Recovering from surgery

Many women get aches and pains in these areas, this can sometimes be made worse by radiotherapy and continue for a year or more.  If, however, you develop a new pain that worsens over a week or more then contact us.

This is due to surgery affecting the nerves that supply this area, resulting in a change of sensation (often numbness or electrical-type discomfort). This altered sensation can be temporary or permanent.

This is a common post operative problem known as cording and is caused when the lymph vessels harden and tighten due to surgery. It usually settles by itself or can be encouraged to ease by self massage and stretching the affected area.

Yes, there are no proven studies to suggest otherwise.

Lymphoedema is due to disruption of the normal channels that the lymph fluid flows through away from the arm. If you develop lymphoedema, please contact the breast care nurses and we can refer you onto a lymphoedema clinic for further advise on special massage or a compression sleeve.

There are various options for breast reconstruction and some types are carried out at Frimley Park and some by plastic surgeons elsewhere. We can discuss this with you in more detail, please contact the breast care nurses for more information. After radiotherapy we like to wait for at least a year for the skin and tissue to settle down before we would consider reconstruction.

Recovering from chemotherapy

Tiredness should start to improve two months after your last chemotherapy cycle, however can often be slower, especially if you are having radiotherapy. It can take at least six months before your energy levels return to normal and some women still feel tired 12-18 months after the end of their treatment.

Most hair starts to grow back 4 weeks after your last chemotherapy session. It grows slowly to begin with and can be quite thin and fluffy but over time thickens up and after six months most women have a good head of hair again. You should wait for at least six months before using any permanent, chemical or semi permanent dyes on the hair as it is quite delicate.

Pins and needles and numbness should gradually improve over weeks or months following the end of your treatment. A small number of patients find their sensation is altered permanently.

Recovering from radiotherapy

Acute side effects such as skin reaction resolve will heal completely four to six weeks after the end of radiotherapy.

Up to half of patients experience some rib tenderness or shooting pains in the breast. Generally these settle after six months or so, but some women suffer intermittently with these pains long term.

Most women feel tired on radiotherapy treatment, this tends to improve six weeks after completing radiotherapy but can often take several months to recover fully. It is often worse if you have had chemotherapy as well.

Sensible precautions need to be taken, the treated area is more sensitive and should be covered. Use high factor sunscreen (UVA/UVB factor 30).

Once skin reactions have settled you can return to normal activities, such as swimming, usually about a month from the end of your treatment.

They are rare, but can occur in a small percentage of women. The skin may be darker and firmer to the touch in the treated area and sometimes the breast atrophies (gets smaller). 

After a mastectomy the skin on the chest wall can feel tight.

Women with implant based breast reconstruction may experience contraction of the capsule around the implant, sometimes this means removing or exchanging the implant.

There is a slightly increased risk of fractured rib in the treated area and of heart damage with left sided treatment. Occasionally radiotherapy causes inflammation of a small area of lung tissue.

Hormonal therapy

If your breast cancer was sensitive to the hormones oestrogen and/or progesterone (sometimes called ER+PR+), we generally recommend taking a hormonal tablet, usually for five years, as it will significantly reduce your risk of disease recurrence in addition to the other treatments you have already had.

Yes, there are two main types:

Tamoxifen – blocks oestrogen receptors on breast cells. Prescribed for pre menopausal women and some post menopausal women.

Aromatase inhibitors (Arimidex (anastazole), Femara (letrozole), Aromasin (exemestane)) – switch off the enzyme which makes oestrogen in the body. Only suitable for post menopausal women.

All types can cause menopausal symptoms such as hot flushes and sweats. Tamoxifen is associated with a small increased risk of blood clots (DVT) and can rarely cause post menopausal bleeding – you should let us know if you have any post menopausal bleeding.

Menopausal side effects can be very troublesome and there are some treatments which may help. Some complementary therapies can be helpful, such as acupuncture, massage or aromatherapy. Contact the Fountain Centre for more details. 

Aromatase inhibitors can cause aching and stiffness of the joints and are associated with thinning of the bones (osteoporosis). You will have a bone density scan at the beginning of treatment and it may be necessary to take calcium and vitamin D supplements.

If you get any troublesome side effects and you are worried about them please contact the breast care nurses.

Remaining breast aware

Women always overestimate this risk. It varies according to the type of breast cancer that you have, being slightly higher if you had lobular cancer, but the risk is still small, between 0.5 and 1% per year.

You should try to examine yourself regularly so you know what your breast feels like, especially after surgery and radiotherapy. We know this is sometimes difficult. Do it when you feel relaxed, such as in the bath or shower or on your bed.

If you find a new lump or other abnormality within your breast or close to your mastectomy scar then contact the breast care nurses who will arrange for you to be assessed in clinic.

Yes, every year for five years.

This will be arranged by us here at the hospital. After five years your GP can ask for a mammogram annually; you might need to remind them of this. This arrangement might change in the future with development of national policies.

Breast cancer can return almost anywhere in the body. If you experience any of the following symptoms for more than one to two weeks please contact the breast care nurses. Remember that all these symptoms can also be caused by other conditions completely unrelated to breast cancer so try not to get too anxious whilst awaiting your review.

  • New lump in or near the breast, a mastectomy scar, armpit or neck
  • New swelling of the arm
  • Unexpected weight loss or loss of appetite
  • Shortness of breath or a persistent cough
  • Nausea or abdominal pain
  • Headaches or visual disturbance
  • Loss of balance
  • Bony pain

We will write to you within three weeks of your mammogram if it is normal. We will contact you if you need further views or tests within three weeks.

Getting back to normal

Reaching the end of treatment can be a difficult time for many patients, you may experience relief that your treatment is finally over, but often might experience a feeling of “what now?” and miss the security of being seen regularly at the hospital. Patients often find it takes them longer than they expect to recover fully from their treatment.

You may have already come to the moving on programme or find talking to other patients has helped. Some people prefer not to talk; there is no right or wrong way.

You can return to work whenever you feel able and ready to do so. Remember that when you do return it might be a big shock to the system and it can be useful to return in a phased manner, increasing your hours gradually over a few weeks.

You may want to travel abroad, if you have difficulties in getting health insurance – our breast care nurses have information on insurers specialising in cover of patients who have had cancer.  Further information is also available on the Macmillan website: www.macmillan.org.uk

Exercise and diet

Enjoying a healthy diet, avoiding excessive weight gain and maintaining a moderate levels of physical activity is important if you have had breast cancer.

You should gradually increase your daily activity after you have completed your treatment, with the aim of trying to build up to three or more twenty minute sessions of moderate activity each week. 

There is evidence that maintaining a healthy weight, avoiding weight gain and maintaining a moderate level of physical activity is associated with increased breast cancer survival.

We recommend trying a low GI diet and you should consider:

  • Eating the right amount to maintain healthy weight
  • Eat plenty of fresh fruit and vegetables
  • Eat foods rich in fibre and starch
  • Avoid eating too much processed or fatty foods
  • Avoid sugary food and drinks
  • Avoid alcohol or drink in moderation

These guidelines are suitable for people who haven’t had cancer and can reduce your risk of heart disease, diabetes and other cancers, so why not get your whole family involved?