Breast Surgery Post-Op

Immediately after surgery, your surgeon will meet with the responsible adult in a private consult room to discuss
how the surgery went and what to expect. The surgeon will also stop by to visit with you in the Post Anesthesia
Care Unit (PACU), but it is possible due to the effects of the anesthesia that you will not remember the visit with
the surgeon.

Post-Operative Discharge Instructions

Immediately before discharge, you will receive a discharge summary with instructions on what to do when you go
home. Your discharge nurse will review the instructions with you and answer all your questions.

Bras after surgery:

• We will provide you with a special post-operative bra that is designed to provide you with proper compression and support for adequate healing and recovery.
• You may request a second bra before leaving so that you have one to wear while washing the other one. You do not need to buy a special bra at this time. You may also buy a snug-fitting sports bra that closes in the front.

For patients going home the same day

• You will be taken to the recovery room where a nurse will watch you closely until you recover from the effects of your anesthesia and your pain is under control.
• You will be given sips of soda, and some crackers to eat if you are hungry. Your family will be allowed to sit with you once you are awake.
• Most patients stay in the recovery room about 1-1 ½ hours before they are ready for discharge home. It depends on how quickly you recover from your anesthesia. Before going home, you will be given discharge instructions telling you exactly how to care for yourself after your surgery.

Prescription Medicines:

• You will receive prescription medicines for pain, anti-nausea and a stool softener. You may take these to a pharmacy and pick them up at any time. If you are still having pain that is not responsive to other methods after 7 days, please contact your provider.
• Narcotics are not called into your pharmacy. These prescriptions are given to your responsible adult before you are discharged from the surgical center. For more narcotic pain medicine, you (the patient) are legally responsible for returning to the clinic to get a written prescription in person.
• There is a pharmacy at both the outpatient surgery center and the main UNC hospital. You can get your medicines here before you go home. Please make sure your provider hands you written paper prescriptions if you prefer. Otherwise, non-narcotic prescriptions are sent to your preferred pharmacy.

Problems with pain

• If you are under the care of a pain management team, you are responsible for getting pain prescriptions from that
  team. If you are not sure how to contact your pain team, we can help.
• If you think you have a problem controlling the amount of narcotic medicines you take, please contact us for help. Excessive pain should be examined by your provider to check for any physical problem needing attention.

For patients spending the night

• If your surgery is at the Ambulatory Care Center, you will be taken to the Short Stay Unit (SSU). The SSU is an extension of your recovery, also known as a 23-hour post-observation stay. It is not considered an overnight stay by insurance. If you ask your insurance company, it will not be posted as an overnight stay in the hospital.
• You are not required to have anyone stay overnight with you, but there is a bed for one guest.
• The SSU is a fully functioning hospital unit equipped 24 hours a day with nursing staff, aides, medicines, meal service, single-patient rooms, and anything else you would find in a hospital-based unit.
• You may bring your own medicines and take your daily dose from your supply. If you do this, please make sure you tell your nurse that you are taking your own medicines.
• Please bring overnight toiletries. We will have you stay in your hospital gown overnight. You may wear your own clothes when you go home. Most patients prefer to wear a loose-fitting button-down shirt at home. You will wear the post-operative surgical bra home.
• The nurse will educate, demonstrate and have you return demonstrate how to properly care for the JP drain. You will not leave until you are comfortable with how to care for the drain alone.
• In the morning, you will be checked out by your surgeon’s resident or nurse practitioner. She or he will check your surgical wound, talk with you about exactly how to care for yourself after surgery and write your discharge instructions. Most patients leave by 12 pm. You will not be allowed to drive yourself home so please arrange for a driver.

• We do not review your pathology report over the phone. But it will be given to you and discussed during your
  post-operative return appointment. Your surgical pathology report is reviewed when you meet with your
  surgical team in clinic after surgery.
• It is important that you receive this report during your post-operative appointment so you can talk together
  about the next steps in your treatment. Your results are released into your My UNC Chart account so you can see these results.

MANAGING PAIN

We want you to be comfortable after your procedure, but please know that you have had surgery and you will experience some pain and discomfort. You will be sent home with a prescription of Oxycodone. This is to be used as needed for severe pain.

If you’re having pain requiring narcotics after 7 days, please call:

• Nurse Navigator if you have not had reconstruction at 984-974-0000
• Plastics Nurse for any surgery with reconstruction at 919-966-6462.

If you can not reach your plastic surgery nurse, please call the after-hours, emergency number at 984-974-1000 and
ask to speak with the plastic surgery resident on call. You may have to call the number several times before getting
in touch with a provider.

• You may not drink alcohol, drive, or sign legal documents while taking oxycodone or any narcotic pain medicine. Narcotic pain medicine, including anesthesia, causes terrible constipation and bloating.
• Most of our patients find adequate pain control by taking over-the-counter Tylenol. Before you leave the hospital, please make sure your discharge nurse tells you what time to take the next dose of Tylenol. Please follow the instructions on the bottle, taking it at regular intervals.
• 5 days after your surgery, you may also start alternating an anti-inflammatory like Advil or Aleve with the Tylenol. Again, follow the instructions on the bottle of the over the counter medicines and do not take more than the recommended amount. Taking too many anti-inflammatory medicines can lead to kidney damage.

Pain management works best if you’re consistent with taking your medicines as directed. Prevention is key.

Comfort measures

• Sleep and rest as much as you can. Prop your arm up or sleep on a recliner to
  relieve any pressure or tugging on your chest.
• Avoid any activities that may cause pressure to your upper body such as:
  • chores, housework, gardening, putting away the dishes
  • gardening, playing with little children or animals
  • driving, texting and desk/computer work
• Avoid all of these activities for several days until you feel fully recovered.
• Wear your surgical bra at all times day and night. You may remove it when you shower.
• You can also try a heating pad on low, or use cool compresses, 20 minutes on/20 minutes off. Because your breast may be numb, please check the temperature prior to use.
• Your pain will be lessened if you provide your body with nutrients that help with tissue recovery such as a healthy well-balanced diet, and 8 glasses of non-caffeinated fluid per day. As an extra bonus – you will experience less
  constipation associated with anesthesia.
• If you’re concerned that you have an opioid addiction, we can make a referral to a specialist if you would like assistance. If you had prior drug use of any kind or want a referral, we can help.

Narcotic Safety

• Take any extra narcotic medicines that are not used back to the pharmacy for discarding. Don’t keep them at
  home, don’t share them and don’t throw them down the toilet.

Nerve Pain

• Some patients experience nerve pain during recovery that may last for a long time, sometimes up to 1 year or longer. This pain feels like a sharp shooting pain that may extend down your arm. Others report a “swollen feeling.” It may be associated with numbness.
• This is a normal pain that is associated with surgery. Although concerning, this is very expected and not an
  emergency. This pain comes and goes and usually gets better over time. The best treatment is rest.
• If your symptoms interfere with your quality of life, there are prescription medicines your provider can order.

MANAGING CONSTIPATION

Constipation is a common problem after surgery. Constipation means having hard, dry and sometimes painful bowel movements and it may be mild or severe.

Anesthetics and narcotic pain medicines may both cause constipation after your surgery by slowing down your body’s ability to push a bowel movement (BM) through the body. We hope these tips may prevent this from happening to you.

1. Resume your regular diet as you can tolerate. Start with smaller meals.
2. Drink plenty of water (8-10 glasses a day).
3. Avoid carbonated beverages.
4. Avoid caffeinated beverages.
5. Eat fresh fruits and vegetables and whole-grain cereals or breads.
6. Take a stool softener such as Colace as directed, usually twice per day.
7. Walk as much as possible to increase bowel function.
8. Eat foods that are high in fiber.

If no bowel movement after 2 days, please try the following over-the-counter medicines. Use as directed on the package.

• Miralax Powder
• Dulcolax tablets or Correctol tablets
• Milk of Magnesia
• Senekot tablets
• Mineral oil

If no bowel movement after 4 days, please try the following over-the-counter medicines. Use as directed on the package.

• Glycerine suppository
• Fleets enema
• Fleets phosphasoda (liquid)
• Magnesium citrate liquid

• It is very important you make sure you have a return appointment scheduled with your surgical team after
  surgery. This appointment should take place 7-10 days after your surgery date. Please make sure you are scheduled for this post-operative appointment.
• If you have not been scheduled, or you are not sure if you are scheduled, please call 984-974-0000 for help. If
  you had breast reconstruction, please call 919-966-6462. Your appointment may be scheduled with either your
  surgeon or nurse practitioner. We will attempt to coordinate all postoperative appointments.
• If you need other appointments with your medical oncologists, your team will work together to make sure those
  appointments are scheduled. Appointments are also available at UNC Hillsborough on certain days. If Hillsborough is more convenient for you, please ask about scheduling your visit there.
• Keep a list of questions to ask your providers and surgery team when you come back to the clinic.