Post-Mastectomy Pain Control: Advice From Angelina Jolie’s Breast Surgeon

 

By Everyday Health Guest Columnist

Published Mar 11, 2016

By Kristi Funk, MD, Special to Everyday Health
So you’re scheduled for a mastectomy and, understandably, you’re worried — not just about the procedure itself, but about what to expect afterward: Will the cancer be gone? How will I feel? What will I look like? How long will I be in bed? How much will it hurt?
I tell my patients to approach the war against breast cancer one battle at a time, and when it comes to answering that last question about pain, here’s what I have to say:
Mastectomy is an operation that removes all of the tissue from one or both breasts. It can be an effective weapon against breast cancer, but given the layers of muscle and tissue disrupted or removed during the procedure, it’s not uncommon to experience postsurgical discomfort during the recovery period. Fortunately, since the time more than 20 years ago that I was trained to perform this operation, the mastectomy procedure has undergone a tremendous evolution in terms of both surgical technique (including the location, size, and type of incision, as well as the surgical tools we use), and how we care for patients before, during, and after surgery to ensure a fast, comfortable, and smooth recovery.
Assuming you’ve done your research to find a qualified, trained, and experienced breast surgeon, then how the surgery is performed — as well as its outcome — will largely fall into the hands of this trusted professional. But you can and should also be an active participant in decisions about how your postsurgical pain is managed so that you can ensure you’re feeling your best after surgery and returning to normal — albeit a new normal — soon afterward.

Start a Dialogue With Your Doctor

Starting a dialogue with your doctor can be as simple as asking the obvious question: How will my pain be managed after surgery?
Most patients take safe and adequate pain management for granted and don’t broach the issue with their doctor. But by not initiating a discussion, you’re missing out on the opportunity to have a voice in choosing the types of pain treatments or medications you’ll be given.
The typical postsurgical pain management protocol consists of narcotics (also called opioids or prescription painkillers) given intravenously (into the bloodstream via a syringe), and sometimes orally (in pill form), while in the hospital. While narcotics are potent pain relievers, they can cause unwanted side effects such as drowsiness, itching, nausea, vomiting, constipation, and even difficulty breathing. Additionally, many studies have linked them to the risk of misuse, abuse, and potentially addiction. In fact, a study published in Pain Medicine in September 2012 suggests that 1 in 15 patients who receive narcotics after surgery will continue to use them long-term, suggesting that we need to use them sparingly or not at all.

Alternatives to Narcotics

The good news is that narcotic use can be minimized or even avoided by using a combination of non-narcotic medications that tackle the various sources and pathways of pain. For most of my mastectomy patients, I’ve successfully avoided giving excessive narcotics by treating pain at every stage of the surgery.
Before the procedure, my patients receive oral Tylenol (acetaminophen), which generally works to blunt the body’s pain response to surgical trauma. They are then given either general or regional anesthesia (where the area around the breast is completely numbed) before I begin to operate.
Once the surgery is complete, but before I close up the surgical wound, I inject a long-acting local anesthetic called Exparel (bupivacaine liposome) into the injured tissues. This anesthetic works much like novocaine in your dentist’s office, numbing the area where it has been placed. The exciting aspect of this new technique is that its numbing effect lasts for days, so most patients wake up without being in severe pain and usually need minimal oral or IV narcotics, relying instead on a high-dose version of Tylenol, Advil (ibuprofen), or Aleve (naproxen) for the remainder of their recovery.
Postsurgical pain is at its worst for the 24 to 72 hours after surgery, so providing adequate pain management during this period is critical to a fast recovery and the patient’s long-term well-being. By using a combination of non-narcotic analgesics (pain medications) and the long-acting local anesthetic, I’m able to get my patients through the most intensive and painful portion of their recovery without putting them at risk for narcotic-related side effects.

Take an Active Role in Your Pain Management

After discharge, your doctor may send you home with a prescription for narcotic pills, such as Tylenol with codeine, Percocet, or Vicodin. Ask your doctor about the risks associated with these medications, when and how many to take, and when to stop taking them. It’s important to know that these medications should be reserved for severe pain that is not controlled by over-the-counter pain medications.
Taking narcotic pills for mild-to-moderate pain, or taking them for an extended period, may increase your chances of developing an addiction.
At your postsurgery follow-up visit (typically one to two weeks after surgery), proactively discuss your pain levels and your narcotic intake to date, and work with your doctor to determine the best way to manage your pain moving forward.
Don’t wait until the day of your surgery to talk to your doctor about pain management, and don’t be afraid to express your preference to minimize the use of narcotics after surgery. For more information about your postsurgical pain management options, and for tips on how to talk to your doctor, visit the Pain Center on HealthyWomen.org.

Kristi Funk, MD, is a board-certified surgical breast specialist who founded the Pink Lotus Breast Center in 2007 with her husband and business partner, Andy Funk. She is an expert in minimally-invasive diagnostic and treatment methods for all types of breast disease. She has helped thousands of women through breast cancer treatment, including well-known celebrities such as Angelina Jolie and Sheryl Crow, who have turned to her for her expertise.
Photo, top: Adrianna Williams/Getty Images
Photo, bottom: Provided by Kristi Funk