Recovery after mastectomy: stage by stage

Hospitals differ in how long you stay, how drains are handled and how arm exercises are paced, and recovery is slower if lymph nodes were removed or if reconstruction was done at the same time. The figures below come from the NHS and two NHS trusts and describe typical ranges.

The practical question most people ask is what to expect and when. The answer is a gradual return to normal over weeks, with firm milestones at about two weeks, three weeks and six weeks. The operation is described in the mastectomy guide.

The NHS says drains remove fluid and blood from the wound and are removed within days or weeks, and some people go home with one. Take pain relief regularly until you can move your arm without pain, which the Bath leaflet says helps with exercises and sleep.

A seroma, a pocket of fluid in the wound or armpit, is common. The Bath leaflet says it is harmless, can be drained in the breast unit if uncomfortable, and is not drained more often than about weekly, because that can encourage it to re-form. Repetitive arm actions such as vacuuming or keyboard work may make it refill faster.

After the wound check you can shower and use a waist-high bath, but the Bath leaflet says not to soak for at least six weeks, since soaking can soften the wound. Surgical glue should not be picked. A roll-on antiperspirant is allowed after two weeks and a spray after six, and you can begin moisturising the scar at about four weeks.

Sudden shooting pains, numbness and tingling over the wound, armpit and upper arm are described by the Bath trust as common, and they typically settle over a few weeks, though some change can be permanent. Phantom breast pain may last a few months, and the nurse specialists can suggest nerve-pain medicines if it persists.

Posture matters more than people expect. The Bath leaflet encourages sitting, standing and walking normally instead of protecting the wound, to avoid a stiff shoulder, neck and elbow. A loose, front-fastening top and a supportive non-wired bra with adjustable straps are the clothing it suggests for the first weeks.

The Bath leaflet advises no driving for at least three weeks and confidence in making an emergency stop; the NHS says to drive again once the wounds have healed and the seat belt is comfortable. Insurers can set their own conditions, and GOV.UK says to tell the DVLA if you are still unable to drive three months after an operation.

Worcestershire says gentle work may resume in one to two weeks. The NHS says to avoid heavy lifting and strenuous activity for two to three weeks. A job that involves repetitive arm movement or lifting may need longer, so discuss it with your breast care nurse.

• Sexual activity can resume as soon as you feel able, according to the Bath leaflet, with time given to adjust.

• Gym or exercise classes are suggested after about six weeks, built up gradually.

• Take extra care with the arm on the operated side for life if lymph nodes were removed.

The Bath leaflet advises the whole exercise sheet three times a day for at least six weeks, until full movement has returned, then daily to maintain it. Cording, a tight cord-like feeling in the arm or armpit that can appear weeks after node removal, is not harmful and is eased by continuing exercises and gentle massage.

To reduce the risk of lymphoedema, the leaflet advises avoiding heavy carrying with the affected arm, steam rooms and saunas, protecting the skin against cuts and grazes, and avoiding injections and blood pressure readings on that arm except in an emergency.

The NHS advises NHS 111 for sudden pain, swelling, wound bleeding or arm numbness, and 999 for severe difficulty breathing, chest or upper back pain, a fast heartbeat or loss of consciousness. The Bath leaflet lists heat, redness, a rash or new discharge at the wound, feeling hot and shivery, or a temperature as reasons to call your breast nurse.