Scroll down this page to find;

  • More information that will help you before your surgery
  • Leaving hospital and going home
  • Discomfort and Pain
  • Posture
  • Positioning in bed
  • Exercises after your operation Day 1-4
  • More advanced exercise after Day 4 onwards
  • Seroma
  • Cording
  • Altered Sensation in your armpit or arm
  • Activity and lifting
  • Lymphoedema
  • Driving
  • Feelings and emotions

Wide local incision (lumpectomy) and sentinel node biopsy

What is a wide local incision?

A ‘wide local incision’ is where a small amount of tissue has been removed with clear margins around the tumour site. Sentinel node biopsy is a sampling of the lymph nodes under your armpit may have also be done at the same time.

This is normally a day case procedure and you will go home the same day.

What to wear

Before you come in to hospital for your operation think about the clothes that you will wear to go home in. Loose fitting nightwear and clothing, with front fastenings, may be easier and more comfortable to wear, both to go home in, and during the first few days after your operation.

A well supported, non-underwired but comfortable bra is best. It would be ideal to be front fastening, with adjustable straps, and be a bigger  size to allow for any swelling. To reduce the risk of infection 2 bras would be appropriate, one to wash and one to wear. Your breast care nurse can give you advice on this.

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Leaving hospital and going home

You must not drive yourself home from hospital but you do still need to wear a seatbelt as a passenger.

You can use the seatbelt normally if that is comfortable. However if you need to cushion your wound for comfort on the journey home, try a small pillow placed across your chest.

Discomfort and Pain

Discomfort, bruising and some pain is common after any operation and you may be asked to bring a small supply of pain relief to the hospital with you. If you need stronger pain relief you should contact your GP after your surgery or speak to your pharmacist for guidance.

Pain_Diagram
  • It is very important to take the pain relief that you have been advised to take regularly especially in the first 1-2 weeks after your operation. If you take the pain relief regularly you will keep it topped up rather than allowing any pain to break through.
  • Pain relief will allow you to move more freely and without discomfort. It will help when you are completing your physiotherapy exercises in the day and can also give you a better night's sleep.
  • Constipation is often a side effect of certain stronger pain relief. If constipation is a problem, drink plenty of fluids, make sure you have enough fibre in your diet, and consider using a gentle laxative available from the chemist. If you are struggling with this talk to your pharmacist.
  • Some people do not experience pain initially after surgery however as your nerves awaken it can become more uncomfortable. This is often in the 2nd week and is a normal part of the healing process.

Posture

It is very important to look after your posture following your operation.  It is common to feel that you need to be protective of your wounds however, it is vital to try and sit, stand and walk normally. This will help you avoid getting stiffness in your shoulder, neck and elbow and limit any future problems.

This picture shows poor shoulder posture.

Here is a really simple exercise to help your posture. Try this little and often during the day.

Posture

Posture Correction Exercise

  • Stand tall, imagining you have a string pulling you up from the middle of your head
  • Gently lower your shoulders down towards the floor.
  • Gently take your shoulders backwards, bringing your shoulder blades together
  • Hold for 5 seconds then relax. Try to complete this 10 times.
  • Hold for 5 seconds then relax. Try to complete this 10 times.
Exercise 8
Exercise 9

Positioning in bed

It can sometimes be a little difficult to find a position in bed where you can be comfortable.

When lying on your back it often helps to rest your affected arm on a pillow. You are safe to lie on your side when you feel able to. Using a pillow in front to rest your arm often helps

Exercise 44
Exercise 45
Exercise 46

Positioning on a chair

If you are struggling with pain or discomfort try sitting with your arms supported on pillows. Remember to relax your shoulders and allow the weight of your arms to be supported.

Try this position for up to an hour but make sure you get up and move around regularly and continue with your exercises.

If you are struggling positioning contact your breast care nurse.

Exercise 10
Exercise 11
Exercise 12

Exercises after your operation Day 1-4

Immediately following your surgery, it is recommended that you complete regular breathing and circulation exercises. This includes taking several deep breaths every hour to keep your lungs clear. Coughing and sneezing will do no harm to your wound

Circulation exercise

Try not to sit or lie with your legs crossed and whilst you are not moving as much as normal try these foot and ankle exercises to keep your circulation working and reduce your risk of blood clots

Moving your feet up and down and circling your ankles regularly 5 times each way every hour

Foot-Exercise

Arm and shoulder exercises

Do your shoulder exercises 3-4 times every day to prevent your shoulder becoming stiff. This will help with healing, and reduce the risk of complications.

All the exercises should be done within the limits of your pain. It is common to feel a pulling sensation when performing these exercises and some temporary discomfort afterwards. Gentle exercise will do no harm and is very important.

You should start your exercises with a posture check. You should be sitting or standing up straight with your shoulders level and relaxed.

Exercise 1: Shoulder Shrugging

Gently lift your shoulders up towards your ears then relax back down.

Repeat 5-10 times

Exercise 1
Exercise 31

Exercise 2: Shoulder Circling

Gently circle your shoulders forwards and then circle backwards.

Repeat 5 times each way

Exercise 1
Exercise 32

Exercise 3 - Lifting your arm forwards

Bend your elbows to allow your hands to rest on your shoulders. Gently lift your elbows to point forwards. You may feel a pulling sensation however, this is not harmful.

Hold for 5 seconds then slowly lower your elbows back down to the starting position.

Repeat 5 times.

Exercise 33
Exercise 2

Exercise 4 - Lifting your arm out to the side

Bend your elbows to allow your hands to rest on your shoulders. Gently lift your elbows out to the side until they reach shoulder level. You may feel a pulling sensation however, this is not harmful.

Hold for 5 seconds then slowly lower your elbows back down to the starting position.

Repeat 5 times.

Exercise 33
Exercise 3

Exercise 5 - Hands behind your head

Bend your elbows to allow your hands to reach behind your head. Gently push your elbows backwards. You may feel a pulling sensation however, this is not harmful.

Hold for 5 seconds then slowly bring your arms back to the starting position.

Repeat 5 times.

Exercise 3
Exercise 5

Exercise 6 - Hands behind your back

Bend your elbows to allow your hands to reach behind your back, aiming to reach your hands higher up your back. You may feel a pulling sensation however, this is not harmful.

Hold for 5 seconds then slowly bring your arms back down by your side.

Repeat 5 times.

Exercise 1
Exercise 6

More advanced exercise after Day 4 onwards

These exercises are to be completed 4 days after your surgery. We recommend that these exercises are completed lying on your back. This can be on a bed with a pillow under your head. You should aim to complete these exercise 3 times daily.

All these exercises should be done within the limits of your pain although it is common to feel a pulling sensation when performing these exercises and some temporary discomfort afterwards. Do not push your movement past the point where you feel a pulling sensation.

Exercise 1 – Lifting your arm forwards (advanced)

Lift your arms up to point to ceiling and link your hands together. Slowly bring your arms backwards over your head, keeping your elbows straight.

Hold for 5 seconds then return your arms to the starting position.

Repeat 5 times.

Exercise 17
Exercise 18

Exercise 2- Lifting your arm out to the side (advanced)

With your arm resting on the bed beside you, turn your palm to face the ceiling. Slowly glide your arm sideways and upwards toward your ear, keeping your elbow straight. You may feel a pulling sensation across your chest or in your armpit however, this is not harmful.

Hold for 5 seconds then glide your arm downwards to return to the starting position.

Repeat 5 times.

Exercise 20
Exercise 22

Exercise 3- Hands behind your head (advanced)

Bend your arms to allow your hands to reach behind your head. Slowly push your elbows backwards. You may feel a pulling sensation across your chest or in your armpit however, this is not harmful.

Exercise 23
Exercise 24

Hold for 5 seconds then slowly bring your arms back to the starting position.

Repeat 5 times.

When you no longer feel a pulling sensation when completing this exercise, remove the pillow from under your head and complete the exercise on a flat surface. You should find this altered position more challenging.

Exercise 4- Arm Circling

With your arm resting on the bed beside you, turn your palm to face the ceiling. Slowly bring your arm out sideways, upwards and across your body to create a small circle. Try to keep your elbow straight during this exercise. You may feel a pulling sensation across your chest or in your armpit however, this is not harmful.

Repeat 5 times, trying to create larger circles each time.

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Exercise 30
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Exercise 27

Exercise 5- Wall exercise

Complete this exercise standing facing a wall.

Place your arms in front of you with your fingertips touching the wall. Slowly slide your arms up the wall, keeping your elbows straight. You may feel a pulling sensation across the front of your chest or in your armpit however, this is not harmful.

Hold for 3 seconds then slide arm back down the wall to the return to the starting position.

Repeat 5 times facing the wall.

You should also complete this exercise 5 times facing sideways to the wall to work on the sideways movement of your operated side

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Exercise 14

You should slowly step closer to wall as your arm movement improves to avoid bending sideways or bending your back during this exercise.

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Exercise 16

It is expected that you will have full movement at your shoulder approximately 2-4 weeks after your surgery.

Should you have any concerns or worries about your exercises please contact the physiotherapists at the Nightingale Centre on 0161 291 4268.

Seroma

It is common to experience swelling around your surgical site or in your armpit after your surgery. This is a natural collection of fluid called a Seroma which the body will gradually reabsorb over time.

Seroma

A seroma is not harmful but occasionally becomes very uncomfortable or puts too much pressure on the new wound. If this happens, you will need to contact your breast care nurse (weekdays) or ward F16 (evenings, weekends and bank holidays) to have this excess fluid drained. This is a small painless procedure which may have to be done more than once during your recovery.

If you have had a seroma drained, please leave your physiotherapy exercises for the rest of that day to prevent the seroma refilling. Start back with your exercises the following day.

Try to reduce any repetitive arm actions that may encourage the seroma to fill more quickly such as sweeping, vacuuming or computer keyboard work. Your breast care nurse may suggest you see the physiotherapist for help if your seroma needs draining frequently.

Over time any old seroma fluid will become firm and solid. This is normal and the body will gradually break it down. A seroma is not lymphoedema and does not cause it.

In the rehabilitation class you will be shown how to massage the seroma and scar by the physiotherapist.

Cording

If you have had some lymph nodes removed, you can sometimes develop a tight feeling when you stretch your arm out in front or to the side. It can feel or like cords or strings in your armpit and arm. This is called cording (or sometimes axillary web syndrome) and may happen several days after your surgery.

Cording is not harmful but may be a little tight and uncomfortable. It will make you want to hold the arm more protectively, but it is important to try not to do this. Rarely, cording can also appear in the abdominal tissues and may pull when you lift your arm.

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Gentle stretching during your physiotherapy exercises and light massage should help this tightness. You will be shown how to do when you come to the rehabilitation class. However if you are struggling with your exercises please contact the Nightingale physiotherapists on 0161 291 4268 or speak to your breast care nurse for advice.

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Altered Sensation in your armpit or arm

The nerve that supplies the armpit and the inside upper part of the upper arm lies close to the lymph nodes. After surgery you may experience complete or partial numbness, extra sensitivity or tingling in this area. These sensations are common and should settle with time over the next few weeks.

We will discuss in the rehabilitation class how and when it is safe to remove underarm hair.

Activity and lifting

It is normal to feel tired and low in energy during your first couple of weeks at home. However we would encourage you to do small amounts of regular activity in the day as you feel able.

You should aim to get up and move around in the day but also have periods of rest. Getting washed and dressed and light cooking are fine to do but don’t try to lift anything too heavy with your affected arm. A small kettle or a weight no heavier than a bag of sugar (approx. 2lbs or 1Kg) is enough.

walking

Avoid heavy and repetitive tasks in the first few weeks such as

  • Vacuuming
  • Sweeping
  • Ironing
  • Changing duvets
  • Moving wheelie bins
  • Lawn mowing

Walking is good exercise, whether it is indoors or outdoors. Be aware of your energy levels though, and plan to gradually walk further as you feel able.

Lymphoedema

Lymph is a normal colourless fluid that occurs in the body, in a system of lymph vessels and lymph nodes often called glands. Some patients may develop a persistent swelling of the arm and/ or breast following removal of lymph nodes in the armpit and this is called Lymphoedema.

The risk of developing lymphoedema is higher if you have had all the lymph nodes removed from your armpit.

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In the first few weeks after surgery you should avoid heavy or repetitive activity such as sweeping and vacuuming to allow your body and lymph system to recover. We want you to use your hand and arm as normally as possible once you have recovered however there are some sensible precautions that you can take to reduce your risk of Lymphoedema. You will be given these precautions in your class as well as full instruction on skin care massage, hair removal, dos and don’ts and exercise which can help reduce your risk.

Look at the Lymphoedema, and How to reduce your risk sections on this website for further information.

Driving

You are advised not to start driving until after your first outpatient clinic appointment.

When you do start to drive you will need to make sure you have good arm movement and be sure that you can control the vehicle. This includes a lot of gear changes, using the handbrake and being able to react in an emergency.

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Start with a small journey and gradually increase the distance as you feel stronger.

You are advised to contact your insurance provider to ensure that you are covered following surgery.

Feelings and emotions

You have just had an operation and it will take you time to recover. You may feel differently about yourself and your body following surgery. Your Breast Care Nurse is always available if you need to talk. The Nightingale Breast Care nurses can be contacted on 0161 291 3113.

In the rehabilitation class we will talk about all the support available to you in your local area. Please see the support section of the website for some immediate support available

 

You will attend a class within 1-2 weeks of your surgery as part of your rehabilitation and treatment. You will have received a letter inviting you to a class. Please contact us if you need to change the date or if you have any requirements e.g. interpreter. For Class information see the website

At this class, you will be shown your follow on physiotherapy exercises and be given advice on activity and exercise now and in the future. There is also information and advice on skin care, massaging scars, cording, diet and how to reduce your risk of Lymphoedema. This session is an opportunity to ask questions and learn how to access local services in the Manchester area.