Dr Lucienne van Schalkwyk explains what to expect when the dressings come off after breast cancer surgery and the red flags to be aware of.
You can listen to this article below, or by using your favourite podcast player at pod.link/buddiesforlife
With the past Olympics, it made me think of a metaphor: breast cancer treatment is a marathon, not a sprint race. By the time you have surgery, you may have seen multiple doctors, had multiple scans and tests, and you may also have had treatment to shrink your tumour.
Many patients tell me that finally having the tumour removed at surgery is a huge relief after a stressful time.
But once the proverbial dust settles after surgery and you have recovered sufficiently to be discharged home, a few interesting issues may be revealed.
Common side effects after breast cancer surgery
You may experience the following in the days and weeks immediately after breast cancer surgery.
Swelling and bruising
Mild bruising and swelling are part of your body’s normal response to injury (in this case surgical injury). As with injuries to other areas of the body, bruising and swelling increases progressively over the first few days after surgery, where after it settles gradually. The swollen tissue may feel heavy or slightly tight, and if you have had reconstruction, your breasts may feel very big or unnaturally high and full. Sometimes one breast may be more swollen than the other.
Bruising is initially blue or purple and tends to settle in the lowest area of the breast. Your doctors will keep a close eye on your bruising and swelling to ensure that it’s improving as time goes by.
Patience is needed; swelling and bruising can take several weeks to vanish completely. Your post-operative bra will be your best friend during this time. It should be snug enough to support the breast properly (which will help to control swelling), without being so tight that it causes discomfort. Gentle massage may also help to improve swelling. Remember to check with your doctors before using any medication, supplements, or treatment in addition to what they’ve prescribed.
RED FLAGS
Contact your doctor immediately if the swelling: is excessive and causing discomfort, rapidly becomes worse (in a matter of hours), and if your bruising is becoming bigger or darker.
Drains
You may have been discharged home with wound drains. Different types of drains are used, but they all have the same purpose: draining excessive fluid from the wound site.
Following surgery, your body will produce fluid in the area of the surgery, to attempt to fill the cavity created during surgery. The drains remove this fluid to prevent a fluid collection (seroma), which can become infected.
Removing the fluid also allows the tissue to heal nicely. Before leaving the hospital, your healthcare team will demonstrate how to empty the contents of the drainage bag and will instruct you on how often to empty the drain. They will ask you to keep a record of how much fluid you have emptied every day following discharge.
You may be supplied with a bag in which you can store your drain bag, otherwise a pocket or waistband of your trousers will do fine.
Once the drainage volume has decreased sufficiently, the drains will be removed by your healthcare provider.
Initially, the fluid might be slightly bloody, but usually becomes a transparent yellow colour. The amount of fluid usually decreases progressively but may be up and down depending on how active you are.
RED FLAGS
Contact your doctor immediately if: a large amount of blood drains rapidly from the drain, the drain becomes blocked, falls out or disconnects from the drainage bag, the drain contains pus.
The incisions
The incisions will be covered with clean dressings after surgery. Your healthcare team will inform you whether you’re allowed to shower or bath, but generally we prefer that the dressings are kept dry. Don’t remove the dressings or apply anything on to the incisions unless specifically told to do so by your doctors.
RED FLAGS
Contact your doctor immediately if: your dressing becomes soiled or loose, the skin around the incision becomes red or black, there is a large amount of blood or pus on the dressing.
Pain
We all have different responses to pain, because pain tolerance varies from person to person. Upon leaving the hospital, you’ll receive pain medication which has been tailored specifically to you. Your doctor will explain whether you need to take your medication strictly at the times prescribed, or whether you may use it as and when necessary.
The goal is for you to be comfortable enough to perform the activities essential to your recovery: resting, eating well, and moving (which may include a series of rehabilitation exercises from the physiotherapist).
The good news is that the discomfort tends to decrease day by day following surgery. Many patients report strange sensations in their breasts after surgery, tingling, shooting pains like little electric shocks or hypersensitivity. These are usually not bothersome and can be an indication of healing.
RED FLAGS
Contact your doctor immediately if: your pain doesn’t improve, you feel unwell in any way (nausea, fever, etc.), you’re experiencing severe side effects from the prescribed pain medication.
Body image
Breast cancer surgery can feel like your body changes in the blink of an eye. The breasts you wake up to after surgery may be vastly different from what you were accustomed to before.
If you have chosen not to undergo reconstruction, it can be challenging to get used to living without a part of your body that has been with you for almost your entire life.
If you have had reconstruction, your reconstructed breasts may feel foreign, like they don’t belong to you. Early on after surgery, your breasts may also still be swollen, bruised and (let’s be honest) a little awkward-looking. This does improve but can add to your concerns.
While you may be very relieved that the cancer has been removed, you may simultaneously struggle with feelings of loss and grief, and anxiety regarding the way forward following your operation. In your journey towards self-acceptance and the creation of a new normal, it’s important to be extremely patient, gentle and kind towards yourself. Give yourself time to process these feelings, and check in regularly with your support system, whether it be family, friends or a mental health professional.
RED FLAGS
Contact your doctor immediately if: your stress, anxiety and/or feelings of sadness and hopelessness interfere with your recovery process.
MEET THE EXPERT – Dr Lucienne van Schalkwyk
Dr Lucienne van Schalkwyk is a general surgeon with a special interest in breast surgery. Her practice manages the entire spectrum of benign and malignant breast disease, and her specific interests include breast-conserving surgery and oncoplastic surgical techniques.
Header image by Freepik