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Wound Care

[This information guide is also available in PDF format to download.]

 

Surgery for breast cancer may involve removing part of the breast or removing the whole breast. Usually some or all of the lymph glands in the armpit are also removed. Some women may also have breast reconstruction surgery at the same time as their breast cancer surgery.

Most women make an uneventful recovery from surgery, quickly returning to their normal daily activities. This brochure gives you information about how to care for your wound after surgery. It describes the normal changes that occur following surgery and explains some of the possible problems that can arise. It also provides contact telephone numbers you may use if you feel you need more help.

 

Looking after your wound

Following surgery for breast cancer, there is normally one wound in the breast (if only part of the breast has been removed) or on the chest wall (if a mastectomy has been performed). If the lymph glands have been removed, there may be other wounds in the armpit and/or breastbone areas.

 

Dressings

The wound or wounds will usually be covered by a waterproof dressing on top of steristrips (paper tapes). These dressings should remain in place until your post- operative appointment 7 to 10 days after surgery. You may shower as usual with the waterproof dressing in place.

In some cases there may be a larger padded (pressure) dressing covering the waterproof dressing. If this is in place you should remove it the day after your surgery before your shower and leave the waterproof dressing in place. This padded dressing is the only dressing you should remove.

The wound is usually closed with dissolving stitches which do not need to be removed. Most patients do not go home with stitches that need removing.

 

Skin Care

The day after surgery, you may shower as usual and pat the wound dry using a soft, clean towel. Allowing  the wound to get wet in the shower will not cause any damage; in fact, keeping the area clean helps prevent infection and encourages healing. It is, however, better not to soak the wound in a bath. Swimming should also be avoided until the wound has healed.

 

Drainage

During surgery, a drainage tube (drain) may be placed in the breast wound. This may be removed in the hospital before you go home; whereas at other times it needs to stay in for longer. If lymph glands are removed from the armpit, a second drain may be placed in the armpit. This one often needs to stay in for a week or more, and you may go home with this armpit drain in place. If you go home with the drain in, you will usually have help looking after it. The hospital will arrange this for you, through your general practitioner (GP) or community nursing team. The drain will be removed at the appropriate time according to your surgeon’s instructions.

In some cases, it may not be possible to arrange community nursing and you will be shown how to look after the drain yourself. You will be asked to keep a record of the volume of fluid that comes down the drain each day. This is important as it will guide the decision as to when the drain should be removed. Breast care nurses will be available to advise you.

Women who have had breast reconstruction that includes a breast implant or tissue expander will usually need oral antibiotic tablets until their drain or drains are removed.

 

Exercise

It is important to perform the arm and shoulder exercises recommended by your doctor and physiotherapist. You should try to use your arm for normal daily activities, within the limits of pain, to prevent arm and shoulder stiffness. Wound healing is not delayed by doing arm exercises or by using your arm as usual. Some patients worry that exercising may ‘pull open’ their wound, but this is not the case.

If you have a drain in place you will be asked to do your shoulder and arm exercises only to shoulder height until the drains are removed.

More information about arm and shoulder care can be found in the brochure Shoulder Care.

 

Common problems following surgery

Most problems arising from breast surgery are not emergencies. These can usually be treated by your community nursing team or your GP. If they have any concerns, they will contact your specialist.

 

Pain

It is normal to experience some pain after breast surgery. Usually the pain tablets recommended by the hospital will control the pain if you take them  in the recommended doses. Some pain tablets can cause constipation. It is important to ensure you are having sufficient fluid during the day and that you are doing some gentle exercise. In some cases you may require a simple laxative. If you need advice about this, contact your GP or breast care nurse.

If you experience an increase in pain after you go home, you may be developing problems with your wound. If this happens, contact your GP or local hospital to have the wound checked and to get advice on how to manage the pain.

Many women experience sharp stabbing like pains that do not last for long but can be concerning. This is normal after breast surgery and can occur when only part of the breast has been removed or when a mastectomy has been performed. These pains do not require any special treatment and they will settle over time.

 

Bruising

Minor bruising around the wound is common after any surgery. More significant bruising will occur in around 25% of patients. Other than giving a dark appearance, which may change to a yellow colour, this is usually not a problem. Most bruising will settle without treatment   as the body breaks down the blood collection over a 2–3 week period.

A more significant form of bruising is a haematoma, which sometimes requires treatment. This is discussed later in this brochure.

 

Wound Swelling

It is common to get some swelling or lumpiness along the edges of the wound. It may take 6–8 weeks for the wound to flatten out. This is early scar tissue forming and it is not a cause for concern.

 

Drain leak and drain blockage

A blocked or leaking drain is an annoying situation. If the drain leaks simply wash around the drain site, apply a clean pad, and tape it around the drain. If the leak continues, call one of the contact numbers on the back of this brochure to obtain advice. It may be that the drain is blocked and may need to be removed earlier than planned. Once again, this is not an emergency.

 

Seroma

A seroma is a build-up of normal body fluid that often occurs after armpit (axillary) surgery. Although seromas can be uncomfortable and cause significant swelling, they are not dangerous. A seroma is not a recurrence of your cancer, nor is it long-term swelling of the arm (lymphoedema). Seromas tend to develop over a period of days to weeks and are not emergencies.

Some patients (up to 30%) will need to have the fluid from a seroma removed using a syringe and needle. Seroma can develop even after a drain has been removed at the “correct” time.

If the fluid is removed with a needle, it will often need to be done a few times over a period of days to weeks until the build-up of fluid settles. This procedure is not usually painful as the needle can be placed in a numb patch in your skin. After you have had a seroma drained once, you will easily be able to recognise the signs if the fluid collects again.

Occasionally, seromas can discharge by themselves causing a release of blood-stained fluid through the armpit wound. This distressing event is not an emergency. If this occurs, simply wash the area with warm water and apply a dry dressing to the wound.

 

Numbness

It is common to experience some numbness under the arm and along the outer part of your chest following surgery in the armpit area. This happens because a nerve that gives feeling to the skin in this area is often cut during surgery. The size of the numb patch may reduce with time but usually does not go away completely. Rarely, women may experience this numbness as a burning sensation.

It is also common to experience some fleeting pains and funny sensations down the arm on the side of the surgery. These will usually settle down in time but can take 6–12 months to go away. Rarely, medication will be required to control these sensations.

 

Stitches

The stitches in your wound are usually dissolving and do not need to be removed. The stitches are internal, but occasionally, part of a stitch does not dissolve and may partly come out through the skin. If this happens, the stitch needs to be cut and removed; you can do this yourself or ask your doctor or nurse to do it for you.

 

More serious problems following surgery

If you think you may have any of these problems, contact your GP, breast clinic or community nursing team within 24 hours to have the wound checked. Your specialist may need to be contacted to review the wound.

 

Wound infection

Wound infections occur in about 1 in 20 patients with a breast or armpit wound. If an infection develops, the wound usually becomes more painful. You may also see swelling and redness, and pus may be seen around the edges of the wound. Rarely, you may feel unwell and develop a fever as a result of a severe infection.

Wound infections usually develop over several days and are not emergencies. If you notice that the wound is becoming hot or red, or it becomes more painful, you should see your GP or specialist within 24 hours. Some wound infections require antibiotics and others may need the stitches removed to allow any collection of pus or fluid to be removed. If you are prescribed a course of antibiotics, it is important to finish all the tablets, even if the infection settles after only a few doses.

 

Wound breakdown

Sometimes the blood supply to the edge of the wound is not adequate to allow proper healing. This is a particular problem for patients who have undergone a mastectomy, had previous radiotherapy, or patients who are smokers. If this problem occurs, it develops gradually over several days and is not an emergency. If this occurs, the edge of the wound in one section or along the whole length   of the wound changes to a dark red or purple colour. This can usually be treated with dressings to the wound. Occasionally, this area may need to be removed in a small operation at a later time.

If you are worried about the edges of your wound you should ask your nurse or doctor to check your wound.

 

Haematoma

A haematoma is a collection of blood in the wound.

It causes swelling and bruising of the wound. Sometimes a small amount of old (dark) blood can be seen leaking from the wound. Rarely the amount of bruising that occurs may require that the blood collection be removed in the doctor’s surgery or in the operating theatre.

If you are experiencing severe swelling with bruising you should ask your nurse or doctor to review your wound. If either is concerned, they will contact your specialist to arrange a review. Many wound haematomas can be drained on an outpatient basis.

 

Wound Care Red Alert Card

Some of the common problems following breast surgery are listed below. These are explained in more detail above. Most problems arising from breast surgery are not emergencies. These can usually be treated by your community nursing team or your General Practitioner (GP). If they have any concerns, they will contact your specialist. If you suspect you may have any of the problems listed below, contact your nurse, community nursing tem, hospital or GP.

 

Looking after your wound

  • If you have a larger outer padded dressing remove it the day after surgery.
  • You may shower the day after surgery (with the waterproof dressing in place).
  • The waterproof dressing should stay on until your post-operative appointment
  • Dissolving stitches are usually used in the skin and will not need to be removed.
  • Use your arm as normally as possible within the limits of painShoulder exercises should be performed as directed by your doctor or physiotherapist. (See ‘Shoulder Care’ brochure).

 

Common problems following surgery

Pain: Some pain is normal but should be well controlled with pain tablets recommended by the hospital.

Bruising: Mild bruising and swelling around the wound is normal; more extensive bruising is explained in the ‘haematoma’ section below.

Leaking or blocked armpit drain: If the drain leaks, wash the area with warm water and apply a clean pad.

Seroma: Fluid may build up in the armpit wound causing swelling and discomfort; this may need to be drained by your doctor or nurse; it may also cause leaking of fluid from the wound.

Numbness: Numbness under the arm and along the outer part of the chest is normal after surgery to the armpit area. If you think you may have any of these minor problems, discuss them with your nurse, community nursing team or GP in the next two days.

 

More serious problems following surgery

Wound infection: If you experience redness, swelling, pus or a significant increase in pain, you may have a wound infection.

Wound breakdown: The edge of the wound in one section or along the whole wound may change to a dark red or purple colour, and may require special dressings.

Haematoma: This is a more serious form of bruising that occurs when there is a collection of blood in the wound; it causes swelling under the wound, and sometimes dark blood leaks out of the wound. The blood collection may have to be drained by your surgeon.

 

If you think you have any of these more serious problems, contact your nurse, community nursing team, hospital or GP in the next 24 hours.

 

IMPORTANT: At all times you should rely on the expert judgement of your medical advisor(s). This information guide is not a substitute for medical advice. It is designed to help you understand and discuss your treatment.

 

[This information guide is also available in PDF format to download.]

 

Version 4, last reviewed September 2014. Document number WSP 234.

Reviewed by consumers, and scientific and plain English editors.

Copyright Westmead Breast Cancer Institute 2016