February 21, 2024

Recovering at home after a double mastectomy

Innovative surgical recovery program helps breast cancer patients safely recover at home after a mastectomy. Learn how Kaiser Permanente supports home care.

Adriana Sanchez-Ochoa is grateful she had the option of recovering at home after her bilateral mastectomy.

Adriana Sanchez-Ochoa learned she had breast cancer in both breasts. At first she wasn’t sure what to make of a suggestion from surgeon Brooke Vuong, MD. Dr. Vuong told her that she could have a double mastectomy and not spend a single night in the hospital. This was a surprise for the Northern California resident.

Her doctor and care team told her what to expect before, during, and after the surgery. They answered her questions and concerns until she was comfortable with the plan.

“My care team is amazing. The biggest factor with being ready to go home was how they prepared me,” said Sanchez-Ochoa.

A better experience after surgery

Many surgery patients prefer recovering at home. Avoiding a hospital stay can mean more comfort, preferred meals, and better sleep. For a long time it had been the norm for mastectomy patients to stay the night in the hospital, said Dr. Vuong.

“As surgeons, we would visit our patients the next morning, and they would usually be ready to go,” Dr. Vuong said. “We thought, what’s the added benefit of staying overnight?”

Kaiser Permanente began an initiative in 2017 to give patients the choice to recover at home without an overnight stay in the hospital.

I don’t remember feeling any pain. And there’s nothing like being at home.

The option builds on Kaiser Permanente’s Enhanced Recovery After Surgery program. Instead of the traditional fast before surgery, patients can have a carbohydrate drink. The program also reduces opioid use. Instead, patients receive local anesthetics and mild pain relievers, such as Tylenol. Patients are also encouraged to walk soon after surgery, if appropriate.

Care teams tell patients and caregivers what to expect at home, including how to manage surgical drains. The teams follow up with patients at home by phone, video, or secure messaging.

“We make sure patients have excellent pain management and know what to expect before and after surgery. And we want them to know how to get hold of their care team after hours, if necessary,” said breast surgeon Gillian Kuehner, MD.

A 2019 study looked at the program’s impact in the first 6 months. Home recovery rates for Northern California mastectomy patients grew from 23% to 61%. There were no significant changes in emergency department visits, reoperations, or readmissions. The program earned Kaiser Permanente the NCQA Innovation Award. The program received recognition for improving value and quality of care.

Growing interest during COVID-19

As of early 2024, 92% of our mastectomy patients in Northern California have used this option. It is also available to Kaiser Permanente patients in other areas. The COVID-19 pandemic highlighted new benefits of this approach. It helps open up beds for patients who need more immediate attention.

For Sanchez-Ochoa, going home after her mastectomy was “the best decision that I made.”

“I don’t remember feeling any pain,” she said. “And there’s nothing like being at home.”

Learn more about cancer care at Kaiser Permanente.