About Your Mastectomy

This guide will help you prepare for your mastectomy at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery. Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.

About 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 with a 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 more information from your plastic surgeon.

Total mastectomy is removal of all your breast tissue. The surgery is usually done through an incision (surgical cut) across the chest but 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 see 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), you may have an axillary lymph node dissection.

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.

About Your Lymphatic System

Understanding how your lymphatic system works can be helpful as you prepare for and recover from breast surgery. Your lymphatic system has 2 functions:

  • 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).

Figure 1. Normal lymph drainage
  • 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, similar to 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.
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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 aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your doctor knows all the medications you’re taking.
  • I take prescription medications, including patches and creams.
  • 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 (medication to make you sleep during surgery) in the past.
  • I am allergic to certain medication(s) or materials, 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 doesn’t have hormones. For example you may use a male condom, a diaphragm, or a Copper T intrauterine device (IUD). If you have any questions about birth control, or for help deciding the type of contraception (birth control) that’s right for you, talk with your gynecologist (GYN doctor).

Fertility Preservation

Many women should avoid becoming pregnant during their treatment. If your doctor has told you to avoid pregnancy for some time and you want to have children in the future, you may want to consider banking your eggs. For more information, ask your nurse for the resource Fertility Preservation: Options for Women Who Are Starting Cancer Treatment or search for it on www.mskcc.org/pe

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s 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, and a 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 can’t 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 can’t stop drinking.
  • Ask us any questions you have about drinking and surgery. As always, all of your medical 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 smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.

About Sleep Apnea

Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, the airway becomes completely blocked during sleep. It can cause serious problems during and after surgery.

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.

Within 30 Days of Your Surgery

Presurgical Testing (PST)

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 (NP) who works closely with anesthesiology staff (doctors and specialized nurses who will give you medication to put you to sleep during your surgery). Your NP 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 NP may also recommend you see other healthcare providers.

Tell your NP if you are breastfeeding or pumping your breastmilk for your child. 

Your NP will talk with you about which medications you should take the morning of your surgery.

It’s 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 a 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’re unable to communicate for yourself. The person you identify is called your health care agent.

If you’re interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advance directive, bring it with you to your next appointment.

Identify Your Caregiver

Your caregiver plays an important role in your care. You and your caregiver will learn about your surgery from your healthcare provider. Your caregiver will need to be present after your surgery for the discharge instructions so that they are able to help you care for yourself at home. Your caregiver will also need to take you home after your surgery.

Arrange for someone to take you home

You must have someone 18 years or older take you home after your procedure. If you don’t have someone to do this, call one of the agencies below. They will send someone to go home with you. There’s usually a charge for this service, and you will need to provide transportation.

Agencies in New York                                         Agencies in New Jersey
Partners in Care: 888-735-8913                                         Caring People: 877-227-4649
Caring People: 877-227-4649                                          

 

10 Days Before Your Surgery

Stop Taking Vitamin E

If you take vitamin E, stop taking it 10 days before your surgery because it can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Figure 2. Hibiclens skin cleanser

Purchase Hibiclens® Skin Cleanser

Hibiclens is a skin cleanser that kills germs for 24 hours after using it (see Figure 2). Showering with Hibiclens before your surgery will help reduce your risk of infection after surgery. You can buy Hibiclens before leaving the Evelyn H. Lauder Breast Center, or from your local pharmacy without a prescription.

7 Days Before Your Surgery

Stop Taking Certain Medications

If you take aspirin, ask your surgeon if you should continue. Aspirin and medications that contain aspirin can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Stop Taking Herbal Remedies and Supplements

Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about if you should continue. For more information, read Herbal Remedies and Cancer Treatment.

2 Days Before Your Surgery

Stop Taking Certain Medications

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®), and naproxen ( Aleve®). These medications can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

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. The clerk will tell you what time you should arrive for your surgery. If you’re scheduled for surgery on Monday you will be called on Friday. If you do not receive a call by 7:00 pm, please call 212-639-5014.

Lymphatic Mapping with Sentinel Lymph Node Biopsy

If you’re 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.

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 nuclear medicine 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 the technologist 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. They will also show which lymph nodes absorb the liquid, creating a “map” of your lymphatic system. Your surgeon will use this map to determine the location of the sentinel node(s).

If you’re 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 your surgery. After you’re 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 (surgical cut). The sentinel nodes will be blue from the blue dye, allowing your surgeon to see them. Your surgeon will remove the sentinel node(s) and the node(s) 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 Hibiclens. To use Hibiclens, open the bottle and pour some solution into your hand or a washcloth. Move away from the shower stream to avoid rinsing off the Hibiclens too soon. Rub it gently over your body from your neck to your waist and rinse.

Don’t let the solution get into your eyes, ears, mouth, or genital area. Don’t use any other soap. Dry yourself off with a clean towel after your shower.

Sleep

Go to bed early and get a full night’s sleep.

Instructions for eating and drinking before your surgery

12 ounces of water
  • Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
  • Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
  • Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.

The Morning of Your Surgery

Shower with Hibiclens

Shower using Hibiclens just before you leave. Use the Hibiclens the same way you did the night before.

Don’t use any other soap. Don’t put on any lotion, cream, powder, deodorant, makeup, or perfume after your shower.

Take Your Medications as Instructed

If your doctor or NP instructed you to take certain medications the morning of your surgery, take only those medications with a 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

  • Don’t put on any lotion, cream, deodorant, makeup, powder, or perfume.
  • Don’t 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, or your checkbook at home.
  • Before you’re taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles.
  • If you wear contact lenses, wear your glasses instead.

What to Bring

  • A button-down or loose fitting top.
  • Your breathing machine for sleep apnea (such as your CPAP), if you have one.
  • Your portable music player, if you choose. However, someone will need to hold it for you when you go into surgery.
  • Your Health Care Proxy Form, if you have completed one.
  • Your cell phone and charger
  • A case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles, if you have it.
  • This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.

Once You’ve Arrived for Your Surgery

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

Get Dressed for Surgery

When it’s time to change for surgery, you will get a hospital gown, robe, and nonskid socks to wear.

Meet With Your Nurse

You will meet with your nurse before surgery. Tell your nurse the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Your nurse may place an intravenous (IV) line into one of your veins, usually in your arm or hand. If your nurse doesn’t place the IV, your anesthesiologist will do it later once you’re in the operating room.

Meet With Your Anesthesiologist

Your anesthesiologist will:

  • Review your medical history with you.
  • Talk with you about your comfort and safety during your surgery.
  • Talk with 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 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 because helps to make sure that all members of your surgical team are clear about the plan for your surgery.

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After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your stay and after you leave. 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

Figure 3. JP drain

When you wake up after your surgery, you will be in the Post-Anesthesia Care Unit (PACU) or your recovery room.

You will have a surgical bra around your chest to cover your surgical site and at least one Jackson-Pratt® drain (JP drain, see Figure 3) attached to the bra. The JP drain will help to drain the fluid from your incision and prevent swelling. You will receive a kit with supplies and an extra surgical bra to take home to help care your incision(s) and drain(s).

Your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.

  • It’s 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.

Commonly Asked Questions

Will I have pain?

Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain isn’t 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, don’t 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 8 (8-ounce) glasses (2 liters) of liquids daily, if you can. Drink water, juices, soups, ice cream shakes, and other drinks that don’t 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.
  • 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’re 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. You may also feel the sensation of liquid trickling down your arm, when there no actual liquid. This is a result of your nerves being cut.

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 or even 5 years or longer. This is because your nerves are the slowest part of your body to heal. Most people report that the sensations aren’t severe or distressing.

Because of the change in sensation, don’t place anything hot or cold directly on your surgical site
(such as 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 go home with at least one JP drain in place. This is a soft catheter (tube) that’s inserted near your incision to drain extra fluid. The drain is usually removed about 1 to 2 weeks after your surgery, but 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. For more information, read Caring for Your Jackson-Pratt® Drainage System.

How do I care for my incisions?

Your incision(s) will be closed with sutures (stitches) under your skin. These sutures dissolve on their own, so they don’t 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 its 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 haven’t had reconstruction, you can shower 24 hours after your surgery. Before you go home, your nurse will teach you how to secure your drains while showering.

When you’re ready to shower, remove your surgical bra and any gauze pads that are covering the incision(s). If you have Steri-Strips on your incision, don’t 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 under the bra.

Avoid baths, hot tubs, saunas, and swimming pools until your doctor or nurse tell you it’s okay. 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 got a surgical bra, continue wearing it until your drains have been removed, then talk with your doctor or nurse about what to wear. Your surgical bra will provide support, help keep you comfortable, and hold your drains in place. You should wear your surgical bra while you sleep, but remove it before you shower.

While you’re 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 the bra is to use a soft breast form. This breast form is a lightweight nylon pouch, and the 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 buy the breast form from the Breast Boutique at the Evelyn H. Lauder Breast Center. The Breast Boutique is located at 300 East 66th Street, at 2nd Avenue. To reach the boutique, call 646-888-5330.

You can also line your bra with soft gauze, which you can get from your nurse. Replace the gauze frequently to make sure that it is always clean.

Can I wear a prosthesis?

A breast prosthesis is a more permanent breast form than the soft nylon pouch. If you’re interested in wearing a breast prosthesis, talk with your surgeon or nurse. If you haven’t 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 to find out if they will pay for your breast prosthesis.

There are many types of breast prostheses. Mastectomy boutiques and lingerie stores sell them, and the boutique at the Evelyn H. 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 800-ACS-2345 (800-227-2345) 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:

  • Don’t drive while you are taking prescription pain medication. These medications can make you drowsy and unsafe for you to drive. Also, don’t drive until:
    • Your drain(s) have been removed.
    • You have recovered your full range of motion.
    • You can comfortably turn the steering wheel.
  • If you have had reconstruction, don’t lift objects heavier than 5 pounds (2.27 kilograms) until your surgeon says it’s safe. This is usually about 6 weeks for people who had surgery with tissue transfers and 4 to 6 weeks for people who had surgery with tissue expanders. Your surgeon will tell you how long you should avoid heavy lifting.
  • 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 them 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.
  • Make sure to follow any other instructions that your surgeon, nurse, or physical therapist gave you.

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 have muscle pain or tightness.

Review the information in Exercises After Breast Surgery for examples of exercises that will help you regain motion in your arm and shoulder. If you’re having discomfort, you may find it helpful to take some pain medication about a half hour before starting the exercises.

How can I cope with my feelings?

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.

The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It’s always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to patients and their families. Whether you’re in the hospital or at home, the nurses, doctors, and social workers are here to help you and your family and friends handle the emotional aspects of your illness.

When can I resume sexual activity?

You can resume sexual activity when you feel ready. Having sexual relations won’t 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 isn’t 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 with 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 birth control. However, you can’t 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’s safe to try to get pregnant. For more information, read the resource Sexual Activity During Cancer Treatment: Information for Women.

Am I at risk for lymphedema?

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 happen in the arm, hand, breast, or torso on your affected side (the side where your lymph nodes were removed).

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

  • There is no standard test for diagnosing lymphedema.
  • Removal 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 1 and a few lymph nodes are removed to check for cancer. With a sentinel lymph node biopsy, the risk of developing lymphedema is low.
  • During an axillary lymph node dissection, 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, the risk of developing lymphedema is higher than with a 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:

  • Maintain or safely work towards a healthy 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.
  • If you get a cut or scratch on your affected arm or hand, clean the area with soap and water and apply antibacterial ointment such as Bacitracin® or Neosporin®. Cover the area with a bandage.
  • If you get a burn on your affected arm or hand, apply a cold pack or cold water for 15 minutes, clean the area with soap and water, and cover it with a bandage.
  • Watch for signs of infection, including redness, swelling, increased heat, or tenderness.

If you have had an axillary dissection,your nurse will give you a resource with more information 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, 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.

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

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

The information in this section contains important information about what medications, herbal remedies, and other dietary supplements you will need to stop taking before your surgery. Read through this section before your surgery so that you are prepared. Write down any questions you have and be sure to ask your doctor or nurse.

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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

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
MSK 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 at 300 East 66th Street. It 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
646-888-0800
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
800-227-2345
Learn techniques to help you feel better about your appearance by taking a workshop or visiting the program at www.lookgoodfeelbetter.org

Patient-to-Patient Support Program
212-639-5007

You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers.

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 Nurse Liaison
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
You 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
212-639-7020
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.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call for more information.

For additional online information, visit LIBGUIDES on MSK’s library website at 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.

External Resources

Access-A-Ride
web.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-ACS-2345 (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.org
800-813-4673
275 Seventh Avenue (Between West 25th and West 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.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.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Free travel to treatment across the country using empty seats on corporate jets.

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.

Good Days
www.mygooddays.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 Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

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.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-844-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

National Cancer Institute
www.cancer.gov

800-4-CANCER (800-422-6237)

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.org
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.

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