Breast and arm changes after breast cancer treatment
Surgery and radiotherapy to the breast can cause a number of changes. These can include pain, problems with movement, changes to the breast tissue or appearance, and swelling of the arm. On this page, we explain these effects and what you can do.
Always let your cancer doctor or nurse know if you have any of these symptoms. Women sometimes worry that their symptoms are caused by the cancer coming back. Your doctor or nurse will be able to reassure you or arrange to have them checked, if necessary. There are different ways that these effects can be managed, and they’ll be able to advise you on what may be helpful in your situation.
Changes in sensation in the breast and arm
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Surgery and radiotherapy can cause changes in sensation in the chest area, the armpit, and the shoulder and arm on the affected side.
These can include:
sharp, shooting or burning pain
sensitivity to touch or to the cold
numbness or pins and needles.
These symptoms happen because the nerves in the chest area or armpit are cut or injured during surgery. It‘s not unusual to experience these symptoms, particularly after surgery to remove all the lymph nodes in the armpit. Symptoms usually improve with time, but in some women they may take months or years to get better.
If you have an aching pain in the breast, wearing a support bra during the day and a soft bra (no underwire) at night may help. Describing your symptoms clearly will help your doctor to prescribe the right painkiller for you. Simple painkillers such as paracetamol, or anti-inflammatory drugs such as ibuprofen, can often control the pain. But if you have nerve pain (shooting or burning pain), you may need other types of painkillers.
Rarely, radiotherapy to treat the lymph nodes in the armpit or an area above the collarbone (clavicle) can damage the nerves to the arm causing pain, numbness and, in extreme cases, loss of movement (brachial plexus neuropathy). As radiotherapy techniques have improved, this problem is now much rarer.
Although this condition can’t be reversed, the symptoms can be improved with drug treatment and physiotherapy. Physiotherapy involves doing exercises to strengthen the muscles and keep them supple. The physiotherapist will also be able to show you how to use slings or splints to support your arm, if needed.
We have more information about peripheral neuropathy, which could be helpful.
If you’re unable to work because of damage to your arm, you may be entitled to some benefits. Our section on work and cancer has information about employment rights, disability rights and financial issues for people with cancer. We also have advice about working while caring for someone with cancer.
Treating nerve pain
Nerve pain can be treated in different ways. There is more information about this on the page about peripheral neuropathy.
We have more information about different ways that pain can be treated in our section on controlling cancer pain.
Changes in movement and strength in your arm/shoulder
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Radiotherapy and surgery, especially to the armpit, can affect the range of movement and strength in your arm and/or shoulder. This may affect your ability to do everyday activities, such as household chores. It may interfere with some types of exercise, such as swimming or tennis.
After breast surgery, a physiotherapist usually gives you exercises to do to help improve recovery of shoulder movement. Arm and shoulder movement gradually improves after treatment. If you continue to have problems, here are some suggestions that may help:
Ask your doctor to refer you to a physiotherapist who will assess you and show you exercises to help improve movement and strength. Exercises you were given previously may not be right for you now. Having good posture is also important and your physiotherapist can give you advice on this.
Having your pain controlled will help to improve movement and relieve stiffness. Problems with pain may mean that you’re not using your arm or shoulder properly, which can make things worse.
Taking painkillers half an hour before you exercise or having a warm bath to relax your muscles can help. If you can’t do your exercises or you find them painful, then stop.
Avoid lifting or carrying heavy things with the affected arm/shoulder or reaching out or lifting if it’s painful. Use a shopping trolley instead of a basket, shop online and get heavy things delivered. Try to make sure that objects you use often are low down and in easy-to-reach places.
Ask to be referred to an occupational therapist (OT) if you’re having difficulty carrying out daily tasks. They can assess your needs and recommend aids or equipment to help you.
Accept offers of help. Let people know what kind of practical help you need. They could help you with things like shopping, taking the rubbish out or mowing the lawn.
Complementary therapies, such as relaxation or deep breathing exercises, may be helpful. Ask your doctor or physiotherapist for advice on this.
After surgery for breast cancer, some women have an uncomfortable sensation that feels like a tight cord running from their armpit to the back of their hand. This is called cording. It may develop weeks or months after surgery and is thought to be due to hardened lymph vessels. Sometimes it makes it difficult to move the arm, but it usually gets better gradually over a few months. Some women may need physiotherapy and massage to improve it.
Changes to the appearance of the breast
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Women who have a breast removed (mastectomy) may find it hard to come to terms with the change in their appearance. This may affect how you feel about yourself as a woman and your sex life. It may also result in problems with depression. Some women choose to have breast reconstruction (see below).
Most women who only have a small part of the breast removed followed by radiotherapy don’t find there are too many changes in the appearance to adjust to. However, there are some changes that can develop over time.
Radiotherapy can cause dilated blood vessels under the skin (telangiectasia). Although this affects how the breast looks, it shouldn’t cause any other problems. Rarely, prominent blood vessels in the skin of the breast or chest can be a sign of more serious conditions so it’s always important to get any changes like this checked out. After radiotherapy, a woman’s breast may shrink slightly over time. Some women also develop a hardening or thickening of the breast tissue (fibrosis). This can cause the breast to become harder and smaller than it was. Breast shrinkage is worse in women who smoke, so doctors strongly advise women who smoke to give it up.
If you notice changes to the appearance or feel of your breast, it’s best to have it checked by your doctor or breast care nurse.
Women’s breasts often get bigger with age or weight gain. But if you’ve had radiotherapy, the treated breast won’t always increase in size in the same way as the other breast.
Keeping to a healthy weight can help to make sure that you don’t have too much of an imbalance between breasts. Wearing a shell or partial breast prosthesis in your bra can help to add symmetry. This is a silicone insert that can be worn inside one cup of a bra to give you a more balanced appearance. Breast Cancer Care provides information on different kinds of prosthesis. Some women choose to have surgery to reduce the size of the larger breast if the imbalance in their appearance is a problem. Your doctor or breast nurse can tell you more about this.
Breast reconstruction is one or more operations to make a new breast shape. It can be done after a mastectomy or to improve the shape of the breast after a lumpectomy.
Newer procedures, developed from liposuction techniques (lipomodelling), may be used to fill in dents in the breast. Fat cells are removed from the tummy area (abdomen) or the thighs by gentle liposuction. The whole fat cells are then separated and injected into the breast.
For some women, breast reconstruction can help to restore self-confidence, feelings of femininity and sexual attractiveness. There isn’t a time or age limit on when the operation should be done, just as long as you’re fit enough. Many women have reconstruction years after their initial breast operation. Your cancer specialist or breast care nurse can discuss this further with you and arrange a referral to a specialist breast cancer surgeon or a plastic surgeon.
Lymphoedema (swelling) of the arm or hand, and occasionally the breast, can develop at any time after treatment for breast cancer. It happens because surgery to remove the lymph nodes in the armpit, or radiotherapy to the nodes, has affected the way that lymph fluid drains from the arm.
Lymphoedema is more likely to happen if you’ve had all, or a large number, of lymph nodes removed together with radiotherapy to the armpit. It usually develops gradually, months or years after treatment. If you’ve only had a sentinel lymph node biopsy (checking just one or two of the lymph nodes), the risk of getting lymphoedema is low. If you’re not sure about what type of lymph node surgery you’ve had, your specialist nurse can tell you.
Reducing the risk of lymphoedema
The following steps could help to prevent lymphoedema. If you already have lymphoedema, this advice may stop it getting worse.
Any cuts in your skin can allow bacteria to enter your body and may quickly develop into an infection. So good skin care and protecting your arm and hand are important.
Here are some things you can do to prevent skin damage and reduce the risk of infection:
Keep your skin clean and moisturise every day with unperfumed cream or oil. Lymphoedema can make the skin dry and itchy, and it may crack. Good moisturising can help prevent this and keeps your skin supple and in good condition.
Treat even small grazes and cuts straight away. Wash the area thoroughly and cover it, if necessary. See your GP immediately if you develop any signs of infection around the cut, for example if it becomes red, hot or swollen.
General advice is to avoid needles (blood tests, injections, drips or acupuncture) and having your blood pressure taken in the arm on the side that has been treated. However, there is limited medical evidence in relation to this and lymphoedema.
Protect your arm and hand by wearing gloves and long sleeves when doing household tasks, DIY, gardening or working with animals.
To avoid burns, use oven gloves or pot holders and long sleeves when cooking and baking.
Use insect repellent to prevent insect bites. If you’re stung on or near the affected area, get medical advice.
Use nail clippers instead of scissors to cut your nails and never push back or cut the cuticles - use cuticle cream instead.
Use an electric razor if you shave under your arms. Numbness under the arm is not uncommon. It can be easy to cut yourself with a blade razor, especially if you have a bumpy scar.
Protect your skin from the sun. Cover up or use a high factor suncream (at least SPF 30) and avoid getting sunburnt.
Lymphoedema is a long-term condition but the earlier it’s diagnosed, the more effective and straightforward treatment is. If you notice any swelling in your arm or chest, always get it checked by your doctor or nurse.
If lymphoedema is diagnosed, you’ll be referred to a specialist lymphoedema nurse, breast care nurse, doctor or physiotherapist for a full assessment.
In some areas of the UK, there are specialist lymphoedema centres where treatment and advice are given. Your doctor or nurse should be able to tell you if there’s one in your area, or you can contact the British Lymphology Society, which produces a directory of centres. If you don’t live close to a centre, there are other organisations that can offer advice and support.
The aim of treatment is to relieve discomfort by reducing swelling and to prevent more build-up of fluid.
Treating lymphoedema involves:
skin care to prevent infection
exercises including limb positioning and movement
support using compression sleeves or bandages that help stop fluid from building up
self-massage or a specialised type of massage called manual lymphatic drainage.
You’ll be given advice on how to look after your skin and you‘ll be shown how to carry out treatment for yourself at home. This will help you to develop a routine that builds lymphoedema care into your everyday activities.