This guide will help you get ready for your lumpectomy and axillary surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.
Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery.
About Your Surgery
This guide has information about several types of breast surgeries. You may be having a:
- Lumpectomy and sentinel lymph node biopsy.
- Lumpectomy and sentinel lymph node biopsy with possible axillary lymph node dissection.
- Lumpectomy and axillary node dissection.
- Another similar surgery.
A lumpectomy is a surgery to remove a malignant (cancerous) tumor from your breast. Only the tumor and a small area of normal tissue around it are removed. A lumpectomy is known as “breast-conserving” surgery. That means it lets you to keep your breast shape and, usually, your nipple.
During your surgery, your surgeon may also remove 1 or more lymph nodes from your armpit. In most cases, you will have a sentinel lymph node biopsy. A pathologist then will check if cancer has spread to the lymph node(s). A pathologist is a doctor who looks at body tissue under a microscope to diagnose disease.
Sentinel lymph node biopsy
A sentinel lymph node biopsy is when sentinel lymph nodes are removed and checked for cancer cells. Sentinel lymph nodes are the first lymph node(s) in your armpit that receive drainage from the breast tumor. If cancer cells spread, the sentinel lymph nodes are usually the first place they go. Your surgeon will identify the sentinel node(s) by injecting a special dye into your breast.
If you’re having a sentinel lymph node biopsy, you may have lymphatic mapping as part of your surgery. There is more information about this procedure later in this guide.
Your surgeon may send the sentinel lymph node(s) to the pathologist during your surgery. If the pathologist sees any cancer cells, your surgeon may then do an axillary lymph node dissection.
Axillary lymph node dissection
An axillary lymph node dissection is when most or all of the lymph nodes in your armpit are removed. The number of lymph nodes removed varies from person to person.
Breast seed localization
Some people may also need to have a breast seed localization. This is a procedure to place a tiny metal seed into the abnormal breast tissue. The metal seed will help your surgeon find the tissue during your surgery. If you’re having a breast seed localization, your nurse will give you more information about it.
About your lymphatic system
It can be helpful to understand how your lymphatic system works if you’re having a sentinel lymph node biopsy or an axillary node dissection. Your lymphatic system has 2 jobs:
- It helps fight infection.
- It helps drain fluid from areas of your body.
Your lymphatic system is made up of lymph nodes, lymphatic vessels, and lymphatic fluid (see Figure 1).
- Lymph nodes are small bean-shaped glands located along your lymphatic vessels. Your lymph nodes filter your lymphatic fluid, taking out bacteria, viruses, cancer cells, and other waste products.
- Lymphatic vessels are tiny tubes, like your blood vessels, that 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.
Getting Ready for Your Surgery
This section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready.
As you read through this section, write down questions to ask your healthcare provider.
Getting ready for surgery
You and your care team will work together to get ready for your surgery. Help us keep you safe by telling us if any of these things apply to you, even if you’re not sure.
I take a anticoagulant (blood thinner), such as:
These are examples of medications. There are others.
Be sure your healthcare provider knows all the medications you’re taking.
- Warfarin (Jantoven®, Coumadin®)
- Clopidogrel (Plavix®)
- Enoxaparin (Lovenox®)
- Dabigatran (Pradaxa®)
- Apixaban (Eliquis®)
- Rivaroxaban (Xarelto®)
I take an SGLT2 inhibitor, such as:
- Canagliflozin (Invokana®)
- Dapagliflozin (Farxiga®)
- Empagliflozin (Jardiance®)
- Ertugliflozin (Steglatro®)
- I take prescription medications (medications my healthcare provider prescribes), including patches and creams.
- I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
- I take dietary supplements, such as 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 (medication to make me sleep during surgery) in the past.
- I’m allergic to certain medication(s) or materials, including latex.
- I’m not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke or use an electronic smoking device, such as a vape pen or e-cigarette.
- I use recreational drugs, such as marijuana.
If there’s any chance you could become pregnant before your surgery, be sure to use a form of birth control (contraception) that doesn’t have hormones. For example, you can use a condom, a diaphragm, or a copper (Paragard®) intrauterine device (IUD).
If you have questions about birth control or want help choosing the type of birth control that’s right for you, talk with your gynecologist (GYN doctor).
Many people should avoid becoming pregnant during their treatment. If your doctor told you to avoid getting pregnant for some time and you want to have children in the future, you may want to think about freezing your eggs. For more information, read the resource Fertility Preservation: Options for Females Starting Cancer Treatment
About drinking alcohol
It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
If you drink alcohol regularly, you may be at risk for problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
If you drink alcohol regularly and stop suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these problems, we can prescribe medications to help prevent them.
Here are things you can do before your surgery to keep from having problems.
- Be honest with your healthcare providers about how much alcohol you drink.
Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
- Get a headache.
- Feel nauseous (like you’re going to throw up).
- Feel more anxious (nervous or worried) than usual.
- Cannot sleep.
- Tell your healthcare provider if you cannot stop drinking.
- Ask your healthcare provider questions about drinking and surgery. All your medical information will be kept private, as always.
If you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help.
About sleep apnea
Sleep apnea is a common breathing problem. If you have sleep apnea, you stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep.
OSA can cause serious problems during and after surgery. Tell us if you have or think you might have sleep apnea. If you use a breathing device, such as a CPAP machine, bring it on the day of your surgery.
MyMSK (my.mskcc.org) is your MSK patient portal. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care.
Watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal to learn more. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.
Within 30 days of your surgery
Presurgical Testing (PST)
You’ll have a PST appointment before your surgery. You’ll get a reminder from your surgeon’s office with the appointment date, time, and location.
You can eat and take your usual medications the day of your PST appointment.
It’s helpful to bring these things to your appointment:
- A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The names and telephone numbers of your healthcare providers.
You’ll meet with a nurse practitioner (NP) during your PST appointment. They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests to plan your care, such as:
- An electrocardiogram (EKG) to check your heart rhythm.
- A chest X-ray.
- Blood tests.
Your NP may recommend you see other healthcare providers. They’ll also talk with you about which medications to take the morning of your surgery.
Identify your caregiver
Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged. They’ll also help you care for yourself at home.
Fill out a Health Care Proxy form
If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.
A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.
- To learn about health care proxies and other advance directives, read Advance Care Planning.
- To learn about being a health care agent, read How to Be a Health Care Agent.
Talk with a member of your care team if you have questions about filling out a Health Care Proxy form.
Arrange for someone to take you home
You must have a responsible care partner take you home after your surgery. A responsible care partner is someone who can help you get home safely. They should be able to contact your care team if they have any concerns. Make sure to plan this before the day of your surgery.
If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you still need a responsible care partner with you.
|Agencies in New York||Agencies in New Jersey|
|VNS Health: 888-735-8913||Caring People: 877-227-4649|
|Caring People: 877-227-4649|
Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser (such as Hibiclens®)
4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser before leaving the Evelyn H. Lauder Breast Center or at your local pharmacy without a prescription.
Buy 325-milligram acetaminophen tablets (such as Tylenol® Regular Strength)
Acetaminophen is an over-the-counter pain medication. You’ll use it after your surgery to help manage your pain at home. It’s helpful to buy it ahead of time. You can get it at your local pharmacy without a prescription. Always follow the instructions on the container or from your healthcare provider when taking any medication.
7 days before your surgery
Follow your healthcare provider’s instructions for taking aspirin
Aspirin can cause bleeding. If you take aspirin or a medication that has aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements
Vitamin E, multivitamins, herbal remedies, and other dietary supplements can cause bleeding. Stop taking them 7 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.
To learn more, read Herbal Remedies and Cancer Treatment.
2 days before your surgery
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), can cause bleeding. Stop taking them 2 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.
1 day before your surgery
Note the time of your surgery
A staff member will call you after the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by , call 212-639-5014.
The staff member will tell you what time to get to the hospital for your surgery. They’ll also remind you where to go.
If you’re having a sentinel lymph node biopsy, you may have a lymphatic mapping procedure the day before or the morning of your surgery. This will help your surgeon find the sentinel lymph node(s) during your surgery. If you’re also having breast seed localization, it may be scheduled before your lymphatic mapping.
During your lymphatic mapping, you’ll lie on an exam table while you get 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 nuclear medicine scan. While you wait for your scan, you can either stay in the hospital or leave for a while. 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’ll lie on a narrow table while they take 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. Your surgeon will use this information as a guide (or map) to determine the location of the sentinel node(s).
If you’re having surgery the same day as your mapping, a staff member will bring you from the scanning room to the operating room. In most other cases, you’ll go home after the mapping.
Shower with a 4% CHG solution antiseptic skin cleanser, such as Hibiclens
Shower with a 4% CHG solution antiseptic skin cleanser before you go to bed the night before your surgery.
- Wash your hair with your usual shampoo and conditioner. Rinse your head well.
- Wash your face and genital (groin) area with your usual soap. Rinse your body well with warm water.
- Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth.
- Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Do not put it on your face or genital area.
- Move back into the shower stream to rinse off the 4% CHG solution. Use warm water.
- Dry yourself off with a clean towel.
Do not use any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Instructions for eating before your surgery
Do not eat anything after midnight (12 a.m.) the night before your surgery. This includes hard candy and gum.
The morning of your surgery
Instructions for drinking before your surgery
You can drink a total of 12 ounces of water between midnight (12 a.m.) and 2 hours before your scheduled arrival time. Do not drink anything else.
Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.
Take your medications as instructed
A member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.
Shower with a 4% CHG solution antiseptic skin cleanser, such as Hibiclens
Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.
Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Things to remember
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Don’t wear any metal objects. Remove all jewelry, including body piercings. The tools used during your surgery can cause burns if they touch metal.
- Leave valuable items at home.
- If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.
What to bring
- A button-down or loose-fitting top.
- A supportive bra, such as a sports bra, to wear after your surgery.
- Your breathing device for sleep apnea (such as your CPAP device), if you have one.
- Your Health Care Proxy form and other advance directives, if you completed them.
- Your cell phone and charger.
- Only the money you may want for small purchases (such as a newspaper).
- A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
- This guide. Your healthcare team will use it to teach you how to care for yourself after surgery.
Once you’ve arrived for your surgery
Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or a similar name may be having surgery on the same day.
When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.
Meet with a nurse
You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight (12 a.m.) and the time you took them. Make sure to include prescription and over-the-counter medications, patches, and creams.
Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist will do it in the operating room.
Meet with an anesthesiologist
You’ll also meet with an anesthesiologist before surgery. They will:
- Review your medical history with you.
- Ask you if you’ve had any problems with anesthesia in the past, such as nausea or pain.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you’ll get.
- Answer your questions about your anesthesia.
Marking your surgical site
Along with asking your name and birth date, staff members may also ask the name of your surgeon, what surgery you’re 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 and to make sure all members of your surgical team understand the plan for your surgery.
Get ready for surgery
When it’s time for your surgery, you’ll take off your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles.
You’ll either walk into the operating room or a staff member will bring you there on a stretcher. A member of the operating room team will help you onto the operating bed. They’ll put compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.
Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.
During your surgery
If you’re having a sentinel lymph node biopsy, your surgeon will inject a small amount of blue dye underneath your nipple or near the tumor. 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 injected during that procedure.
Once they locate the sentinel lymph node(s), your surgeon will make a small incision (cut) and remove them. They may send them to the Pathology department to be checked for cancer cells during your surgery. If the pathologist sees cancer cells, your surgeon may remove more lymph nodes. This is called an axillary lymph node dissection. Your surgeon will discuss this with you in more detail, if needed.
Because blue dye was used during your sentinel lymph node biopsy, your skin, urine (pee), and stool (poop) may be bluish-green for 1 to 2 days after your surgery.
Once your surgery is finished, your incision(s) will be closed with sutures (stitches) under your skin. You may also have Steri-Strips™ (thin pieces of surgical tape) or Dermabond® (surgical glue) over your incision(s). Your incision(s) may be covered with a bandage.
Recovering after your surgery
This section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home.
As you read through this section, write down questions to ask your healthcare provider.
In the Post-Anesthesia Care Unit (PACU) or recovery room
When you wake up after your surgery, you’ll be in the PACU or your recovery room. A nurse will be keeping track of your body temperature, pulse, blood pressure, and oxygen levels. You’ll be getting oxygen through a thin tube that rests below your nose.
Tubes and drains
If you had an axillary lymph node dissection, you’ll have a soft catheter (flexible tube) called a Jackson-Pratt (JP) drain inserted near the incision in your armpit. It will drain extra fluid from the area and will still be in place when you’re discharged from the hospital. Your nurse will give you information to help you take care of it at home.
Managing your pain
Your healthcare provider will ask you about your pain often and give you pain medication as needed. You’ll also get pain medication to take at home. Talk with your healthcare provider about possible side effects and when to start switching to over-the-counter pain medication.
Leaving the PACU or your recovery room
Once you’re awake and your pain is under control, you can go home with your responsible care partner. Before you leave, look at your incision(s) with one of your healthcare providers. Knowing what it looks like will help you notice any changes later.
Filling out your Recovery Tracker
We want to know how you’re feeling after you leave the hospital. To help us care for you, we’ll send questions to your MyMSK account. We’ll send them every day for 10 days after you’re discharged. These questions are known as your Recovery Tracker.
Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how you’re feeling and what you need.
Based on your answers, we may reach out to you for more information. Sometimes, we may ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions.
To learn more, read About Your Recovery Tracker.
Caring for your incision(s)
Look at your incision(s) every day. Call your healthcare provider if you see any redness or drainage.
Your incision(s) will be closed with sutures under your skin. These sutures dissolve on their own and don’t need to be removed.
If you go home with Steri-Strips or Dermabond on your incision(s), they’ll usually loosen and fall or peel off on their own. If not, your healthcare provider may remove them when they see you at your follow-up appointment. If they haven’t fallen off after 14 days, you can take them off.
A week or two after your surgery, a pocket of fluid may form under the skin of your armpit or breast where tissue was removed. This is called a seroma, and it’s harmless. The area may feel soft and puffy. It may also feel tender.
Seromas often go away on their own. If you develop a seroma that’s large or feels uncomfortable, call your healthcare provider’s office to discuss with your doctor or nurse.
New sensations (feelings) in your breast
As you’re healing, you may feel a few different sensations in your breast or arm. Tenderness, numbness, and twinges are common examples.
These sensations usually come and go and will lessen over time, usually within the first few months after surgery. However, some may last months, even 5 years or longer. This is because your nerves are the slowest part of your body to heal. Most people tell us the sensations aren’t severe or distressing.
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.
You can shower 24 hours after your surgery. Taking a warm shower is relaxing and can help decrease discomfort.
When you’re ready to shower, take off your bra and any gauze pads covering your incision(s). If you have Steri-Strips or Dermabond on your incision(s), don’t remove them. Gently wash your incision(s) with soap and water, letting the shower water run over them. Pat the areas dry with a clean towel.
You can leave your incision(s) uncovered, unless you have drainage. If you have drainage, call your healthcare provider. If it feels more comfortable, you can place a clean gauze pad over your incision(s).
Don’t take tub baths, swim, or use hot tubs or saunas until talking with your healthcare provider at your first appointment after surgery. Also, talk with your healthcare provider before using deodorant, lotion, powder, or perfume anywhere near your surgery site.
Managing your pain
People pain or discomfort for different lengths of time.
Follow these guidelines to help manage your pain at home.
- Take your medications as directed and as needed.
- Call your healthcare provider if the medication prescribed for you does not help your pain.
- Do not drive or drink alcohol while you’re taking prescription pain medication. Some prescription pain medications can make you drowsy (very sleepy). Alcohol can make the drowsiness worse.
You’ll have less pain and need less pain medication as your incision heals. An over-the-counter pain reliever will help with aches and discomfort. Acetaminophen (Tylenol®) and ibuprofen (Advil® or Motrin®) are examples of over-the-counter pain relievers.
- Follow your healthcare provider’s instructions for stopping your prescription pain medication.
- Do not take too much of any medication. Follow the instructions on the label or from your healthcare provider.
- Read the labels on all the medications you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medications. Taking too much can harm your liver. Do not take more than one medication that has acetaminophen without talking with a member of your care team.
- Pain medication should help you get back to your normal activities. Take enough medication to do your activities and exercises comfortably. You may have a little more pain as you start to be more active.
- Keep track of when you take your pain medication. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.
Some prescription pain medications (such as opioids) may cause constipation (having fewer bowel movements than usual).
Talk with your healthcare provider about how to prevent and manage constipation. You can also follow the guidelines below.
- Go to the bathroom at the same time every day. Your body will get used to going at that time. If you feel the urge to go, though, don’t put it off.
- Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. That’s when the reflexes in your colon are strongest.
- Exercise, if you can. Walking is an excellent form of exercise.
- Drink 8 (8-ounce) glasses (2 liters) of liquids daily, if you can. Choose liquids such as water, juices (such as prune juice), soups, and ice cream shakes. Avoid liquids with caffeine (such as coffee and soda). Caffeine can pull fluid out of your body.
- Slowly increase the fiber in your diet to 25 to 35 grams per day. Fruits, vegetables, whole grains, and cereals contain fiber.
Both over-the-counter and prescription medications are available to treat constipation. Check with your healthcare provider before taking any medications for constipation. Follow the instructions on the label or from your healthcare provider. Examples of over-the-counter medications for constipation include:
- Docusate sodium (Colace®). This is a stool softener (medication that makes your bowel movements softer) that causes few side effects. You can use it to help prevent constipation. Don’t take it with mineral oil.
- Polyethylene glycol (MiraLAX®). This is a laxative (medication that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid. Only take it if you’re already constipated.
- Senna (Senokot®). This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime. Only take it if you’re already constipated.
If you haven’t had a bowel movement in 2 days, call your healthcare provider.
Physical activity and exercise
You can start doing most activities again right away, but it’s best to pace yourself as you return to your daily routine. Talk with your healthcare provider before starting strenuous exercise (such as running, jogging, or lifting weights).
Exercises after surgery
If you had a lumpectomy, sentinel lymph node biopsy, or axillary lymph node dissection, read Exercises After Your Lumpectomy or Axillary Lymph Node Procedure . It has exercises that you can do to help you regain motion in your arm and shoulder.
You can start driving again as long as you aren’t taking prescription pain medication that may make you drowsy. You should also have full range of motion of your arm and be able to comfortably turn the steering wheel.
Sometimes, removing lymph nodes can make it hard for your lymphatic system to drain properly. If this happens, lymphatic fluid can build up in the area where the lymph nodes were removed. This extra fluid causes swelling called lymphedema.
Lymphedema can develop in the arm, hand, breast, or torso on your affected side (the side where your lymph nodes were removed).
Most people don’t develop lymphedema, but some do. It’s hard to know a person’s risk of developing lymphedema because:
- There’s no standard test for diagnosing lymphedema.
- Removing or injuring lymph nodes affects people differently.
- Lymphedema can develop soon after surgery, or it can develop years later.
- Current cases of lymphedema can be caused by older treatment methods.
Your risk of developing lymphedema depends on how your lymph nodes are removed (see Figure 2).
During a sentinel lymph node biopsy, between 1 and a few lymph nodes are removed from your armpit and checked for cancer cells. The risk of developing lymphedema after a sentinel lymph node biopsy is low. About 0 to 7 out of every 100 people who have a sentinel lymph node biopsy develop lymphedema.
During an axillary lymph node dissection, more than a few lymph nodes are removed from your armpit. This is done to remove additional lymph nodes that may have cancer cells. The risk of developing lymphedema after an axillary lymph node dissection is higher than it is after a sentinel node biopsy. About 15 to 25 out of every 100 people who have an axillary lymph node dissection may develop lymphedema.
There’s no way to know for sure who will develop lymphedema.
Lowering your risk of developing lymphedema
Doing the following things may help lower your risk of developing lymphedema.
- Stay at or safely work towards a healthy body weight.
Exercise and stretch your muscles regularly. Talk with your surgeon or nurse about which exercises are right for you.
- When you resume exercise and activity, make sure to build up slowly and gradually. If you feel discomfort, stop and take a break. Exercise shouldn’t cause pain.
- Try to minimize your risk of infection to your hand and arm. Ask your healthcare provider how best to care for cuts, scratches, and burns.
If you had a sentinel lymph node biopsy:
- It’s OK to use your affected arm for blood draws, injections (shots), IV lines, and blood pressure measurements. Ask your healthcare providers to try to use your unaffected arm if it’s available.
- If you start to notice any signs of lymphedema, always use your unaffected arm. If this isn’t possible, talk with your healthcare provider about which arm is safest to use.
If you had an axillary lymph node dissection:
- Read the resource Hand and Arm Guidelines After Your Axillary Lymph Node Dissection for information about lowering your lymphedema risk after your procedure.
Signs of lymphedema
Some mild swelling after surgery is normal. The swelling may last for up to 6 weeks. It’s often temporary and will gradually go away. You may also feel pain or other sensations, such as twinges and tingling, after surgery. These feelings are common and aren’t necessarily signs of lymphedema.
If you’re at risk of developing lymphedema, watch for these signs in your affected arm, hand, breast, and torso:
- A feeling of heaviness, aching, or pain.0
- A tight feeling in your skin.
- Less flexibility.
- Skin changes, such as tightness or pitting (skin that stays indented after pressing on it).
If you have any signs of lymphedema or aren’t sure, contact your healthcare provider.
You can start sexual activity when you feel ready. It won’t harm your surgical area. 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.
It may be helpful to let your partner see your incision(s) soon after surgery. This may ease any anxiety you both may feel. Your partner might worry that touching your incision(s) will hurt you. Let them know what is and isn’t comfortable.
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.
Your follow-up appointment will be 1 to 2 weeks after your surgery. Your healthcare provider will talk with you about your pathology results during this appointment.
Addressing your emotional needs
After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200.
The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to help you and your family. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness.
When to call your healthcare provider
Call your healthcare provider if:
- You have a fever above 101 °F (38.3 °C).
- You have shortness of breath.
- The skin around your incision is warmer than usual.
- You have more discomfort in the area.
- The area around your incision is getting redder.
- The area around your incision is starting to swell.
- Swelling around your incision is getting worse.
- There’s discharge coming from your incision.
Monday through Friday from to , call your healthcare provider’s office.
After , during the weekend, and on holidays, call 212-639-2000 and ask to speak to the person on call for your healthcare provider.
This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery.
As you read through this section, write down questions to ask your healthcare provider.
MSK support services
Visit the cancer types section of MSK’s website at www.msk.org/types for more information.
Call if you have questions about your hospital admission, such as asking for a private room.
At MSK, the Caregivers Clinic provides support specifically for caregivers who are having difficulty coping with the demands of being a caregiver. For more information, call Dr. Allison Applebaum’s office at 646-888-0200.
Many people find that counseling helps them. Our Counseling Center offers counseling for individuals, couples, families, and groups. We can also prescribe medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.
Food Pantry Program
We give food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.
Integrative Medicine Service
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. To schedule an appointment for these services, call 646-449-1010.
You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call 646-608-8550.
You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit the library’s Patient and Health Care Consumer Education Guide.
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. To make an appointment, ask a member of your care team for a referral or call the number above.
Patient and Caregiver Education
Visit our Patient and Caregiver Education website to search for educational resources, videos, and online programs.
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.
Patient Representative Office
Call if you have questions about the Health Care Proxy form or concerns about your care.
Perioperative Nurse Liaison
Call if you have questions about MSK releasing any information while you’re having surgery.
Private Duty Nurses and Companions
You can request private nurses or companions to care for you in the hospital and at home. Call for more information.
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.
- Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. To learn more, call Rehabilitation Medicine (Physiatry) at 646-888-1929.
- An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. To learn more, call Rehabilitation Therapy at 646-888-1900.
Resources for Life After Cancer (RLAC) Program
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.
This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.
Sexual Health Programs
Cancer and cancer treatments can affect your sexual health, fertility, or both. MSK’s sexual health programs can help you before, during, or after your treatment.
- Our Female Sexual Medicine and Women’s Health Program can help with sexual health problems, such as premature menopause or fertility issues. For more information or to make an appointment, call 646-888-5076.
- Our Male Sexual and Reproductive Medicine Program can help with sexual health problems, such as erectile dysfunction (ED). For more information or to make an appointment, call 646-888-6024.
Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members.
Our social workers can also help refer you to community agencies and programs. They also have information about financial resources, if you’re having trouble paying your bills.
Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion).
MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.
Tobacco Treatment Program
MSK has specialists who can help you quit smoking. For more information about our Tobacco Treatment Program, call 212-610-0507. You can also ask your nurse about the program.
Our Virtual Programs offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.
Sessions are private, free, and led by experts. Visit our website for more information about Virtual Programs or to register.
External support services
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.
American Cancer Society (ACS)
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
A resource for education, tools, and events for employees with cancer.
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.
Cancer Support Community
Provides support and education to people affected by cancer.
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.
LGBT Cancer Project
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.
Look Good Feel Better Program
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.
National Cancer Legal Services Network
Free cancer legal advocacy program.
National LGBT Cancer Network
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.
Lists Patient Assistance Programs for brand and generic name medications.
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.
Patient Advocate Foundation
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.
This section lists the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery.
As you read through these resources, write down questions to ask your healthcare provider.
- A Guide for Caregivers
- About Your Recovery Tracker
- Advance Care Planning
- Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E
- Exercises After Your Lumpectomy or Axillary Lymph Node Procedure
- Fertility Preservation: Options for Females Starting Cancer Treatment
- Hand and Arm Guidelines After Your Axillary Lymph Node Dissection
- Herbal Remedies and Cancer Treatment
- How to Be a Health Care Agent
- How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal
For more information about lymphedema, you can also read the New York State Department of Health’s resource Understanding Lymphedema.