Postoperative Care

Wound dressing and drain care after your surgery

image showing what a JP Drain looks like and how it fits into the breast areaWhen you go home, you will have a dressing over your incision or wound where the surgery was done. If you had a mastectomy or reconstructive surgery, you may also have Jackson-Pratt drains (JP drains) for a few days or week after your surgery. Below are some general care guidelines. Your surgeon will give you more specific instructions on how to care for your dressing and drains. (**If these instructions differ from what your individual surgeon recommends, follow the directions from your surgeon's office.**)

  • Make sure that the dressing stays clean and dry. The dressing should not become saturated with blood or clear fluid. If it does, apply an extra dressing and contact your surgeon.
  • Your surgeon will let you know when you can take a shower.
  • Your surgeon will tell you when to remove or change the dressing. He or she may want you to leave on the original dressing until your first post-surgery visit. When your surgeon gives you the okay, it is often easiest to remove the dressing by wearing in it in the shower and using the warm water to loosen it. After a shower, pat the incision dry and apply another dry dressing to keep the wound clean.
  • Check the incision or wound to make sure it is healing well. The wound should be dry without a lot of redness or pink surrounding it. It is normal to have some swelling, tenderness and numbness in the area.
  • Symptoms to watch for include:
    • redness around the wound leakage of clear, bloody or white fluid
    • large amount of swelling
    • excessive warmth around the wound
    • fever
  • If any of these symptoms develop, contact your surgeon. You may have an infection at the wound that requires treatment.
  • The JP drain(s) need to be emptied regularly. Your nurse will show you how to empty them before you leave the hospital. It may be easier to have someone help you empty the drains. To empty the drain, pull the stopper out of the top of the drain and pour the liquid into the container your nurse sent home with you. After the drain is empty, squeeze the drain flat with one hand and push the stopper back into the top of the drain. The collapsed drain will create suction and help pull the excess fluid out of the wound. Record the date, time and amount of fluid collected for each drain. The amount of fluid coming out of each drain will decrease over time.
  • The JP drain(s) can develop infections so it is important to watch the area around the tube for redness, warmth, drainage (clear, bloody or white) and fever. Call your surgeon if you have any of these symptoms. Sometimes fluid may drain around the tube instead of into the drain. If this occurs, you can apply a small dressing around the tube. Change it frequently if it becomes wet. Call your surgeon if there is a lot of drainage around the tube.
  • Occasionally, the JP drain may fall out on its own. If this happens, call your surgeon and do not panic.
  • Sometimes after the JP drain is removed, or if you never had a JP drain, fluid may collect under the skin and in the tissues under your arm. This may feel like a fluid filled ball and look visibly swollen. If it is uncomfortable, you can contact your surgeon, and the fluid can be drained very easily. Always stay alert to signs of infection as well.
The following is form that you can use to keep track of your JP Drain care.
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Activities after surgery

The time it takes to return to normal activities after surgery depends on the type of surgery performed. In general, lumpectomies require the least amount of recovery time, while a mastectomy with a tissue flap reconstruction takes the longest. Always check with your breast and reconstructive surgeons to determine when it is safe for you to resume specific activities.

General guidelines

  • When you first return home, you will be able to do much of your own personal care, such as bathing, dressing, preparing simple foods, etc.
  • You may find that you need to take rest breaks between activities, but you should not need to stay in bed for prolonged periods during the day.
  • A short walk each day will help your recovery.
  • You can resume light household and work activities such as simple meal preparation, folding laundry, using your computer and completing paperwork as you feel ready.
  • Avoid activities that require moderate to heavy lifting (grocery shopping) or pushing/pulling (vacuuming) and repetitive motions (such as washing windows or long hours at the computer).
  • A good rule during this time is to listen to your body, do what is comfortable, and stop and rest when you feel tired.
Driving
If you had a lumpectomy or a simple mastectomy without lymph nodes removed, you may be able to resume driving within a few days. If you had lymph nodes removed and/or reconstructive surgery, you may need to wait several days or weeks before you feel comfortable driving. You should not be driving as long as you are on pain medications. A pillow or seat belt positioning device may help cushion or adjust the seat belt to a more comfortable position when you drive.

Exercising
You will gradually be able to resume all of your pre-surgery activities over the course of the first several weeks and months after your surgery. Again, the best rule is to listen to your body, do what is comfortable, and stop and rest when you feel tired or sore. If you participated in vigorous sports before your surgery, check with your doctor to determine when it is safe to return to these activities.

Returning to work
Most women are ready to return to work within several weeks after their surgery. Again, this time frame depends upon the extent of the surgery and the type of work a woman does. Some women may choose not to return to work while they undergo adjuvant (additional) treatments, such as radiation therapy and chemotherapy. Another option may be to return to work part-time, gradually adding additional hours as you feel ready. Your doctor will help you determine what is best for you.
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Stretches

During your early recovery period, you need to maintain the range of motion in your arm and shoulder. At your first post-surgery check up, ask your surgeon if you can start some of these simple stretches and exercises:

  • Shoulder shrugs: with your arms at your sides, pull your shoulders up towards your ears and hold for a few seconds. Repeat several times.
  • Raise your arms in front and to the side
  • Wall walks
  • Broomstick/yardstick behind the back or climbing
  • Hands behind head stretch
  • Arm away from body stretch (broomstick/yardstick to the side)
  • Overhead stretch


Hand head stretch
Arm body stretch

Overhead stretch
Behind the back stretch

Arms stretch-raises
Clasp lift stretch-raises

Climbing
Arm extension

Biceps curl
Upper torso stretch

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First aid for your arm following surgery

Despite all the planning and care you take with your arm following surgery, sometimes you may find yourself with an injury that requires treatment. Be prepared to handle any of these minor emergencies by keeping the following supplies on hand: bandages, antibiotic ointment, antihistamine cream and lotion without dyes or fragrance.

Cut or scratch to the hand or arm
1. Apply pressure gently to stop any bleeding.
2. Wash the cut with tepid water and soap.
3. Dry the area.
4. Apply antibiotic ointment to cut.
5. Cover with a bandage.
6. Clean, reapply ointment and bandage once a day or more often if wet or soiled. Do not leave a wet bandage on to dry.
7. Watch for signs of infection at the site and arm: redness, warmth, drainage and/or fever. Contact your doctor if you experience any of these symptoms.

Burn to the hand or arm
1. Rinse area with tepid water and pat dry.
2. If burned skin is open, contact your doctor. Otherwise follow the steps below.
3. Apply an antibiotic ointment to burn.
4. Apply a non-adherent bandage.
5. Watch for signs of infection at the burned area and arm: redness, warmth, drainage and/or fever. Contact your doctor if you experience any of these symptoms.

Insect bite to the hand or arm
1. Wash area and dry.
2. Do not scratch site. Apply an antihistamine cream, such as Benadryl, to site to decrease itching. A cool compress may also help decrease itching.
3. Watch for signs of infection at the site and arm: redness, warmth, drainage and/or fever. Contact your doctor if you experience any of these symptoms.

Sunburn to the hand or arm
1. Bathe in tepid water.
2. Liberally apply lotion containing aloe vera, with out fragrance or dyes, to arm at least four times a day.
3. Expect some swelling in the arm, but the swelling should begin to decrease after 48 to 72 hours. When sitting or lying down, try to keep your arm elevated. If it is still swollen as the sunburn improves, contact your doctor.
4. Wear loose fitting clothing.
5. Watch for signs of infection: redness, warmth, drainage and/or fever. Contact your doctor if you experience any of these symptoms.

Overuse of the arm
1. It is okay to use the arm for everyday tasks, but try not to do any heavy lifting or repetitive motions with the arm.
2. Rest the arm if it is sore or tired.
3. Try to keep the arm elevated when sitting or lying down.
4. Contact your doctor if swelling does not improve within 48 hours.

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Lymphedema

Lymphedema is the collection of protein-rich lymph fluid in the tissues of the hand, arm and/or chest wall on the side of the breast surgery. Lymphedema causes painless swelling of the hand, arm and/or chest. The condition occurs when the normal lymphatic drainage in the chest and arm are injured during surgery and/or radiation therapy. Read more about lymphedema

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