were offered. My tumour had responded to the chemotherapy and had shrunk by half. But, I felt that I was ‘done’ with that breast – even if not a medical fact. Given the biopsy-proven involvement of one lymph node and a suspicious second node on ultrasound, I was not offered a sentinel node biopsy. Instead my surgeon followed the current standard of care in my situation and proceeded with an axillary lymph node dissection (ALND). She took nine nodes.