Risk-reducing mastectomy is major surgery involving a general anaesthetic. Usually a drip is put in during the operation to keep you hydrated; when you are drinking enough it can be removed. Painkillers can be given through the drip or by injections, and then as tablets when the drip has been removed. The pain will gradually decrease over time.

The mastectomy wound(s) will be covered by dressings and there may be a drainage tube coming out of the wound(s) attached to a small container to collect any excess blood/body fluid. This will be removed once the drainage has slowed and the surgeon advises that this can be done. This is usually within a few days of the operation.

How long you stay in hospital, and your recovery time, depends on the type of surgery you have. The length of stay in hospital after mastectomy without reconstruction is quite short; usually a few days. If you have reconstruction your stay will be longer and determined by the type of reconstruction you have.

All surgery has a risk of complications. Problems associated with any type of surgery include:

• bleeding
• problems associated with having a general anaesthetic
  (eg sickness)
• pain and discomfort
• wound infection
• collection of fluid under the wound (seroma)
• excessive scar tissue (hypertrophic or keloid scarring)
• the formation of a blood clot in the leg (deep vein thrombosis or DVT).

You should discuss these possible complications with your surgeon and anaesthetist.

After a risk-reducing mastectomy with/without breast reconstruction, the wounds should heal completely within six weeks of surgery. However, getting back to normal can take a while; once again, it very much depends on the type of surgery you have had. Some women will have numbness or pins and needles across their chest for some time, but this is usually temporary.

Many women want to know when they can get back to doing everyday things like driving, carrying the shopping or doing the housework and gardening. This will vary, but you may need to be patient. You will need to avoid heavy physical activity until the wounds have healed and the soreness has disappeared. You are bound to feel tired, and unable to do as much as you used to, for a considerable time. It is a good idea to put alternative arrangements in place as far as you can and to be as flexible as possible.

In 2003, a study was carried out on women who had risk-reducing mastectomy. Some women in the study reported that if they had been better prepared and informed about what they would and would not be able to do after the operation, they would have organised better support at home and/or childcare.

The study concluded that more research is needed into the length of time women have discomfort after the operation. Research is also needed into how long women are unable to do such things as driving, housework, self-care etc, so that alternative arrangements can be put in place. So these are issues that you may need to think carefully about.

Driving

There are currently no specific guidelines laid down by the DVLA regarding driving after this type of surgery. So, advice about when to start driving again should be given by your surgeon. You should be able to comfortably wear a seat belt; safely do an emergency stop or move the steering wheel around suddenly when needed; be able to look over your shoulder; and manoeuvre in and out of parking spaces. It may be helpful to sit in the car with the engine off but with the seat belt on and try to do all the manoeuvres that you would normally do when driving.

Also, you should not be taking any medication that may have a sedative effect.

Some women find that driving is possible within a few weeks of surgery (but it does depend on the type of surgery they have had) and others find that it takes longer. Some car insurance policies have specific criteria for when you can drive after surgery, so it is essential to check with your insurance company.

The process of risk-reducing mastectomy with or without reconstruction is a lot to cope with emotionally. There may well be a sense of relief when the surgery is over, but getting used to the physical appearance after such an operation will take some time, and some women feel the emotional effects more than others. You will already have had a lot to cope with; learning that your family has a strong history of breast cancer, and worrying about your own children and other members of your family who may or may not also be at increased risk. Risk-reducing surgery is a big step to take and will bring out many different emotions and feelings in yourself and people you choose to discuss it with.

Many women are pleased with the result of the surgery and feel that the anxiety about developing breast cancer is much reduced. However, they will understandably still have feelings of loss of their previous appearance and sense of health. Some women are very disappointed with their appearance after surgery and feel very angry and distressed. There are people and organisations that can help you talk through and deal with any feelings and emotions that you may have. Your breast care nurse can discuss your situation with you.