As the saying goes, “three parts medical care, seven parts nursing care”, post-operative care and rehabilitation are also essential for a rapid recovery from breast cancer.
Adopting the right position
Most breast cancer surgeries are performed with general anesthesia. When the anesthesia is not fully awake or when there is still nausea, the patient should be placed in a flat position with the head tilted to the side to prevent aspiration of vomitus leading to aspiration pneumonia. Thereafter, except for those with special position requirements, such as breast reconstruction using back tissue that may require pressure on the back for a period of time to facilitate flap apposition, patients can adopt any position that they feel comfortable in, but avoid pressure on the surgical side to avoid aggravating upper extremity edema and avoid pressure on the drainage tube that may lead to poor drainage.
If the general condition is good, you can get out of bed early to prevent deep vein thrombosis in the lower extremity. When you are not out of bed, you should mostly lie up or sit up to facilitate breathing, coughing up sputum, and drainage.
Postoperative close observation
To ensure safety during recovery from general anesthesia, cardiac, blood pressure, and oxygen saturation monitoring are usually received on the day of surgery to detect possible abnormalities in vital signs during recovery from anesthesia in a timely manner. If the monitor alarms, the health care provider should be notified in a timely manner to check and address the situation.
With the exception of some patients undergoing breast-conserving surgery + sentinel lymph node biopsy, many patients require drain placement. The drainage may be slightly excessive at 2 to 3 days postoperatively, and then gradually decreases and changes color from dark red to light red to yellow. At 24 hours, when the drainage is less than 20 ml, the surgeon may consider removing the drainage tube. However, if a large amount of bright red drainage fluid or blood clot suddenly appears in the drainage bottle, and/or if the surgical area becomes swollen, blood soaks the dressing, the face becomes pale, and there is panic and cold sweating, be on high alert for the possibility of sudden bleeding and report it to your healthcare provider immediately. If the drainage fluid becomes cloudy and unclear, accompanied by local pain and fever, the doctor will consider whether local infection has occurred. If the drainage fluid is prolonged and does not decrease in volume, the physician will consider the possibility of lymphatic leakage and treat it accordingly according to the amount of drainage.
In addition to this, the wound dressing is dry, the temperature is normal, the limb is swollen, and the bowel movements are normal, all of which need to be observed after surgery. For example, the skin color of the nipple-areola area and whether it is crusted and necrotic after some procedures that preserve the nipple-areola, and the survival of autologous tissue breast reconstruction needs to be observed by skin color after the procedure.
Meticulous observation allows early detection and management of possible complications to prevent serious consequences.
Rational diet
While better nutrition after surgery is good for recovery, it does not mean “big fish and big meat” but rather a balanced diet. For postoperative patients with breast cancer, nausea may occur due to anesthesia and analgesic drugs, so eating on the day of surgery is generally not recommended. On the first day after surgery, if there is no special discomfort, you can resume your normal diet. In general, appropriate protein supplementation is beneficial to promote tissue growth and wound healing, while increased dietary fiber intake is helpful to avoid or reduce constipation caused by bed rest and reduced activity.
Early rehabilitation
On the day of surgery, patients are mostly bedridden, and then they can start finger grasping, wrist rotation, and forearm flexion and extension activities while keeping the shoulder joint immobile. They can move their lower extremities with family assistance or ask them to massage their lower extremities to avoid deep vein thrombosis. Before the drainage tube is removed, the functional exercise of the upper limb is mainly for the forearm and hand. After the axillary flap is firmly attached and the drainage tube is removed, shoulder joint training should also be performed as early as possible to gradually expand the range of motion of the shoulder joint, especially to strengthen the exercise of supination and abduction function, so that the affected upper limb can return to its preoperative functional state as much as possible.
Intensive psychological care
Postoperative psychological recovery is often overlooked. Whether it is breast-conserving surgery or mastectomy, it may cause certain flaws in female beauty, and at this time family members and others need to encourage patients to accept such imperfections. On the other hand, patients may also have anxiety about whether the surgery is complete, whether there is metastasis, and whether there will be recurrence. The surgeon will inform the patient about the surgery and the postoperative pathology results at the appropriate time to help build confidence in the treatment.
Control of concomitant disease
Middle-aged and older patients with breast cancer have a high incidence of concomitant systemic disease, and good control of concomitant disease is important for postoperative recovery. High blood glucose will seriously affect wound healing, so diabetic patients should have good control of blood glucose levels after surgery. Hypertension and coronary artery disease should also be actively managed.
Correct selection of prosthetic breast
For patients with total mastectomy, there are ways to compensate for the deficiencies of female beauty through breast reconstruction or wearing a prosthesis. The choice of breast reconstruction needs to be based on your situation and communicated with your doctor. If you choose to wear a prosthesis, you can proceed with the choice after the stitches are removed. The role of the prosthesis is to restore a symmetrical appearance after dressing, on the one hand, and to counterweight it with the opposite side to prevent deformities such as sloping shoulders and scoliosis from occurring, so the appropriate shape and weight are important parameters to consider in prosthesis selection.
