2.4 Expectations of the Surgery

2.4.1 Before Surgery

Before your surgery, you will be able to ask any questions that you might have regarding your surgery – do not hesitate to ask any questions that you might have. Your healthcare team will also provide information about any specific things you need to do before your surgery.

You might feel many emotions before your surgery, such as nervousness, sadness, anger, frustration, and fear. All these emotions are normal; however, recognizing them is crucial for dealing with them.

2.4.2 Right After Surgery

After breast cancer surgery, you should be able to go home the same day (Boudarra et al., 2020). You should have someone to drive you and stay with you for the next 24 hours following the surgery.

Pain and general discomfort around your chest and shoulders are normal (Lymphedema Working Group, 2012). Other common symptoms are weakness, numbness, tingling, stiffness, and swelling; they may go away six months to 1-year post-surgery. You might also experience nausea from anesthesia, but you can receive medication for it.

For the first 24 hours post-surgery, do not do any of the following:

• operate machinery (e.g. driving your car),
• drink alcohol,
• make any important decisions,
• and take medications for sleep (Boudarra et al., 2020).

While at home, remember to move around, ensure your incision dressings stay dry, and take care of your emotional well-being (Lymphedema Working Group, 2012). Movement after your surgery can help encourage you to start your daily routines again, such as eating, dressing, and personal hygiene. However, ask for help from a family member or friend when needed.

2.4.3 Stages of Healing

Typically, there are three stages of healing:

• right after surgery until your drain removal (usually five to seven days),
• after your drain removal until six weeks post-surgery,
• and more than six weeks post-surgery (Lymphedema Working Group, 2012).

Exercises, treatments, and other activities vary depending on which stage you are in (Lymphedema Working Group, 2012).

2.4.4 Incision Dressings

A nurse will cover your incision site with a dressing to prevent infection and collect any fluid that may leak out (Boudarra et al., 2020). You may have the dressing for three days after surgery, but the length of time can vary depending on your surgeon’s recommendations.

One of the most important things to remember is to keep your dressing dry (Lymphedema Working Group, 2012). You will have your dressing changed either by a home health nurse or by going to a medical centre. Do not be afraid to ask questions regarding what to do if your dressing becomes soaked or if you need to change your dressing in an emergency. Your healthcare team might provide the appropriate materials to change your dressing at home.

After removing your dressing, your healthcare provider will provide instructions on how to clean the incision site (Boudarra et al., 2020). Common instructions are to clean the incision site with unscented soap, rinse well with water, and then pat (not rub) dry; do not scrub the site.

2.4.5 Incision Drain

Along with your dressing, you might also have a drain coming out of your incision site (Boudarra et al., 2020); this drain will remove excess fluid from the wound to promote faster healing. Typically, your drain will be in place for 1 to 2 weeks post-surgery.

Your drain consists of a small tube and a small container with a cap (Lymphedema Working Group, 2012). The tube is inserted into your incision site and attached to your skin via a stitch. Fluid from the site drains into the small container attached to you at your waist level. You can use a safety pin to fasten the container to your clothes to prevent it from moving around.

Before you go home after surgery, a nurse will show you how to empty the drain so you can do it at home (Boudarra et al., 2020). You will need to track how much drainage you collect in a 24-hour period. You might also have to change part of your dressing or unblock your drain.

Do not shower or bathe while the drain is in; use a damp cloth to keep your body clean (Boudarra et al., 2020).

If you experience significant pain or discomfort from your drain, redness or swelling far from the incision site, or a strong odour, immediately contact your doctor (Lymphedema Working Group, 2012).

If you would like a visual and audio description of what having a drain can look like, check out Video 9 (MyHealth.Alberta.ca, 2018).

How to Empty the Drain

If you have a Jackson-Pratt drain, here are the specific steps to empty it according to the McGill University Health Centre:

1. Wash your hands before handling the drain.
2. Open the cap, and the bulb will take back its shape. The bulb is like a measuring cup.
3. Empty the fluid into the given container by squeezing the bulb until it is empty. Measure the amount of fluid.
4. Write the amount in [your] fluid diary.
5. Empty the fluid in the container into the toilet.
6. Once empty, squeeze the bulb. Hold the squeeze while you close the cap.
7. Let go of the bulb. It should stay collapsed and slowly fill with fluid during the day. (Boudarra et al., 2020)

2.4.6 Drain Removal

Over time, your drainage colour and amount will change (Lymphedema Working Group, 2012). The colour will change from red to pink and, finally, to yellow. Meanwhile, the amount of drainage will decrease until you only have around 25 to 30 ml of fluid in a 24-hour period. Once you reach this amount, a nurse will remove your drain.

After your healthcare provider removes the drain, another dressing will cover it to help prevent debris from entering the wound and causing an infection (Lymphedema Working Group, 2012).

2.4.7 Questions to Ask After Surgery

1. How likely is it that my breast cancer returns?
2. Did you remove lymph nodes during my surgery? What does that mean for me now and in the future?
3. Did you find out if my cancer spread to the rest of my body? If not, are there tests to find out if it did?
4. Were you able to remove all the cancer?
5. What should I expect immediately after surgery?
6. Who do I call if I have any questions or concerns?
7. Will I have a nurse come to my home and teach me about emptying my drain and changing my dressings if needed?
8. How will the drain be removed? Who will remove my sutures or staples from my incision?
9. What should I do if I experience a lot of pain and run out of prescribed medication?
10. Are there any signs of concern that I should watch out for?
11. Are there any exercises that I should do after my surgery?
12. What should I not do after my surgery?
13. I have heard about breast prostheses before. How could I find out more information about this?
14. Do I have a follow-up appointment with my healthcare team soon? (Lymphedema Working Group, 2012)