How long does pain last after double mastectomy with reconstruction

Posted on October 29, 2017

One of the most common questions I get asked by patients is how long recovery will take after surgery. This is actually a difficult question to answer! It’s a bit like asking how long it will take you to recover after your morning run. Obviously, it matters how long your run was. It also matters if you’re in good running shape. Plus, it depends on the weather that day, whether you had a sore knee from moving furniture last week, if you stubbed your toe in the first mile, … you get the point.

So the short answer is: It depends. My goal with today’s post is to help you figure out what your particular recovery might be like. This will depend on the type of surgery you will have, your overall health, and a few other factors that we’ll discuss.

What does recovery mean?

This is a source of great confusion and miscommunication between doctors and patients. Patients and doctors often mean different things by the word recovery. So it’s important to think about the various aspects of recovery individually. Are you thinking of recovery from the anesthesia? Or recovery in terms of leaving the hospital? Your doctor might be think of “recovery” as being able to go back to work, while you might consider it being pain free. Clarifying your recovery goals is the first step to understanding how long recovery will take.

Recovery from anesthesia

Not counting breast biopsies, most breast cancer surgeries and reconstructions are carried out with general anesthesia. The old joke goes that anybody can put a patient to sleep, but it takes an anesthesiologist to wake them up. Patients are usually awake from anesthesia within 30 minutes or so of surgery. But the medications used for anesthesia tend to linger in the body for a little while. So patients are often a bit hazy and don’t quite feel like themselves for hours. The longer the surgery, the more anesthesia medications are used. As a result, if you had a very long surgery – like a double mastectomy and DIEP flaps – it might take your body days to get rid of the anesthesia effects.

Going home from the hospital

Some breast cancer surgeries, like lumpectomies, don’t require you to stay in the hospital. They are outpatient surgeries, and you are able to return home a few hours after your surgery. Similarly, some minor reconstruction surgeries (like fat grafting) can be outpatient surgeries.

A mastectomy without reconstruction, or an implant reconstruction, often requires a night or two in the hospital. On the other hand, you might spend 4 or 5 nights in the hospital after a more complex reconstruction like a DIEP flap. Rarely, patients stay in the hospital for a week or more.

Becoming pain-free

Often this is what patients are thinking of when they think of “recovery”: how long before nothing hurts? This is actually one of the more variable parts of your recovery. Predicting how long it will take you to become pain free is like trying to predict the number of points scored in a basketball game. On average, each team scores a 100 points, but the exact number varies a lot from game to game.

Surgical pain

Just as you know that the Harlem Globetrotters are always going to score a lot of points, there are some aspects of your surgery that can predict your pain level. Lumpectomies in general are associated with mild pain. This is one of the reasons that patients are able to go home right after this surgery. A mastectomy or reconstruction is a more significant surgery. But, after a couple of days the pain is controllable with oral pain medications like hydrocodone. Becoming totally pain free can take much longer. If you’ve ever had a paper cut, you know that it throbs and aches for days. Surgery is a significant injury to the body, and it will take weeks before you the aches and pains are completely gone.

Chronic pain

Finally, some patients can develop chronic pain after surgery. This is pain that lasts for three months or longer after surgery. It’s usually related to nerve irritation, and it is very hard to predict its occurrence. There are treatments for it, so if you have lingering pain months after surgery, you should absolutely mention it to you surgeons.

Returning to work – at home or in the office

A lot depends on how active you are at home and at work. For example, if you work at a desk all day, you might be able to return to work as quickly as a week or two after surgery (depending on the type of surgery you had). On the other hand, if you have a job that involves any lifting, it might be 4 to 6 weeks before you can get back to it. Similarly, if you have small children at home, it could be weeks before you are allowed to lift them. So you might need help around the home during that time.

Recovering your energy

The feeling of fatigue that can occur after surgery often comes as a surprise to patients. If the surgery was more involved – like a double mastectomy or complex reconstruction – it can really sap your energy. As I’ve mentioned, surgery is a major ordeal for your body. Having a major surgery is like running a marathon, but without any training. You may feel tired and worn out for a few weeks after such a surgery. And, a marathon is a great analogy here, because the effects on your body depend on your overall health. If you are older, or in poor health, you can expect that it will take you longer to recover your vim and vigor.

Mental recovery

I think of this as the last, but ultimately most important step, of recovery after breast cancer. It’s the point at which your surgery stops being something that you think about. I usually tell patients that this will take up to a year after surgery. You know that your breast cancer is truly in the rear-view mirror when you forget your plastic surgeon’s address.

tl;dr Version

• Recovery can mean many different things – it’s important to think about your specific goals, and discuss them with your doctor
• Anesthesia medications can linger in the body for hours to days, and can make you feel hazy during this time
• Depending on the type of procedure you have, you might go home right after surgery, or stay in the hospital for a week
• Your pain is usually controllable with oral medications in a day or two, but becoming completely pain-free can take weeks
• Similarly, recovering your energy and feeling like yourself takes weeks. If you are older, or in poor health, it can take even longer.

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