Expected Symptoms One Day After Mastectomy
Pain, drainage, fatigue, and limited arm mobility are the typical symptoms to expect on the first day after mastectomy, with most patients experiencing manageable discomfort that resolves quickly in the immediate postoperative period.
Common Early Postoperative Symptoms
Pain and Discomfort
- Pain is the most frequently reported symptom in the first 24-48 hours after mastectomy, though it is typically well-controlled with analgesics 1
- Chest wall tenderness is common and expected, occurring in a significant proportion of patients 2
- Pain severity sufficient to trigger clinical alerts occurs in the early postoperative period but generally resolves quickly 1
Surgical Site Symptoms
- Wound drainage is normal and expected, with surgical drains typically placed to prevent fluid accumulation 3
- Mild swelling around the surgical site is common 2
- Some degree of numbness or altered sensation in the chest wall and upper arm area is typical due to nerve disruption during surgery 3, 2
Systemic Symptoms
- Fatigue is a significant symptom that impacts quality of life in the immediate postoperative period 4
- Low-grade fever may occur but should be monitored, as it can indicate infection if persistent 1
- Nausea related to anesthesia may be present 3
Mobility Limitations
- Reduced shoulder and arm mobility on the operative side is expected, particularly if axillary surgery was performed 3
- Patients should be counseled that some limitation in range of motion is normal initially but requires early mobilization to prevent long-term complications 4
Important Clinical Considerations
What Requires Immediate Attention
- Severe, uncontrolled pain despite medication may indicate hematoma formation, which occurs more frequently in certain patient populations 5
- Excessive bleeding or rapidly expanding swelling suggests hematoma requiring urgent evaluation 3
- High fever (>38.5°C/101.3°F) or signs of systemic infection warrant immediate assessment 1
- Wound dehiscence or separation of surgical edges requires prompt surgical evaluation 3
Reassuring Findings
- Breast cancer patients undergoing mastectomy in the ambulatory setting have a low burden of concerning symptoms, even in the first few days after surgery 1
- The 30-day readmission rate is only 3.8% and reoperation rate is 2.4%, indicating most patients recover without significant complications 1
- Most symptoms that do present resolve quickly without intervention 1
Reconstruction-Specific Considerations
With Immediate Reconstruction
- Patients who undergo mastectomy with immediate breast reconstruction may experience slightly different symptom profiles 5
- Hematoma formation requiring reoperation is more common in older patients (≥65 years) with reconstruction compared to younger patients (5.3% vs 0.9%) 5
- Overall complication rates requiring treatment occur in approximately 6.8% of younger patients and 12.6% of older patients with reconstruction 5
Without Reconstruction
- Patients undergoing mastectomy alone typically have fewer early complications related to the surgical site 5
- Sensation changes and chest wall tenderness remain common regardless of reconstruction status 2
Early Rehabilitation Needs
- Rehabilitation should start before treatment with clear specific information about possible post-treatment complications and how they can be prevented 4
- Early physiotherapy is indicated for functional problems of arm or shoulder movement 4
- Patients should be educated about drain management and signs of complications before discharge 6