Self Care After Your Breast Surgery

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1 NEWYORK PRESBYTERIANHOSPITAL SelfCareAfterYourBreastSurgery SelfCareAfterYourBreastSurgery SelfCareAfter Your BreastSurgery PhysicalTherapy DepartmentofRehabilitationMedicine 1 Page WWW. N Y P R E H A B M E D. O R G 2 Page

2 SelfCareAfterYourBreastSurgery SelfCareAfterYourBreastSurgery The physical therapists of NewYork- Presbyterian Hospital have created this booklet for you. We have put together some information that will help you understand how to care for yourself after your mastectomy surgery. We want to help you to recover from your surgery and prevent some possible problems that may happen because of the operation. This booklet will explain about the risk of developing arm stiffness or swelling, also called lymphedema, both of which you can minimize by following our instructions. Your physical therapist (PT) will review the information with you during your sessions. You should take this booklet home with you as a reference. Please feel free to call us with any questions or concerns you might have. Your PT is. Phone: (212). Arm Stiffness after Mastectomy What causes arm stiffness after mastectomy surgery? After a mastectomy surgery, the incision will heal by forming a scar. This scar can sometimes heal in a way that can limit the motion of your arm, especially in your shoulder. What can I do to avoid arm stiffness? There are certain exercises that you can do that can prevent your arm and shoulder from becoming stiff or from losing movement. Doing the exercises outlined later in this booklet will help you to avoid this problem. It is easier to prevent this problem from happening early on rather than to try to fix it later on. In addition to doing the exercises, watching your posture while sitting, standing, and walking can also help to keep your arm from getting stiff. Try to always sit and stand up straight. Hold your head straight over your body rather than forward. Do not hunch your shoulders. Instead, hold your shoulders in a relaxed position, back and down. 3 Page 4 Page

3 SelfCareAfterYourBreastSurgery SelfCareAfterYourBreastSurgery When should I begin these exercises? You can start these exercises as soon as your doctor says it is okay to do so. If you have had a TRAM (transverse rectus abdominus muscle) flap procedure, your doctor will probably tell you to wait 10 days before starting the exercises. Unless your doctor tells you otherwise, for the first 10 days you can move your arms to do regular every day activities. For example, you may reach your arm to put on a shirt, hold a phone up to your ear, put on your glasses, or wave hello to a friend. If you have had a tissue expander, your doctor will probably tell you to wait 7 days before starting the exercises. Until then, you can move your arm to do typical every day activities, as described above. How long will I need to do the exercises? The exercises may seem hard at first and you may feel as if they are not working. If you continue to do them, you will become stronger and the exercises will get easier. If you find that your arm or shoulder motion is still limited, keep working at it. Since everyone heals differently, it is hard to say how long it will take. If you do not think that you are getting better on your own, ask your doctor to refer you to outpatient physical therapy. Once you reach your full arm mobility, you will want to keep it from getting stiff again. Make sure to keep moving your arm over your head on a regular basis to avoid the stiffness from coming back. Will the exercises hurt? You should feel only a slight pull or stretch at your incision when you are doing the exercises. Do not force the motion to the point of pain. How often should I do the exercises? Try to do each exercise 10 times; repeat the whole exercise program once or twice a day. 5 Page 6 Page

4 SelfCareAfterYourBreastSurgery SelfCareAfterYourBreastSurgery The Exercise Program Deep Breathing Exercise Sitting upright or lying down, focus on taking calming deep breaths. Take slow deep breaths in through your nose and breathe out slowly through your mouth. Make your breath in as long as your breath out, about 5 seconds each. Repeat this 10 times. Neck Stretches Sitting in a chair with back support, slowly drop your head to one side. Roll your head forward so your chin is close to touching your chest and roll it to the other side and back in a circle. Repeat 5 times in each direction. Next, turn your head to look to one side, as if looking over your shoulder. Turn your head to the other side. Repeat 5 times in each direction. First, stand facing a wall, arms and shoulders relaxed. Slowly walk the fingers of your affected arm up the wall as high as you comfortably can until you first begin to feel a stretch or pull in the area of the incision. Hold the stretch for about 15 seconds, as long as it is pain-free. Walk your fingers back down. Repeat 10 times. Next, stand sideways with your affected arm next to the wall. Again, slowly walk your fingers up the wall as high as you comfortably can until you first begin to feel a stretch or pull in the area of the incision. Hold the stretch for about 15 seconds, as long as it is pain-free. Repeat 10 times. Wall Climbs 7 Page 8 Page

5 SelfCareAfterYourBreastSurgery SelfCareAfterYourBreastSurgery Chest Stretch Sitting in a chair or standing, clasp your hands behind your head. Move your elbows apart and backwards until you feel a light stretch. Move your elbows forwards and backwards 10 times. Arm Lifts Lying flat on your back, begin with your hands at your sides. Slowly raise one arm up and overhead until you can feel a stretch. Return it back to your side and raise the other arm. Repeat each arm 10 times. Lymphedema after Mastectomy 9 Page What is lymphedema? Lymphedema is a type of swelling where fluid from the lymphatic system builds up in the soft tissues of the body, usually the arm or leg. It can become an ongoing condition, and it can worsen over time. It can cause problems with wound healing and can cause a type of infection called cellulitis. What causes lymphedema? Lymphedema happens when the vessels of the lymph system are missing or damaged. It can be present at birth or develop later in life from unknown causes or problems with the vascular system of the body. It can also occur from surgery, radiation, infection or trauma. Mastectomy surgery often requires the removal of lymph nodes, which can also lead to lymphedema. What is my risk of getting lymphedema? Your risk for getting this type of swelling increases with the number of lymph nodes that you have had removed. Sentinel node removal (the first node to receive lymph from the affected breast) or the removal of several lymph nodes may cause it. It can also begin days, months or even years later. Because of this, you must follow the outlined precautions for the rest of your life. What are the symptoms of lymphedema? 10 Page

6 SelfCareAfterYourBreastSurgery SelfCareAfterYourBreastSurgery Swelling in a part of your arm or in your entire arm, including your fingers A feeling of heaviness or tightness in your arm, including your skin feeling tight Restricted motion or flexibility in your arm Difficulty fitting into clothing or tightness of jewelry such as a ring or watch Hardening and thickening of your skin Cellulitis of your affected arm What is Cellulitis? Cellulitis is a type of infection that can occur if you also have lymphedema. Germs can enter your body through even small cuts in the skin. If you have any ongoing swelling in the tissues, the germs can cause a serious infection. What are the symptoms of cellulitis? Symptoms of cellulitis are redness or blotchy skin, itching, pain, warmth and swelling. You may also have a sudden onset of high fever and chills. If you begin to notice signs of possible infection, call your doctor right away. If you cannot reach your doctor, go to the emergency room. Cellulitis may require treatment with antibiotics and requires immediate medical attention. How can I prevent lymphedema and cellulitis? 11 Page You can help prevent getting lymphedema or cellulitis by following special hand and arm care instructions if you have had any lymph nodes removed. Hand and Arm Care Instructions After Lymph Node Removal Rest your arm Take rest breaks when doing repeated motions with your arms, such as scrubbing, mopping, or sports activities. Rest with your arm in a position above the level of your heart to avoid swelling. Avoid lifting heavy objects, such as a gallon of milk, with the arm on the affected side. Avoid carrying heavy objects with the arm on the affected side, especially with your arm hanging down. Avoid carrying heavy shoulder bags on the affected side. Take care of your skin Check your skin often, and look for any changes in color, size or feeling, such as fullness in the arm, numbness, or tingling. Keep your skin moisturized daily by using a fragrance free, ph-balanced lotion. Be careful not to over-heat your skin. Avoid hot baths, showers, saunas, hot tubs 12 Page

7 SelfCareAfterYourBreastSurgery SelfCareAfterYourBreastSurgery or steam baths. Also, do not use heating pads or hot compresses on your arm, neck, shoulder or back on the side that had surgery. Avoid deep tissue or Swedish massages to the affected arm. Protect your skin from cuts, burns, and bites Use gloves when washing dishes, doing outdoor chores and while cooking. When your wound has healed, you may shave under your arm and begin using deodorant. Use a mirror or an electric razor to avoid nicks and cuts. Use sunscreen and insect repellant when needed to protect your skin. Do not get your cuticles cut when getting a manicure. Apply antibiotic ointment immediately for small cuts, insect bites and torn cuticles. Wear lose fitting clothes and jewelry Make sure your clothes are loose enough that they do not limit your upper body and arm movement. Make sure that your jewelry, such as watches and rings are not too tight. Other things to consider Wear special compression bandages or a compression sleeve when flying. Choose lightweight breast prostheses. Do not smoke. Avoid drinking alcohol. Additional Information The following resources will help you begin to navigate the wealth of information available to you on the internet and in New York City. Women at Risk (WAR) Women at Risk is NewYork-Presbyterian s high-risk breast cancer program, which provides various types of support for women at risk for breast cancer and to those who already have the disease. The WAR Resource Library provides patients with the most up-to-date materials about breast cancer and other health issues of concern to women. Breast cancer survivors staff the library and can provide one-on-one support to women in need. The Library is located in Room 1035 in the Herbert Irving Pavilion, Floor 10. WAR and the Department of Social Work Services sponsor a support group that meets weekly. Ask your social worker or visit the website for more information. 13 Page 14 Page

8 SelfCareAfterYourBreastSurgery SelfCareAfterYourBreastSurgery WAR Library Patient Navigator SHARE: Self-Help for Women with Breast and Ovarian Cancer SHARE is a non-profit organization that offers a hotline, a periodical newsletter and sponsors support groups throughout the five boroughs. The hotline is available to answer questions and provide emotional support, and is available in English and Spanish. The groups allow newly diagnosed or treated women an opportunity to meet over an extended period and to explore common concerns Hotline American Cancer Society s Reach to Recovery Program This special program for breast cancer recovery runs monthly support group meetings. Volunteers are also available for individual meetings in hospital or at home. Reach for Recovery is also able to provide a temporary breast form/prosthesis in a front- 15 Page closure bra. Many local chapters also sponsor monthly seminars ACS-2345 ( ) Cancer Care This non-profit social service agency provides free psychological and financial support. Cancer Care is also able to provide financial assistance for transportation to radiation and chemotherapy treatments HOPE YWCA Encore YWCA Encore offers an exercise program and group discussions. You can get additional information from your local YWCA or the national office National Office Adelphi State Wide Breast Cancer Hotline and Support Program Adelphi University offers a free hotline, support group, and newsletter for women with breast cancer who live in New York State Hotline Office 16 Page

9 SelfCareAfterYourBreastSurgery SelfCareAfterYourBreastSurgery The Susan G. Komen Breast Cancer Foundation This organization strives to eliminate breast cancer by advancing research, education, screening and treatment GO KOMEN ( ) Breast Cancer Network of Strength This non-profit organization provides information, educational programs, self-help meetings, and a 24/7 YourShoes hotline service. The hotline offers trained peer counselors who are all breast cancer survivors and they have interpreters in 150 different languages English Hotline Spanish Hotline National Lymphedema Network This internationally recognized non-profit organization offers education and guidance regarding lymphedema Hotline Page National Cancer Institute, Cancer Information Service The National Cancer Institute, part of the US National Institutes of Health, offers a telephone service that answers questions and provides publications about cancer, clinical trials, support, resources and treatment options CANCER ( ) My Secret Mastectomy Salon A breast prosthesis salon located in New York City and online W. 71st Street, Suite 1F NY, NY Underneath It All Boutique Provides products to women after breast surgery to improve self-image and selfesteem; products include breast prostheses, enhancers, bras, swimsuits, scarves, hats and wigs. Your insurance may cover many of their products. They also offer fittings by appointment at the Columbia campus of NYPH (see website for more information). 18 Page

10 SelfCareAfterYourBreastSurgery SelfCareAfterYourBreastSurgery E.75 th Street, #1b (at York) New York, NY E.34 th Street, 4 th Floor (at 3 rd & Lex) New York, NY This information is brief and general. It should not be the only source of your information on this health care topic. It is not to be used or relied on for diagnosis or treatment. It does not take the place of instructions from your doctor. Talk to your health care providers before making a health care decision. Department of Rehabilitation Medicine Physical Therapy NewYork-Presbyterian Hospital Copyright NewYork-Presbyterian Hospital All rights reserved. (RL7.9, SAM, 12/2010) 19 Page 20 Page

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