Breast Cancer After Treatment Education

• Drain Care After Breast Surgery
• Dealing with Hair Loss Due to Chemotherapy
• Lifestyle & Breast Cancer (Nutrition & Fitness Management)
• Breast Prosthesis & Camisole Information

Drain Care After Breast Surgery

The purpose of the drain in your surgical incision is to remove blood and other fluid that collects following surgery. The drain helps avoid build up of this fluid and reduces swelling and chances for infection. It's helpful to remember that the drain is:

• made with a one way valve, so fluid and air cannot get into your incision
• stitched to your skin, to prevent it from falling out
• not painful, just slightly uncomfortable

The majority of fluid will drain during the first 24-48 hours after your surgery. It will start out bright red and will lighten and get a more watery appearance. Occasionally small clots may appear in the fluid or the color may revert to the deeper red. This is normal. If drainage does not appear or is very scant, your incision is healing and the drain may not be needed much longer.

You will be instructed on how frequently to empty the drain; usually twice a day is sufficient. Wash your hands before and after emptying the drain and discard the fluid in the toilet. If your surgeon asks you to keep track of the amount of fluid, you can record it on the back of this handout. The record can help your surgeon determine when to remove the drain.

If you notice any of the following conditions, it is important to seek medical advice the same day:

• Leaking of fluid around tube
• Drain slips out
• Increased burning or pain around the area where the tube is inserted.
• Swelling in the affected arm
• Fluid becomes thick, yellow or has a foul odor.

Drain Instruction & Record Sheet

Begin by washing your hands. Measure drain fluid by using the measurements on the drain or by unplugging the drain and pouring it into a disposable measuring cup. Record the amount on the record sheet, noting the date and time. Dispose of fluid in the toilet.

After emptying the drain, squeeze it as much as possible and close the plug. You may want to ask for help from a family member if it is awkward or uncomfortable to do this due to your surgery. Wash your hands again.

Dealing with Hair Loss Due to Chemotherapy

Before Hair Loss

What to Expect:

• Fear of change in appearance

Hair and Scalp Care:

• Wash hair regularly with mild shampoo (preferably one for dry or damaged hair)
• Use crème rinse for fine or limp hair after washing
• Pat hair gently with a towel until dry
• May use blow dryer on low setting 4" from head
• Use a wide-toothed comb
• Sleep on satin pillowcase to avoid tugging on hair root
• Do not use hair dyes or permanents
• Do no use bobby pins, curlers, or put hair in ponytails

Comfort and Image Needs:

• Take a snip of hair and a snapshot of yourself before hair loss occurs
• Meet with hair loss consultant to familiarize him/her with style, color, and length of hair you prefer
• Select items such as wigs, turbans, scarves, and other headwear accessories
• Purchase cotton stretch cap

During Hair Loss

What to Expect:

• Stress from change in appearance
• Shedding of hair
• Matted hair
• Loss of body heat through scalp
• Scalp sensitivity

Hair and Scalp Care:

• Wash hair regularly with mild shampoo (preferably one for dry or damaged hair)
• Use crème rinse for fine or limp hair after washing
• Pat hair gently with a towel until dry
• Wash, rinse, and pat hair dry in one direction to avoid matting hair
• Use wide-toothed comb

Comfort and Image Needs:

• Contain hair in cotton stretch cap or turban
• Wear wig with a wig liner to contain shedding hair
• Wear a cotton sleep cap to bed to keep warm and to catch shedding hair

After Hair Loss

What to Expect:

• Stress from change in appearance
• Scalp sensitivity
• Loss of body heat through scalp

Hair and Scalp Care:

• Wash scalp regularly with mild shampoo (preferably one for dry or damaged hair)
• Pat scalp with a towel until dry (do not rub)
• Keep scalp covered when outdoors or apply a maximum protection sunscreen to uncovered scalp

Comfort and Image Needs:

• Wear cotton caps, turbans, scarves, hats, or combinations of the above
• Wear wig with a wig liner

During Hair Regrowth

What to Expect:

• Stress from change in appearance
• Scalp sensitivity
• Loss of body heat through scalp
• Fragile new hair

Hair and Scalp Care:

• Wash hair regularly with mild shampoo (preferably one for dry or damaged hair)
• Use crème rinse for fine or limp hair after washing
• Pat hair gently with a towel until dry
• May use blow dryer on low setting 4" from head
• Minimize hair styling, avoid brushing, combing, hair pins, and curling
• Use moderately: mousse, styling or sculpting gel, spritz, hair spray
• Select products with light to moderate holding ability
• Sleep on satin pillowcase
• Avoid hair dyes or permanents until hair is 3" long and scalp is no longer sensitive

Comfort and Image Needs:

• Wear cotton caps, turbans, scarves, hats, or a wig

Clarifying Myths

No hair growth stimulants, shampoos, conditioners, or other cosmetic treatments will prevent or retard hair loss. Wearing a wig or hair prosthetic during cancer treatment will not damage your scalp or retard hair growth.

After Cancer Therapy Treatment

It is important to understand that it may take 6 months to 1 year before adequate hair growth recurs. The body has had a significant insult and healing is directed to vital body functions before full attention is directed at hair growth. The following helpful hints will ensure a healthy new head of hair.

How to Have Your Hair Chemically Curled or Waved

To get nice curls on short hair and to minimize hair breakage, use a mild body wave, leaving it on for a short time. Wrap hair loosely on the largest curling rod. (Loose curls are less damaging to recovering hair shafts).

How to Color Your New Hair

Permanent hair color is the most damaging to the hair shaft, therefore, the use of semi-permanent color (washes away after 4-6 weeks of shampooing) is the best at this time. Change your hair no more than 3 shades from the regrowth color. Do not bleach your hair to lighten it.

Lifestyle & Breast Cancer (Nutrition & Fitness Management)

Melanine Larson, RD, MSN, put together these ways to improve energy and health during treatment and beyond.

Nutrition Recommendations

• Try to plan your meals around "Whole Foods" instead of highly processed or Fast Foods.
• Seek out foods high in cancer-fighting phytochemicals (non-nutrient plant molecules).

Phytochemicals

• Indoles: may trigger production of enzymes that block DNA damage from carcinogens; may inhibit estrogen action. Sources are crucirferous vegetables
• Protease Inhibitors: may suppress enzyme production in cancer cells slowing tumor growth; inhibit hormone binding; inhibit malignant changes in cells. Sources are broccoli, potatoes, legumes

Achieve & Maintain a Healthy Weight

• Regular exercise, 30 minutes per day—optimizes health and promotes a strong immune system.
• Recent research suggests exercise improves survival in women who already have breast cancer.
• The maximum benefit was found in those who walk 3-5 hours a week at a speed of 2 to 3 mph.

Eliminate or Reduce Alcohol

• If desired and on occasion, choose red wine or dark beer because it contains more phytochemicals.
• Limit your alcohol consumption to one or less drinks per day.
• The research is conclusive that 1 drink per day is associated with a 8-10% increase and 2 drinks per day is associated with a 25% increase in risk for breast cancer.

Increase Fruits and Vegetables to 9 Servings per Day

• Fruits and vegetables contain hundreds of phytochemicals, with possibly thousands more to be discovered.
• 1 serving = 1/2 cup or one small piece

Reduce Fat to 20% of Total Caloric Intake

• Fat is needed to efficiently absorb fat-soluble phytochemicals.
• Choose healthy fats such as extra virgin olive oil, expeller pressed canola oil, avocado, nuts, seeds, natural nut butters, olives, ground flaxseeds, flaxseed oil.

Lean Protein Consumption

• Choose 2-3 ounces of very lean meats 2-3 times per day.
• Choose 12 ounces of ocean fish per week for their omega-3 content supporting anti-cancer benefits. These include salmon, herring, sardines, ocean trout, and bluefish. Consider avoiding farm-raised fish because of their potentially higher amount of carcinogenic toxins compared to wild fish.

Preparing Lean Protein

• Try baking, boiling, steaming, microwaving, poaching, or stewing instead of grilling, broiling, or frying meats. The latter produces carcinogens in meats (does not apply to veggies).

Dairy Products

• Choose 2-3 servings of reduced-fat dairy per day.
• Dairy fat contains a high "CLA" (conjugated linoleic acid) content, which may contribute towards anti-cancer activity.
• Organic milk has been shown to have an even higher content of CLA, plus no insulin like growth factor (IGF-1). Higher blood levels of IGF-1 have been associated with several types of cancer.

Exercise

• The evidence is most conclusive for the benefit of exercise. Research has shown that four hours of exercise a week may lower the risk of developing breast cancer, by lowering the amount of estrogen (a hormone that can promote the growth of some breast cancers)

Overall Fitness

• Flexibility exercises are easy to perform and can help you maintain a wide range of motion.
• Arm stretches also increase flow in the lymphatic channels.
• Gradual strengthening exercises with light weights (one or two pounds) may be helpful.
• Swimming is an ideal exercise because it combines muscle action on the inside with the additional benefit of water pressure on the outside of the arm.

The 10,000 Steps® Program

Increasing your daily steps can give you more energy, lessen stress, improve weight management and decrease your chance of developing many diseases. Using a personal pedometer, you'll measure every step you take. A few extra steps in the morning, during a lunch break or while shopping can add up. The more you step, the better you will feel! You'll also learn fun ways to be more active, track your progress, and get daily motivational tips. Sign up for 10,000 Steps.

Breast Prosthesis & Camisole Information

All women receiving a mastectomy at Kaiser Permanente are entitled to postoperative camisoles, breast prosthesis (breast form) and prosthetic bras. Women who have a significant tissue deficit after a lumpectomy are also eligible. Many members have a copay, unless they have supplemental coverage and coverage changes often. To learn what your coverage is, call Member Services at (800) 464-4000.

All covered items require a physician signed form prior to being fitted. Please call the Breast Care Coordinator at (707) 393-4698.

Covered Items

Camisole

These are soft undershirts that can be worn immediately following surgery. They can be used to help with the adjustment period after surgery and before you are ready to be fitted for a breast prosthesis. They come with soft breast forms and some have lace and pouches for the drain. These can be worn until you are ready to be fitted for a prosthesis or ready for reconstruction.

Two are covered for a woman who has had a mastectomy. This may increase your comfort after surgery before you are fitted for your prosthesis, usually at 4 – 6 weeks. You may opt to get three camisoles annually instead of prostheses and bras.

Prosthesis

One every two years or when medically necessary (eg: significant weight loss/gain or changes in breast size, shape etc.). The 24 month eligibility starts from the first prosthesis. It is recommended to wait about 6 weeks after your surgery, until all swelling is gone and your incision is healed before being fitted for one. If you are unsure, check with your surgeon or oncologist.

Bras or Skin Supports

Each person is allotted 3 bras per year. Skin supports may be substituted for bras if patient desires attachable prosthesis. The 12 month period starts with the first bras.

Tips for Shopping for a Prosthesis

• Take a close friend or relative with you when you go shopping. This person should be able to give you an honest opinion on how you look with the various breast forms.
• Bring a sweater or fitted blouse/shirt (that will hug your chest) with you to the fitting so that you can see a clear outline of your bosom through your clothes.
• Try on several different forms before you buy. It should look good and feel comfortable.
• Prostheses are made for different skin colors, if you have dark skin be sure to ask.
• You may be able to wear the same bras you have always worn. Bring your favorites to your fitting to see how it holds the prosthesis. A pocket can be sewn into your bra. Check with the provider to see if they can assist you with this.
• There are many more Northern California vendors. Cal the Breast Care Coordinator at (707) 393-4698 to get a list.

Kaiser Approved Breast Prosthesis Vendors

Below is a list of approved breast prosthesis vendors. You may visit any or all of these shops prior to deciding on what breast prosthesis is right for you. If you go to an unauthorized vendor not on this list, Kaiser will not reimburse you for your expenses.

Sonoma County Vendors

Accent On Health
625 Steele Lane, Santa Rosa, CA 95404 [Map]
(707) 571-8842
By appointment only

Marga's Corset Shop
2322 Midway Drive, Santa Rosa, CA 95404 [Map]
(707) 542-3941

Marin County Vendors

A Lady's Touch
612 D Street, San Rafael, CA 94901 [Map] (415) 454-6058
(415) 927-1690
By appointment only

Nordstrom
1870 Redwood Highway, Corte Madera, CA 94925 [Map]