Breast and arm changes

Surgery and radiotherapy to the breast can cause changes in sensation and movement in the treated area, arm and shoulder. Treatments can also affect the appearance of the breast or cause swelling of the arm.

Some women have pain or pins and needles because treatment causes damage to the nerves. How much you can move your arm or shoulder may also be affected. Taking painkillers or drugs to treat nerve pain can help. A physiotherapist can give you advice about exercises too. If symptoms don’t improve always let your doctor know.

Swelling of the arm (lymphoedema) can sometimes develop after surgery or radiotherapy to the armpit. If you notice swelling in your arm or hand contact your breast nurse. The earlier it’s diagnosed the easier it is to treat.

After radiotherapy, a woman's breast may shrink slightly or the tissue may thicken. Let your nurse or doctor know about any changes.

After a mastectomy, women can have breast reconstruction years later. Reconstructive surgery can also be done if you had part of your breast removed but aren’t happy with the shape.

Effects on the breast and arm

Surgery and radiotherapy to the breast can cause a number of changes. These can include:

  • changes to the breast tissue or to the appearance of the breast
  • pain and changes in sensation
  • problems with movement
  • swelling of the arm (lymphoedema) if the armpit is treated.

Always let your cancer doctor or nurse know if you have any of these symptoms.

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 to the appearance of the breast

Surgical changes

Following any type of breast cancer surgery there will be a scar. The amount of scarring will depend on the type of surgery you have and how well it heals. Most scars fade with time and become less obvious. 

The best way to reduce scarring is to prevent an infection developing in the wound. You should keep the wound as clean as possible and follow the advice you are given by your nurse or surgeon.

Stretching and massaging the scar area every day during the first year after surgery can help to reduce scarring. Ask your breast care nurse or doctor for further advice.

Women who have a breast removed (mastectomy) may find it hard to come to terms with the change in their appearance. It may change how you feel about yourself as a woman and affect your sex life. It may also result in problems with depression. Some women choose to have breast reconstruction.

Having only a small part of the breast removed (wide local excision) will result in fewer changes in the appearance of the breast. This may be easier to adjust to.

Changes caused by radiotherapy

After radiotherapy, the skin of the breast may darken in colour. It may also be more sensitive, so it’s important to protect the area from strong sunlight by covering up or using a sunscreen with a high SPF.

Radiotherapy can cause dilated blood vessels under the skin (telangiectasia). Although this changes 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, some women develop a hardening or thickening of the breast tissue (fibrosis). The breast may also shrink slightly over time. 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 up. Sometimes, after radiotherapy the breast may be red and swollen.

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 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 prostheses. 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

Breast reconstruction is surgery to make a new breast shape after a mastectomy. It is also sometimes used to improve the shape of the breast after a wide local excision.

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 with you and arrange a referral to a specialist breast cancer surgeon or a plastic surgeon.


Pain and changes in sensation

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
  • aching 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 have 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 supportive sports bra during the day and a soft bra (no underwire) at night may help. You may find a bra with adjustable straps, soft seams and full cups more comfortable.

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.

Very rarely, radiotherapy to treat breast cancer can damage the nerves in the shoulder. This is called brachial plexus neuropathy. It can cause problems with pain, numbness and, in extreme cases, loss of movement. As radiotherapy techniques have improved, this problem is now very rare.

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.

If you’re unable to work because of damage to your arm, you may be entitled to some benefits. We also have information for people who are working while caring for someone with cancer.

Nerve pain can be treated in different ways.


Movement and strength in your arm and shoulder

Radiotherapy and surgery, especially to the armpit, can affect the range of movement and strength in your arm or shoulder. This may change 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 that will help you recover shoulder movement. Arm and shoulder movement gradually improve after treatment.

Tips to help improve movement and strength:

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 some exercises to improve movement and strength. Exercises you were previously given may not be right for you now. Having good posture is also important and your physiotherapist can give you advice on this.
  • Talk to your doctor about controlling your pain. This will help to improve movement and relieve stiffness. Problems with pain may mean that you’re not using your arm or shoulder properly. This 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 and shoulder, or reaching out and 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, nurse or physiotherapist for advice on this.


Cording

After surgery to remove lymph nodes in the armpit (axilla), some women develop a painful sensation that feels like a tight cord running from their armpit to the back of their hand. This is called cording and is thought to be due to hardened lymph vessels. It may develop six to eight weeks after surgery. It usually gets better gradually over a few months. Sometimes, it makes it difficult to move the arm.

Physiotherapy to stretch the ‘cords’ and massage can help to improve the condition. Your specialist nurse or physiotherapist can give you more information.


Lymphoedema

Lymphoedema (swelling) of the arm or hand, and occasionally the breast, can develop at any time after treatment for breast cancer. Surgery to remove the lymph nodes in the armpit, or radiotherapy to the nodes, can change the way that lymph fluid drains from the arm.

Lymphoedema is more likely to happen if you’ve had all, or many, of your lymph nodes removed together with radiotherapy to the armpit. It usually develops gradually, months or years after treatment. If you’ve had just one or two of the lymph nodes removed (a sentinel lymph node biopsy), 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

It’s thought that some things may trigger swelling in someone who is at risk of developing lymphoedema. This could be overuse of a limb (causing inflammation) or a skin infection.

The following steps could help to reduce the risk of infection and help prevent lymphoedema. If you already have lymphoedema, this advice may stop it getting worse.

  • 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.
  • Try to avoid needles (blood tests, injections, drips or acupuncture) and avoid having your blood pressure taken in the arm on the side that has been treated. Although there is limited medical evidence to support this, most lymphoedema experts think it’s a wise precaution to take to reduce the risk of infection.
  • Protect your arm and hand by wearing gloves and long sleeves when doing household tasks, DIY, gardening or looking after 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 sun cream (at least SPF 30) and avoid getting sunburnt.

Treating lymphoedema

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 will 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: