This guide will help you get ready for your mastectomy surgery 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.Back to top
About Your Surgery
This guide contains information about several types of breast surgeries. The surgery you’re 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)
If you’re interested in breast reconstruction, talk with your doctor. They can provide you with additional information.
Total mastectomy is the 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 methods. Your breast surgeon will talk with you about which option is right for you.
The lymph nodes in your armpit will be removed and checked during your surgery to see if the cancer has spread. In most cases, lymph nodes are tested by performing a sentinel lymph node biopsy.
Sentinel lymph node biopsy is the removal of the first lymph node(s) in your armpit that gets drainage from the breast tumor. This means that cancer cells may spread to it. Your doctor can identify the node by injecting a special dye into your breast and seeing which lymph nodes contain the dye. More information about this procedure is included later in this guide.
After the sentinel lymph node(s) is removed, it may be tested by the pathologist during your surgery. If any cancer cells are found in the sentinel node(s), your doctor may then do an axillary lymph node dissection.
Axillary lymph node dissection is the removal of most or all of the lymph nodes found in the armpit. The number of nodes removed varies from person to person.
About Your Lymphatic System
Understanding how your lymphatic system works can be helpful as you get ready for and recover from your 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).
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, and carry lymphatic fluid to and from your lymph nodes.
Lymphatic fluid is the clear fluid that travels through your lymphatic system. It carries cells that help fight infections and other diseases.Back to top
Before 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 be giving you medication to put you to sleep during your surgery). Your NP will review your medical and surgical history with you. You may have 1 or more of the following tests, such as 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.
Your NP will talk with you about which medications you should take the morning of your surgery.
It is very helpful if you bring the following with you to your PST appointment:
- A list of all the medications you are 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 healthcare provider(s).
10 Days Before Your Surgery
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 lower your risk of infection after surgery. You can buy Hibiclens before leaving the Evelyn H. Lauder Breast Center or at your local pharmacy without a prescription.
7 Days Before Your Surgery
2 Days Before Your Surgery
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 at the hospital for your surgery. If you are scheduled for surgery on a Monday, you will be called on the Friday before. 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 done the day before your surgery or the morning of your surgery.
During your procedure, you will lie on a reclining chair for about 20 minutes. While you’re in the reclining chair, a doctor or nurse will inject a small amount of a radioactive liquid under your skin below the areola of your affected breast. You might feel stinging or burning during the injection.
After the injection, you will massage the area of the injection site for 10 minutes. This will help the radioactive liquid travel to the sentinel node(s). Then, a technologist will measure the radioactivity in your breast and axilla (armpit), on your affected side to see how much of the liquid was absorbed. There are 2 ways they can do this.
- Your radiation technologist might use a small handheld device called a neoprobe.
- You might have an imaging scan done using a larger machine that you lie down on. Read the section “Nuclear Medicine Scan” for more information.
Both ways work equally well. Your doctor or nurse will tell you what to expect.
Nuclear Medicine Scan
If you need an imaging scan after your injection, your technologist will take you to the scanning room. You will lie on a table while the technologist takes pictures. The pictures will show the flow of the radioactive liquid through your body, and which of your lymph nodes absorbed it. Each picture takes 5 minutes to complete, 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. This creates a “map” of your lymphatic system. Your surgeon will use this map to find the location of your sentinel node(s).
If you’re having surgery the same day as your mapping, you’ll be taken from the scanning room to the operating room. If you’re having surgery at the Josie Robertson Surgical Center (JRSC), your care team will arrange for you to take an MSK van to the JRSC after your procedure. In most other cases, you’ll go home after the mapping.
Sentinel Node Biopsy
Your sentinel lymph node biopsy will take place during surgery. During this procedure, 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) and will turn them blue. If you had a lymphatic mapping procedure, your surgeon will also use a small device that measures radioactivity from the liquid that was injected during that procedure.
Once the sentinel node(s) are located, your surgeon will make a small incision. The sentinel nodes will be blue from the blue dye, which will let your surgeon see them. The surgeon will remove the sentinel node(s) and then the Pathology department will examine them to see if they contain cancer cells. If they do contain cancer cells, you may need to have more lymph nodes removed. 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 procedure, your skin, urine (pee), and stool (poop) may be a bluish-green color for 1 to 2 days after your procedure.
The 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. Don’t use any other soap. Don’t put on any lotion, cream, powder, deodorant, or cologne 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 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 lotions, creams, deodorants, powders, or cologne.
- 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 are taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), hairpiece, and religious articles (such as a rosary).
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead.
What to Bring
- A button-down or loose-fitting shirt
- Only the money you may need for a newspaper, bus, taxi, or parking.
- Your portable music player, if you choose. However, someone will need to hold this item for you when you go into surgery.
- Your breathing machine for sleep apnea (such as your CPAP), if you have one.
- Your Health Care Proxy Form, if you have completed one.
- A case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), hairpiece, 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’re in the Hospital
You will be asked to state and spell your name and date of birth 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 is 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.
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 mark the site on your body that will be operated on. This is for your safety. This helps to make sure that all members of your surgical team know the plan for your surgery.
Get Ready For Your Surgery
Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to start. When it’s time for your surgery, your visitor(s) will be taken to the waiting area.
You will either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed 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 will fall asleep. You will also get fluids through your IV line during and after your surgery.Back to top
After Your Surgery
In the Post-Anesthesia Care Unit (PACU)
When you wake up after your surgery, you will be in the Post-Anesthesia Care Unit (PACU).
A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose or a mask that covers your nose and mouth. You will also have compression boots on your lower legs.
Tubes and Drains
You will have a wrap around your chest to cover your surgical site and 1 or 2 Jackson-Pratt® drains (JP drain, see Figure 3) attached to the wrap. The JP drain will help drain the fluid from your incision and prevent swelling. You will get supplies to take home before you leave the hospital to help you care for your incision(s) and drain(s).
Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them. Your healthcare provider will let you know how long you will need to stay in the PACU.
Managing Your Pain
You will have some pain after your surgery. To help you manage this:
- You will get pain medication in your IV line.
- Once you’re able to eat normal food, you will get oral pain medication (medication you swallow).
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. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain will help you recover better.
You will be given pain medication before you leave the hospital. Talk with your doctor or nurse about possible side effects and when you should start switching to over-the-counter pain medications.
Moving Around and Walking
Moving around and walking will help lower your risk for blood clots and pneumonia. It will also help stimulate your bowels so you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around.
Exercising Your Lungs
It’s important to exercise your lungs so they expand fully. This helps prevent pneumonia.
- Use your incentive spirometer 10 times every hour you’re awake. For more information, read the resource How to Use Your Incentive Spirometer.
- Do coughing and deep breathing exercises. A member of your care team will teach you how to do these exercises.
Eating and Drinking
You will be able to eat starting 1 to 2 hours after your surgery. First, you will be on a clear liquid diet. After that, you can start eating your normal foods again, as tolerated.
If you have questions about your diet, ask to see a clinical dietitian nutritionist.
Learning to Care for Your Tubes and Drains
You will go home with at least 1 JP drain in place. This is a soft catheter (thin flexible tube) that’s inserted near your incision to drain extra fluid. The drain(s) will usually be removed about 1 to 2 weeks after your surgery, but it may be left in longer. Your nurse will teach you how to care for the drain before you leave the hospital. For more information, read Caring for Your Jackson-Pratt Drain.
It’s helpful if your caregiver also learns how to care for your JP drain(s). This will make it easier for them to help you care for yourself at home.
You can shower 24 hours after your surgery. Before you go home, your nurse will teach you how to secure your drain(s) while showering.
When you’re ready to shower, take off your wrap and any gauze pads that are covering your 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 wrap back on and secure the drains to your wrap. If it feels more comfortable, you can place a clean gauze pad over your incision, under the wrap.
Planning for Your Discharge
Your first appointment after surgery will usually be within 1 to 2 weeks after you leave the hospital. Your nurse will give you instructions on how to make this appointment, including the phone number to call
Leaving the Hospital
Before you leave the hospital, look at your incision with your nurse and caregiver. Knowing what your incision looks like will help you notice any changes later.
On the day of your discharge, you should plan to leave the hospital between 8:00 am and 11:00 am. You will need a responsible care partner to take you home once you’re discharged.
Before you leave, your doctor will write your discharge orders and make sure you have all the prescriptions you need. You will also get written discharge instructions. Your nurse will review these instructions with you before you leave.
Managing Your Pain
People have pain or discomfort for different lengths of time. You may still have some pain when you go home and you will have pain medication available for this if needed. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This doesn’t mean that something is wrong.
Follow the guidelines below to help manage your pain at home.
- Take your medications as directed and as needed.
- Call your doctor if the medication prescribed for you doesn’t ease your pain.
- Don’t drive or drink alcohol while you’re taking prescription pain medication.
- As your incision heals, you will have less pain and need less pain medication. An over-the-counter pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil®) will ease aches and discomfort.
- Follow your doctor or nurse’s instructions for stopping your prescription pain medication.
- Don’t take more acetaminophen than the amount directed on the bottle or as instructed by your doctor or nurse. Taking too much acetaminophen can harm your liver.
- Pain medication should help you resume your normal activities. Take enough medication to do your exercises comfortably. However, it’s normal for your pain to increase a little 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 your pain first begins is better than waiting for the pain to get worse.
Pain medication may cause constipation (having fewer bowel movements than what’s normal for you).
Talk with your nurse about how to 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. But, if you feel like you need 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. The reflexes in your colon are strongest at this time.
- Exercise, if you can. Walking is an excellent form of exercise.
- Drink 8 to 10 (8-ounce) glasses (2 liters) of liquids daily, if you can. Drink water, juices (such as prune juice), soups, ice cream shakes, and other drinks that don’t have caffeine. Drinks with caffeine, such as coffee and soda, pull fluid out of your body.
- Slowly increase the fiber in your diet to 25 to 35 grams per day. If you have an ostomy or have had recent bowel surgery, check with your doctor or nurse before making any changes in your diet. Foods high in fiber include:
- Whole-grain cereals and breads
- Unpeeled fruits and vegetables
- Mixed green salads
- Apricots, figs, and raisins
- Both over-the-counter and prescription medications are available to treat constipation. Try one of the following over-the-counter medications first.
- Docusate sodium (Colace®): This is a stool softener (medication that makes your bowel movements softer) that causes few side effects. 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.
- Senna (Senokot®): This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime.
For more information, read the resource Constipation.
The Healing Process and New Sensations
As you’re healing from your surgery, you may feel many different sensations in your arm, chest, or chest wall. You may feel sensations such as tenderness, numbness, twinges, or all 3. You may also feel the sensation of liquid going down your arm, when there’s no actual liquid. This can happen because your nerves were cut during surgery.
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 get better within the first few months after surgery. Some sensations may last months, or even 5 years or longer. This is because the nerves are the slowest part of your body to heal. Most people say 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 it will soften over the next few months.
Caring for Your Incision
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-StripsTM) over your incision(s), your surgeon or nurse will remove them at your follow-up appointment. If you have surgical glue (Dermabond®) over your incision, it will dissolve on its own over time.
Take a shower every day to clean your incision. Follow the instructions in the “Showering” section below.
Call your doctor’s office if:
- The skin around your incision is very red.
- The skin around your incision is getting more red.
- You see drainage that looks like pus (thick and milky).
Take a shower every day to clean your incisions.
Take your bandage(s) off before you shower. Gently wash your incisions with soap and water, letting the shower water run over them.
After you shower, pat the area dry with a clean towel. Put your wrap back on and secure the drains to your wrap. If it feels more comfortable, you can place a clean gauze pad over your incision, under the wrap.
Avoid baths, hot tubs, saunas, and swimming pools until your doctor or nurse tell you it’s okay. Also, talk with your doctor or nurse before you use deodorant, lotion, powder, or cologne anywhere near your surgery site.
Eating and Drinking
You can eat all the foods you did before your surgery, unless your doctor gives you other instructions. Eating a balanced diet will help you heal after surgery. Try to eat a good protein source (such as meat, fish, or eggs) at each meal. You should also try to eat fruits, vegetables, and whole grains.
It’s also important to drink plenty of liquids. Choose liquids without alcohol or caffeine. Try to drink 8 to 10 (8-ounce) glasses of liquids every day.
If you have questions about your diet, ask to see a clinical dietitian nutritionist.
Physical Activity and Exercise
In about 2 to 4 weeks, your incision may look like it’s healed on the outside, but it won’t be healed on the inside. For the first 6 to 8 weeks after your surgery:
- Don’t do any strenuous activities (such as jogging and tennis).
- Don’t play any contact sports (such as football).
Your physical therapist will give you written instructions on what exercises and movements you can do while your incisions are healing. The scar tissue that forms around your surgical site can limit the range of motion in your arm and shoulder. If you’ve had reconstruction, you may also experience muscle pain or tightness.
Review the information in Exercises for Men After Mastectomy for examples of exercises that will help you regain motion in your arm and shoulder. If you feel pain during the exercises, it may be helpful to take some pain medication 30 minutes before starting the exercises
Doing aerobic exercise, such as walking and stair climbing, will help you gain strength and feel better. Walk at least 2 to 3 times a day for 20 to 30 minutes. You can walk outside or indoors at your local mall or shopping center.
It’s normal to have less energy than usual after your surgery. Recovery time is different for each person. Increase your activities each day as much as you can. Always balance activity periods with rest periods.
You can start sexual activity when you feel ready. Having sexual intercourse won’t harm your surgical area.
If you feel comfortable, let your partner see your incision soon after your surgery. This may ease any worries you both might have. 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.
Our Male Sexual and Reproductive Medicine Program is available to help you if you have any concerns about the effects of your cancer or treatment. For more information or to make an appointment, call 646-888-6024.
You can find more information in the American Cancer Society resource Sexuality for the Man with Cancer: www.bit.ly/2oBLwXC.
Ask your doctor when you can drive. Most people can start driving again within 6 weeks after surgery. You shouldn’t drive until your drain(s) have been removed, you have a full range of motion in your arms and can comfortably turn the steering wheel.
Don’t drive while you’re taking pain medication that may make you drowsy. You can ride in a car as a passenger at any time after you leave the hospital.
Going Back to Work
Talk with your doctor or nurse about your job and when it may be safe for you to start working again. If your job involves lots of movement or heavy lifting, you may need to stay out a little longer than if you sit at a desk.
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 your lymph nodes were removed. This extra fluid causes swelling called lymphedema.
Lymphedema can happen in your arm, hand, breast, or torso on your affected side (the side where your lymph nodes were removed).
Most people won’t develop lymphedema, but some will. It’s hard to know someone’s risk of developing lymphedema because:
- There isn’t a standard test for diagnosing lymphedema.
- The removal of lymph nodes can affect everyone differently.
- Lymphedema can develop soon after you have surgery, or it can develop many years later.
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:
- If you had a sentinel lymph node biopsy, the risk of developing lymphedema is low.
- If you had an axillary lymph node dissection, studies show the risk of developing lymphedema is higher than with a sentinel node biopsy.
Lowering Your Lymphedema Risk
There is no way to know who will develop lymphedema, but there are things you can do to lower your risk of getting it:
- Maintain or safely work towards a healthy body weight.
- Exercise and stretch your muscles regularly. When you start exercising and being physically active again, start out slowly, then build up to doing more. If you feel discomfort, stop and take a break. Talk with your healthcare team 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 put an antibacterial ointment on it such as Bacitracin® or Neosporin®. Cover the area with a bandage.
- If you get a mild burn on your affected arm or hand, apply a cold pack or cold water on the area for 15 minutes, clean the area with soap and water, and cover it with a bandage.
- If you notice any signs of infection such as increased redness, pain, swelling, or heat, call you doctor or nurse. If you had an axillary dissection, you will get more information in the resource Hand and Arm Guidelines After Your Axillary Lymph Node Dissection
If you’re worried about developing lymphedema, talk with your healthcare provider.
Signs of Lymphedema
Some mild swelling after surgery is normal. The swelling may last for up to 6 weeks, but it shouldn’t last forever and will slowly go away. You may also feel pain or other sensations, such as twinges and tingling, after surgery. These feelings are common and likely aren’t signs of lymphedema.
If you’re at risk of developing lymphedema, watch for these signs:
- A feeling of heaviness or aching in your chest, arm, hand, or fingers.
- A tight feeling in the skin of your arm, hand, or chest.
- Less 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.Back to top
Call Your Healthcare Provider if:
- A fever of 101° F (38.3° C) or higher
- Drainage from your incision line
- Trouble breathing
- Warmer than normal skin around your incision
- Increased discomfort in the area around your incision
- Increased redness around your incision
- New or increased swelling around your incision
- Any questions or concerns
Monday through Friday from 9:00 am to 5:00 pm, contact your doctor’s office.
After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask to speak to the doctor on call for your doctor.Back to top
MSK Support Services
External Support Services
General Support Services
Breast Cancer Support Services
HIS Breast Cancer Awareness
Offers education and information on male breast cancer.
Male Breast Cancer Coalition
Patient advocacy organization that educates about male breast cancer.
Susan G. Komen
Provides information and support services for men with breast cancer.
Triple Negative Breast Cancer Foundation
Provides information to help people understand triple negative breast cancer.
- Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Herbal Remedies and Cancer Treatment
- Caring for Your Jackson-Pratt Drain
- Exercises for Men After Mastectomy
- What You Can Do to Avoid Falling