After breast cancer surgery

Most people recover well after breast surgery with few major side effects.

Common after-effects of breast cancer surgery can include:

• Pain and discomfort
• Feeling sick (nausea)
• Bruising 
• Swelling
• Seroma
• Wound infection 
• Haematoma 
• Change in sensation 
• Scars 
• Discolouration 
• Stiff shoulder
• Cording
• Lymphoedema

Not everyone will have these effects, and they are usually temporary or can be controlled.

Talk to your treatment team or breast care nurse if you have any concerns after surgery. 

Any of the following symptoms could mean you have a wound infection: 

• The wound feels tender, swollen or warm to touch 
• Redness in the area 
• Fluid (discharge) from the wound 
• Feeling generally unwell with a raised temperature 

Contact your GP, breast care nurse or specialist straight away if you think you may have a wound infection. 

You may need a course of antibiotics to stop the infection and discomfort. 

A wound infection can happen any time after surgery until the wound is completely healed. 

It usually takes about 2 to 3 weeks for skin to heal and around 10 weeks for any internal stitches to dissolve. 

Swelling soon after the operation is common and will usually settle over time. Your treatment team may call this swelling oedema.

The swelling may affect your breast, chest wall, shoulder and arm.

It’s a normal part of the healing process and should lessen 6 to 8 weeks after your surgery.

Women may want to wear a supportive bra day and night if the swelling is uncomfortable and feels heavy.

If you’re unsure or concerned about the swelling, talk to your breast care nurse. They may want to see you to check the swelling.

After surgery some people develop a collection of fluid called a seroma. 

This normally occurs under the arm or in the breast or chest wall and is usually reabsorbed by the body over time. 

Seromas can also occur in the tummy area if tissue has been taken from here for reconstruction. 

If the seroma causes discomfort or doesn’t reduce or go away, your specialist or breast care nurse may decide to draw off (aspirate) the fluid using a syringe and needle. 

Sometimes a seroma will refill after it has been aspirated so it may need to be aspirated several times over a few weeks before it goes away completely. 

This is usually a painless procedure as the area is likely to be numb. 

If the seroma restricts your arm movement and prevents you doing your arm and shoulder exercises, speak to your breast care nurse or surgeon for advice. 

Pain and discomfort

You’re likely to have some pain or discomfort after surgery but everyone’s experience is different. 

There are different types and strengths of pain relief.

Pain relief can be given as:

• Tablets
• Suppositories: waxy pellets placed into your rectum (back passage)
• Injections

You’ll be given pain relief according to your needs. It’s important to take it as prescribed. 

Some people find changing position and using pillows to support the wound can help reduce pain or discomfort. 

Sometimes pain relief may be given through a device called a PCA (patient-controlled analgesia). This is a pump designed to give pain relief straight into your vein when you press a button. It’s usually removed a day or two after surgery. This is commonly used if you’re having breast reconstruction. 

Many people experience pain, numbness and a burning sensation as a result of temporary damage to the minor nerves under the arm and scar area. 

If you’re in any pain while in hospital tell the ward staff. You may need a strong dose of pain relief, or a different type. 

If you don’t feel your pain is controlled when you’re back at home, contact your hospital team or GP. 

Feeling sick 

Not everyone will feel sick (nausea) after surgery. Some people are more likely to do so than others, for example people having very long operations such as those involving breast reconstruction. 

Any sickness is usually only short term. 

Anti-sickness drugs (anti-emetics) given as a tablet or injection can help relieve nausea, so tell the nursing staff if you feel sick. 

Bruising 

Bruising is common after surgery but will disappear over time. 

Haematoma 

Occasionally blood collects in the tissues surrounding the wound causing swelling, discomfort and hardness. This is called a haematoma. 

The blood will eventually be reabsorbed by the body but this can take a few weeks. 

If a very large haematoma develops after your surgery, your surgeon may suggest removing it by drawing the blood off with a needle and syringe. Occasionally, a small operation is needed to remove it. 

Contact your breast care nurse or ward if you have any concerns after you have left the hospital. 

Change in sensation 

Some people have pins and needles, burning, numbness or darting sensations in the breast area and down the arm on the operated side. 

These symptoms are quite common and may last for a few weeks or even months. 

The scar may feel tight and tender. This is because the nerves under the arm have to be disturbed to reach the lymph nodes behind them. 

If you had a mastectomy, with or without breast reconstruction, you may have similar symptoms in your chest area. 

If you had breast reconstruction using a flap of your own tissue you may also feel a change in sensation in the area where tissue was taken from. 

These symptoms are usually temporary and improve with time or completely disappear over a few months. Some people who have had lymph nodes removed are left with some permanent numbness or changed feeling in their upper arm. 

If you’re concerned about these symptoms, tell your specialist or breast care nurse. Although it may not be possible to relieve all your symptoms, some helpful treatments are available. 

Scars 

Whatever breast surgery you have will leave some type of scar. 

Looking at and feeling the scar for the first time can be difficult. Some people find it helpful to have someone with them when they first look at their scars while others will want to be by themselves. For many women this can take some time. 

Getting to know how your scars look and feel will help you notice any immediate and possible future changes. 

Scar tissue is produced naturally by the body during healing. At first your scar will feel uneven to the touch and may feel tight and tender. Scars are often initially red but will fade and become less obvious over time. 

Your treatment team should be able to tell you when you can start moisturising your scars to help them heal.

Women may find it uncomfortable at first to wear a bra or anything that puts pressure on the affected area. As the scars become less sensitive you should be able to wear a comfortable bra. 

If you had a mastectomy you’ll also be able to wear a lightweight prosthesis (artificial breast form) as soon as you feel comfortable. 

Discolouration in sentinel lymph node biopsy 

If you have a sentinel lymph node biopsy including the use of radioactive dye, your breast may be discoloured and your skin may have a blue or grey–black tinge, depending on the dye used. 

This is temporary and usually fades slowly, though can sometimes take several months to go completely. 

The blue dye usually flushes out in your urine, which will make it look a green colour for a few days. 

Stiff shoulder 

Your arm and shoulder on the operated side may feel stiff and sore for some weeks. 

Your breast care nurse or physiotherapist will give you some gentle exercises to help you get back the range of movement you had before your surgery. 

Normally you start the exercises as soon as you can, ideally the day after your surgery. It’s a good idea to take regular pain relief to help you when doing these exercises. 

Our exercises after breast cancer surgery leaflet may also help. 

It’s important to have a full range of shoulder movement before starting radiotherapy. 

If you’ve had or are having breast reconstruction, talk to your breast surgeon or physiotherapist before you start your exercises and follow their advice. 

Cording 

After surgery, some people develop a tight ‘cord’ of tissue under the skin, causing pain and restricting arm movement. The cord is not always visible, but can usually be felt. 

This cord starts in the armpit and can vary in length. It may just be in the armpit, or may travel down to the elbow or wrist. This ‘cording’ is also known as axillary web syndrome. 

It can appear even months after surgery to the area under the arm. 

No one is sure what causes cording, but it may happen when lymph vessels, which carry lymph fluid from the arm, become hardened. 

Stretching and massaging the cord can improve your symptoms and you may need physiotherapy to help with this. You’ll sometimes be advised to take pain relief before doing the stretches as they may feel uncomfortable. 

Cording usually gets better with physiotherapy and exercise. Some people develop cording more than once.

If you have any symptoms you’re concerned about tell your specialist as soon as possible. 

Lymphoedema 

Lymphoedema is swelling of the arm, hand, breast or chest area caused by a build-up of lymph fluid in the surface tissues of the body. 

It can occur as a result of damage to the lymphatic system, for example because of surgery or radiotherapy to the lymph nodes under the arm and surrounding area.

How long does it take to recover? 

Your wound should heal within 6 to 8 weeks. 

But it may take several months for your affected breast or chest area and arm to feel ‘normal’ again, particularly if you’ve had surgery under your arm. 

In some cases, the affected area will always feel different.

Looking after your wound and drains 

Follow any instructions you’re given about caring for your wound.

You may have wound drains inserted during the operation. These are tubes that drain blood and fluid from the wound into a bottle or small bag. 

At some hospitals you may be discharged with your drains still in place, while in others you are discharged once they have been removed. 

Find out more about caring for drains in our booklet: Your operation and recovery.

Returning to normal activities 

You should be able to return to most of your normal activities within a few weeks of your operation. However, this will vary from person to person and will depend on the type of surgery you’ve had. 

It can help to take things gently at first. You may have more discomfort and stiffness as you begin to move your arm more and become more active. This usually improves naturally over time. 

Once you get home from hospital, you can try to do a little more physical activity each day. 

Don’t set yourself enormous tasks and remember to rest between them. Your body needs time and energy to recover. 

Eating well will also help your body recover and your wound to heal.