About Your Breast Surgery

About Your Surgery

Total mastectomy is removal of all the breast tissue. The surgery is usually done through an incision (surgical cut) across the chest; however it can be done using different techniques. Your breast surgeon will talk with you about which option is right for you.

The lymph nodes in your armpit may be examined during your surgery to determine if the cancer has spread. In most cases, lymph nodes are examined by performing a sentinel lymph node biopsy.

Sentinel lymph node biopsy is removal of the first node(s) in your armpit that receives drainage from the breast tumor. This node(s) is identified by injecting a special dye into the breast. More information about this procedure is included later in this guide.

After the sentinel lymph node(s) is removed, it may be examined by the pathologist during your surgery. If any cancer cells are found in the sentinel node(s), an axillary lymph node dissection may then be performed.

Axillary lymph node dissection is the removal of most or all of the nodes found in the armpit. The number of nodes varies from person to person.

This guide will help you prepare for your surgery, learn what to expect on the day of your surgery, and help guide you through your recovery. We recommend that you bring this guide with you to all of your appointments, including your surgery.

This guide contains information about several types of breast surgeries. The surgery you are having is called a:

  • Total mastectomy
  • Total mastectomy and sentinel lymph node biopsy
  • Total mastectomy and sentinel lymph node biopsy; possible axillary lymph node dissection
  • Total mastectomy and axillary node dissection (also called a modified radical mastectomy)
  • Other ____________________

If you’re having breast reconstruction, you will receive additional information from your plastic surgeon.

 

 

 

 

 

 

 

 

Normal lymph drainageNormal lymph drainage

Understanding how your lymphatic system works can be helpful as you prepare for and recover from breast surgery. Your lymphatic system is made up of:

  • Lymph nodes are small, bean-shaped structures located along your lymphatic vessels. Your lymph nodes filter out bacteria, viruses, cancer cells, and other waste products.
  • Lymphatic vessels are tiny tubes, similar to blood vessels, which carry fluid to and from your lymph nodes.
  • Lymphatic fluid is the clear fluid that travels though your lymphatic system. It carries cells that help fight infections and other diseases.
Notes





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Before Your Surgery

The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

Preparing for Your Surgery

You and your healthcare team will work together to prepare 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. Some examples are heparin, warfarin (Coumadin®), clopidogrel (Plavix®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
  • I take prescription medications.
  • I take any over-the-counter medications, 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 have had a problem with anesthesia in the past.
  • I have allergies, including latex.
  • I am not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke.
  • I use recreational drugs.

Preventing Pregnancy

If there is any chance that you could become pregnant before your surgery, be sure to use a form of birth control that does not have hormones. For example you may use a male condom, a diaphragm, or a Copper T IUD. If you have any questions about birth control, or for help deciding the type of birth control that’s right for you, talk with your healthcare provider.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.

  • Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are risk for these complications, we can prescribe medication to help prevent them.
  • If you use alcohol regularly, you may be at risk for other complications during and after surgery. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.

Here are things you can do to prevent problems before your surgery: 

  • Be honest with your healthcare provider about how much alcohol you drink.
  • Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you cannot stop drinking.
  • Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.

About Smoking

People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you want to quit, call our Tobacco Treatment Program at 212-610-0507. You can also ask your nurse about the program.

About Sleep Apnea

Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems when you have surgery. Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (CPAP) for sleep apnea, bring it with you the day of your surgery.

Within 30 Days of Your Surgery

Presurgical Testing

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

You can eat and take your usual medications the day of your PST appointment. During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will be giving you medication to put you to sleep during your surgery). He or she will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care.

Your nurse practitioner may also recommend you see other healthcare providers. Your nurse practitioner will talk with you about which medications you should take the morning of your surgery. To help you remember, we’ve left space for you to write these medications in this guide. It is very helpful if you bring the following with you to your PST appointment:

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

Complete a Health Care Proxy

If you haven’t already completed a Health Care Proxy Form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. The person you identify is called your health care agent. If you are interested in completing a Health Care Proxy Form or to learn more, talk with your nurse. If you have already completed one or if you have any other advance directive, bring it with you to your next appointment.

10 Days Before Your Surgery

Purchase Hibiclens® Skin Cleanser

Hibiclens® is a skin cleanser that kills germs for 6 hours after using it. Showering with Hibiclens® the day before and the morning of your surgery will help reduce your risk of infection after surgery. You can pick up Hibiclens® before leaving the Evelyn H. Lauder Breast Center, or from your local pharmacy without a prescription.

Make Travel Arrangements

If you will be going home the day after your surgery, someone who is 18 years or older must come to the hospital to take you home. Please make arrangements for someone to pick you up by noon. If you don’t have someone who can do this, one of the agencies listed below can help you find someone to take you home.

  • Partners in Care: 888-735-8913
  • Caring People: 877-227-4649

Stop Taking Certain Medications

If you take vitamin E, stop taking it 10 days before your surgery. If you take aspirin, ask your surgeon whether you should continue. Medications such as aspirin, medications that contain aspirin, and vitamin E can cause bleeding. More information is located in the “Medications” section of this guide.

7 Days Before Your Surgery

Stop Taking Certain Medications

Stop taking herbal remedies 7 days before your surgery. More information is located in the “Medications” section of this guide.

2 Days Before Your Surgery

Stop Taking Certain Medications Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g., Advil®, Motrin®), and naproxen (e.g., Aleve®). These medications can cause bleeding. More information is located in the “Medications” section of this guide.

1 Day Before Your Surgery

Note the Time of Your Surgery

A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on Monday you will be called on Friday. The Admitting clerk will tell you where to go on the day of your surgery. This will be either the Surgical Day Hospital (SDH) or the Presurgical Center (PSC). If you do not receive a call by 7:00 pm, please call 212-639-5014.

Use this area to write in information when the clerk calls:

Date______________ Time______________

Both locations are at 1275 York Avenue between East 67th and East 68th streets.

  • Surgical Day Hospital (SDH), M elevator to 2nd Floor
  • Presurgical Center (PSC), B elevator to 6th Floor

Lymphatic Mapping with Sentinel Lymph Node Biopsy

If you are having a sentinel lymph node biopsy, you may have lymphatic mapping as part of your surgery. The mapping will be performed the day before or the morning of your surgery.

Use this area to write in the time and location of your lymphatic mapping, if you wish:

Date ______________ Time ______________

  • The Evelyn H. Lauder Breast Center, 300 East 66th Street (at Second Avenue); elevator to 6th floor
  • Nuclear Medicine Department, 1250 First Avenue (Between East 67th and East 68th Street); elevator to 2nd floor
Lymphatic Mapping

During your lymphatic mapping, you will lie on an exam table while you receive an injection of a small amount of a radioactive liquid near the site of the cancer. During the injection, you may feel a stinging or burning sensation. The radioactive liquid will travel to the sentinel node(s) so they can be seen later during your scan. While you wait for your scan, you can either stay in the hospital or leave for a while. However, you must return on time for your scan, so be sure to note the time you’re told to return.

When it’s time for your scan, your technologist will take you to the scanning room. You will lie on a narrow table while he or she takes a series of pictures. Each picture takes 5 minutes, 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 and which lymph nodes absorb the radioactive dye. This information will be used by your surgeon as a guide (or map) to determine the location of the sentinel node(s).

If you are having surgery the same day as your mapping, you will be escorted from the scanning room to the operating room. In most other cases, you will go home after the mapping.

Sentinel Node Biopsy

Your sentinel lymph node biopsy will take place during surgery. After you are asleep from the anesthesia, your surgeon will inject a small amount of blue dye underneath your nipple or near the site of the cancer. This dye will travel in your lymphatic fluid to the sentinel node(s), staining them blue. If you had lymphatic mapping, your surgeon will also use a small device that measures radioactivity from the liquid that was injected. Once the sentinel node(s) are located, your surgeon will make a small incision. The sentinel nodes will be blue from the blue dye, allowing your surgeon to see them. He or she will remove the sentinel node(s) and they will be examined by the Pathology department to see if they contain cancer cells. If they do contain cancer cells, you may need to have additional lymph nodes removed. This is called an axillary lymph node dissection.

Because blue dye was used during your procedure, your skin, urine, and stool may be a bluish-green color for 24 to 48 hours.

Shower with Hibiclens®

The night before your surgery, shower using the Hibiclens® solution. To use Hibiclens®, open the bottle and pour some solution into your hand or a washcloth. Rub gently over your body from your neck to your waist and rinse. Do not let the solution get into your eyes, ears, mouth, or genital area. Dry with a clean towel after your shower.

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

Morning of Your Surgery

Shower with Hibiclens®

Shower using Hibiclens® just before you leave for the hospital. Use the Hibiclens® the same way you did the night before. Do not put on any lotion, cream, powder, deodorant, makeup, or perfume after your shower.

Take Your Medications as Instructed

If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a small sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.

Things to Remember

  • Do not put on any lotion, cream, powder, deodorant, makeup, or perfume.
  • Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
  • Leave valuables, such as credit cards, jewelry, and your checkbook, at home.
  • Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
  • If you wear contact lenses, wear your glasses instead.
  • ___________________________________________
  • ___________________________________________
  • ___________________________________________

What to Bring

  • A button-down or loose fitting top.
  • Only the money you may need for a newspaper, bus, taxi, or parking.
  • A CD player and CDs or iPod, if you choose. However, someone will need to hold it for you when you go into surgery.
  • Your breathing machine for sleep apnea (such as your CPAP), if you have one.
  • If you have a case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary, bring it with you.
  • Your Health Care Proxy Form, if you have completed one.
  • This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
  • ___________________________________________
  • ___________________________________________
  • ___________________________________________

Parking When You Arrive

Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a tunnel that goes from the garage into the hospital. There are also garages nearby: four on East 69th Street between First and Second Avenues, one on East 67thStreet between York and First Avenues, and three on East 65th Street between First and Second Avenues. For questions about prices, call 212-639-2338.

Once You’re in the Hospital

You will be asked to state and spell your name and birth date many times. This is for your safety. Patients with the same or similar names may be having surgery on the same day.

Get Dressed for Surgery

You will be given a hospital gown, robe, and nonskid socks. Do not bring anything extra with you. Storage space is very limited.

Meet With Your Nurse

Your nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them. Your nurse will insert an intravenous (IV) line into a vein in your arm.

Meet With Your Anesthesiologist

He or she will:

  • Review your medical history with you.
  • Talk to you about your comfort and safety during your surgery.
  • Talk to you about the kind of anesthesia you will receive.
  • Answer any questions you may have about your anesthesia.
Marking Your Surgical Site

In addition to being asked your name and birth date, you may also be asked the name of your surgeon, what operation you are 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; it ensures that all members of the surgical staff are clear about the plan for your surgery.

Information for Family and Friends for the Day of Breast Surgery

Before the Surgery

Upon arrival to the hospital, the patient will be asked to provide contact information for the person who will be speaking to the surgeon after the surgery. If the patient is having an outpatient procedure, he or she will also be asked to provide contact information for the person who will be taking the patient home.

Once the patient is checked in, he or she will go to the Presurgical Center (PSC) to be examined before surgery. One person may come along, but others should wait in the waiting area. If the patient wishes, other people may join him or her when the nurse has finished the examination.

When the operating room (OR) is ready, the surgical team will take the patient there. They will prepare the patient for surgery, which usually takes 15 to 30 minutes, then the surgery will begin.

Please remember the following:

  • Do not bring food or drinks to the waiting area or the PSC. Patients are not allowed to eat or drink before their surgery or procedure.
  • If the patient brought any valuables, such as a cell phone, iPod, iPad, etc., please keep it safe for them.
  • Children under the age of 11 are not allowed to go into the PSC. They must wait in the waiting area with a responsible adult.

During the Surgery

After the patient is taken to the OR, all visitors should go to the PSC waiting area.

  • Food and drinks are available on the 1st floor in the cafeteria and in the gift shop. You can also bring your own food and eat it in the cafeteria.
  • The coat-check room is at the bottom of the escalator on the ground level. It is open Monday through Friday from 11:00 am to 4:00 pm.
  • Wireless Internet access is available in most areas of the hospital. You may also use the computers in the rooms off the main lobby.
  • Please use the designated cell phone area to accept and make calls. It may be useful to bring your phone charger to the hospital. Please be courteous and mindful of others while using your cell phone.
  • The Mary French Rockefeller Chapel, an interfaith chapel near the main lobby on the 1st floor, is open at all times for meditation and prayer.
  • The Patient Recreation Pavilion is open daily from 9:00 am to 8:00 pm for patients and their visitors over the age of 11. Arts and crafts, a library, an outdoor terrace, and scheduled entertainment events are available in this area. To get there, take the M elevators to the 15th floor.
  • If you leave the PSC area, be sure we have your cell phone number so we can reach you with updates. The Unit Assistant at the concierge desk will:
    • Give you information about the patient
    • Prepare you for your meeting with the surgeon
    • Prepare you for visiting the patient in the Post-Anesthesia Care Unit (PACU)

After the Surgery

When the patient’s surgery is done, we will call you to come back to the concierge desk. The concierge staff will bring you to a private consultation room to speak with the surgeon.

After you have met with the surgeon, you should return to the waiting area.

After surgery, the patient will be taken to the PACU. It can take up to 90 minutes before the patient is ready to have visitors. You can use this time to take a walk or just relax in the waiting area until the patient is ready to see you.

Once the patient is ready for visitors, a staff member will take you to the PACU, where the nurse will update you on the patient’s condition. Please remember that a limited number of visitors can go into the PACU. This is to keep the area quiet and avoid crowding.

While Visiting in the PACU
  • Silence your cell phone.
  • Apply hand sanitizer before entering the room.
  • Keep noise to a minimum. All patients in the room need to rest.
  • Do not wander away from the patient’s bedside. It’s important to respect each patient’s right to privacy.
  • Do not bring food or flowers into the PACU.
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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 will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

What to Expect

After your surgery, you will be taken to the Post Anesthesia Recovery Unit (PACU). You will be monitored there until you have recovered enough to be discharged to a room on one of the hospital floors. You should plan to be discharged from the hospital before noon the next day. You will receive a kit with supplies and an extra surgical bra to take home.

Below are 2 examples of ways you can help yourself recover safely.

  • It is important to walk around after surgery. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs.
  • Use your incentive spirometer. Your nurse will show you how. This will help your lungs expand, which prevents pneumonia.
Will I have pain?

Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain is not relieved, tell your doctor or nurse. You will be given a prescription for pain medication before you leave the hospital. Pain medication may cause constipation (having fewer bowel movements than what is normal for you). 

How can I prevent constipation?
  • Go to the bathroom at the same time everyday. Your body will get used to going at that time.
  • If you feel the urge to go, do not put it off. Try to use the bathroom 5 to 15 minutes after meals.
  • After breakfast is a good time to move your bowels because the reflexes in your colon are strongest then.
  • Exercise if you can; walking is an excellent form of exercise.
  • Drink eight, 8-ounce glasses (2 liters) of liquids daily, if you can. Drink water, juices, soups, ice cream shakes, and other drinks that do not have caffeine. Beverages with caffeine, such as coffee and soda, pull fluid out of the body.
  • Slowly increase the fiber in your diet to 25 to 35 grams per day. Fruits, vegetables, whole grains, and cereals contain fiber. If you have an ostomy or have had recent bowel surgery, check with your doctor or nurse before making any changes in your diet.
  • Both over-the-counter and prescription medications are available to treat constipation. Start with 1 of the following over-the-counter medications first:
    • Docusate sodium (Colace®) 100 mg. Take _____ capsules _____ times a day. This is a stool softener that causes few side effects. Do not take it with mineral oil.
    • Polyethylene glycol (MiraLAX®) 17 grams daily.
    • Senna (Senokot®) 2 tablets at bedtime. This is a stimulant laxative, which can cause cramping.
  • If you haven’t had a bowel movement in 2 days, call your doctor or nurse.
Is it normal to feel new sensations?

As you are healing from your surgery, you may feel a variety of different sensations in your arm, breast, or chest wall. Tenderness, numbness, and twinges are common examples. 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 decrease within the first few months after surgery. However, some may last months, even 5 years or longer. This is because the nerves are the slowest part of your body to heal. Most people report that the sensations are not severe or distressing.

Because of the change in sensation, do not place anything hot or cold directly on your surgical site (e.g., 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 will soften over the next several months.

Will I have any drains when I go home?

You will leave the hospital with at least one Jackson Pratt® drain in place. This is a soft catheter that is inserted near your incision to drain extra fluid. The drain is usually removed about 1 to 2 weeks after your surgery, however it may be left in longer depending on how much fluid is draining. Your nurse will teach you how to care for the drain before you leave the hospital. Instructions on how to care for your Jackson Pratt® drain are included in the “Resources” section of this guide.

How do I care for my incisions?

Your incision(s) will be closed with stitches under your skin. These stitches dissolve on their own, so they do not 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 when they see you at your follow-up appointment. If you have surgical glue (Dermabond®) over your incision, it will dissolve on it’s own over time.

When can I shower?

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

If you have not had reconstruction, you can shower 24 hours after your surgery. Before you’re discharged from the hospital, your nurse will teach you how to secure your drains while showering.

When you are ready to shower, remove your surgical bra and any gauze pads that are covering the incision. If you have steri-strips on your incision, do not remove them. Gently wash your incision(s) with soap and water, letting the shower water run over them. 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.

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

Can I wear a bra?

If you were given a surgical bra, continue wearing it until your drains have been removed, then talk with your doctor or nurse about what to wear. Your bra will provide support, help keep you comfortable, and hold your drains in place. You should wear your bra while you sleep, but remove it before you shower.

While you are 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 your bra is to temporarily use a soft breast form. You can get one at the boutique on the 2nd floor of the Evelyn H. Lauder Breast Center. This form is a lightweight nylon pouch, and its size can be adjusted to match your opposite breast by adding or removing 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 line the bra with soft gauze, but if you do you should replace the gauze frequently to make sure it’s always clean.

Can I wear a prosthesis (breast form)?

If you are interested in wearing a breast prosthesis, talk with your surgeon or nurse. If you have not had 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 regarding their policy for reimbursement for your breast prosthesis.

There are many types of breast prostheses. Mastectomy boutiques and lingerie stores sell them, and the boutique at the Evelyn 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 1-800-ACS-2345 to get a list of stores in your area.

When can I resume my normal activities?

You can resume most activities right after your surgery, but below are some exceptions:

  • Do not drive while you are taking prescription pain medication. These medications can make you drowsy and unsafe for you to drive. Also, do not drive until:
    • Your drain(s) have been removed;
    • You have recovered your full range of motion; and
    • You can comfortably turn the steering wheel.
  • If you have had reconstruction, do not lift objects heavier than 5 pounds until your surgeon says it’s safe. This is usually about 6 weeks after your surgery.
  • If you have not had reconstruction, follow the instructions given to you by your surgeon, nurse, or physical therapist.
  • Avoid strenuous activity until your surgeon 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 him or her before starting heavy exercises, such as running, jogging, or lifting weights.
  • Talk with your surgeon or nurse about when you will be able to return to work.
Should I perform any exercises after surgery?

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 experience muscle pain or tightness. Please review the information in Exercises After Breast Surgery in the “Resources” section of this guide for examples of exercises that will help you regain motion in your arm and shoulder. If you are having discomfort, you may find it helpful to take some pain medication about a half hour before starting the exercises.

Are there services to help me adjust emotionally?

The diagnosis and treatment of cancer can be a very stressful and overwhelming event. You may feel depressed, anxious, confused, afraid, or angry. You may have strong feelings about any permanent changes. These changes can have an impact on your emotional well-being. Help is available for you at any time. If you would like counseling, your nurse can give you a referral to see a social worker, psychiatrist, or counselor.

When can I resume sexual activity?

You can resume sexual activity when you feel ready. Having sexual relations will not harm your surgical area.

It may be helpful to let your partner see your incision soon after surgery. This may decrease any anxiety you both may feel. Your partner might worry that touching the incision(s) will hurt you. Let your partner know what is and is not 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 to 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 is any chance you can become pregnant, be sure to use contraception (birth control). However, you cannot use any form of hormonal birth control. Your options are to use a male condom or diaphragm each time you have sex or to have your gynecologist place a Copper T IUD in your uterus. This type of IUD can be kept in place for a long as 10 years, or can be removed earlier. Continue to use birth control throughout your treatment and until your doctor tells you it is safe to attempt pregnancy. Additional information can be found in the resource Sexual Activity During Cancer Treatment: Information for Women.

Am I at risk for lymphedema?

If you have had axillary lymph nodes removed, the way fluid circulates in your arm may have changed. This means you are at risk for lymphedema. Lymphedema is an abnormal swelling that can occur in the arm, hand, breast, or torso on the side where your lymph nodes were removed.

Most women will not develop lymphedema, but some will. It’s difficult to determine the risk of developing lymphedema because:

  • There is no standard test for diagnosing lymphedema.
  • Disruption of lymph nodes affects people differently.
  • Lymphedema can develop soon after surgery, or years later.
  • Current cases of lymphedema can be caused by older treatment methods.

Studies show the risk of developing lymphedema varies based on how the lymph nodes are removed. There are 2 types of surgeries used to remove lymph nodes:

  • During a sentinel lymph node biopsy, between one and a few lymph nodes are removed to check for cancer. With a sentinel lymph node biopsy, studies show the risk of developing lymphedema is very low.
  • During an axillary lymph node dissection, a wider incision is made and more lymph nodes are removed from the armpit. This is done to remove additional lymph nodes that may have cancer. With axillary lymph node dissection, studies show the risk of developing lymphedema is higher than sentinel node biopsy.
How can I reduce my risk of developing lymphedema?

There is no way to know who will develop lymphedema, but there are things you can do to reduce your risk:

  • Try to maintain your normal weight, or safely work towards a more ideal body weight.
  • Exercise and stretch your muscles on a regular basis. When you resume exercise and activity, make sure to build up slowly and gradually. If you feel discomfort, stop and take a break. Talk with your surgeon, nurse, or physical therapist about which exercises are right for you.
  • Try to minimize your risk of infection to your hand and arm. Ask your doctor or nurse how best to care for cuts, scratches, and burns.

If you have had an axillary dissection, you will receive additional information in the resource called Hand and Arm Guidelines After Your Axillary Lymph Node Dissection.

What are the signs of lymphedema?

Some mild swelling after surgery is normal and will go away with time. You may also feel pain or other sensations, such as twinges and tingling, after surgery. These feelings are common and are not necessarily signs of lymphedema.

If you’re at risk of developing lymphedema, it’s a good idea to watch for signs of it developing. For example:

  • A feeling of heaviness or aching in your breast, arm, hand, or fingers.
  • The skin of your arm, hand, or breast feels tight.
  • Decreased flexibility in your arm, hand, or fingers.
  • Swelling or changes in your skin, such as tightness or pitting (skin that stays indented after being pressed).

If you have any signs of lymphedema, or you’re not sure, it’s important you talk with your doctor or nurse so that a correct diagnosis can be made.

What if I have other questions?

If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm. Call their offices directly at the numbers listed below.

Doctor: _______________________________________________

Telephone: ____________________________________________

Nurse: ________________________________________________

Telephone: _____________________________________________

After 5:00 pm, during the weekend, and on holidays, please call (212) 639-2000 and ask for the doctor on call.

Call your doctor immediately if you have:

  • A temperature of 101° F (38.3° C) or higher
  • Drainage from the incision line
  • Shortness of breath
  • Warmer than normal skin around your incision
  • Increased discomfort in the area
  • Increased redness around your incision
  • New or increased swelling around your incision

 

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Resources

This section contains a list of MSK support services, as well as the resources that were referred to throughout this guide. These resources will help you prepare for your surgery and recover safely. Write down any questions you have and be sure to ask your doctor or nurse.​

MSK Resources

Admitting Office

212-639-5014

Call to discuss private room or luxury suite options. If you want to change your room choice after your presurgical testing visit, call 212-639-7873 or 212-639-7874.

Anesthesia

212-639-6840

Call with any questions about anesthesia.

Blood Donor Room

212-639-7643

Call for more information if you are interested in donating blood or platelets.

Bobst International Center

888-675-7722

MSKCC welcomes patients from around the world. If you are an international patient, call for help arranging your care.

Chaplaincy Service

212-639-5982

At MSK, our chaplains 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. The interfaith chapel is located near the main lobby of Memorial Hospital, and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.

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.

Evelyn H. Lauder Breast Center Boutique

646-888-5330

Our boutique is located on the 2nd floor of the Evelyn H. Lauder Breast Center and is open Monday through Friday from 9:00 am to 5:00 pm. The boutique offers a large selection of head wear and head coverings, prosthetics and bathing suits.

Integrative Medicine Service

800-525-2225

Integrative Medicine Service offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

Look Good Feel Better Program

212-639-5665

Learn beauty techniques to help you feel better about your appearance. This program is for both women and men. There are many tips on the program website, www.lookgoodfeelbetter.org. To register for a workshop at MSK, call 212-639-LOOK. To find out if a group program is available in your area, check www.lookgoodfeelbetter.org, or call 800-395-LOOK.

Patient Billing

646-227-3378

Call Patient Billing with any questions regarding preauthorization with our insurance company. This is also called preapproval.

Patient Representative Office

212-639-7202

Call if you have any questions about the Health Care Proxy Form or if you have any concerns about your care.

Perioperative Clinical Nurse Specialist

212-639-5935

Call if you have any questions about MSK releasing any information while you are having surgery.

Private Duty Nursing Office

212-639-6892

Patients 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

646-639-7020

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 referring you to community agencies and programs, as well as financial resources if you’re eligible.

You may also find it comforting to speak with a cancer survivor who has been through a similar treatment. Our social workers can help arrange this if you are interested.

Tobacco Treatment Program

212-610-0507

If you want to quit smoking, MSK has specialists who can help. Call for more information.

External Resources

Access-A-Ride

http://www.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 are unable to 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

800-227-2345

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 comprehensive resource for education, tools, and events for employees with cancer.

CancerCare

www.cancercare.com

800-813-4673

275 Seventh Avenue (Between 25th & 26th Streets)

New York, NY 10001

Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community

http://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 those who care for loved ones with a chronic illness or disability.

Chronic Disease Fund

www.cdfund.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 is part of the CDF formulary.

Corporate Angel Network

www.corpangelnetwork.org

866-328-1313

Free travel to treatment across the country using empty seats on corporate jets.

fertileHOPE

www.fertilehope.org

855-220-7777

Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

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.

Healthwell Foundation

www.healthwellfoundation.org

800-675-8416

Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Hospital Hosts

www.hospitalhosts.com

National resource to help reduce costs related to medical travel needs such as air, car, and lodging near hospitals.

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 a online support groups and a database of LGBT friendly clinical trials.

National Cancer Institute

www.cancer.gov

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.com

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

Help 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 obtain medications that they have trouble affording.

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

A comprehensive resource for the fight against breast cancer.

Triple Negative Breast Cancer Foundation

www.tnbcfoundation.org

Provides information to help people understand triple negative breast cancer.

For additional online information, visit LIBGUIDES on MSK’s library website at http://library.mskcc.org or the Breast Cancer section of MSKCC.org. You can also contact the library reference staff at 212-639-7439 for help.

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If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at ____________________. After 5:00 pm, during the weekend, and on holidays, please call____________________. If there’s no number listed, or you’re not sure, call 212-639-2000.
About Your Breast Surgery
©2015 Memorial Sloan Kettering Cancer Center - Generated on September 3, 2015