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.

Treatments that cause breast and arm changes

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 to the appearance of the breast, and 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. 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 in which 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

Surgery and radiotherapy can cause changes in sensation in the chest area, the armpit, and the shoulder and arm on the affected side.

This 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 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.

If you're unable to work because of damage to your arm, you may be entitled to some benefits. We have information about employment rights, disability rights and financial issues for people with cancer. We also have information about working while caring for someone with cancer.

Treating nerve pain

Nerve pain can be treated in different ways. There is more information about in our section on our section 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

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 improve after treatment. But, 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, 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 in 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. It could be 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. There's more information in our section on complementary therapies.


Cording

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

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.

Most women who have only 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 which 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 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 if weight is gained. 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 each breast. 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

Breast reconstruction is one or more operations to make a new breast shape. It can be done after a mastectomy or may be used to improve the shape of the breast after 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 specialist or breast care nurse can discuss this further with you and also arrange a referral to a specialist breast cancer surgeon or a plastic surgeon.

We have more information on breast reconstruction.


Lymphoedema

Lymphoedema is a swelling of the arm that sometimes happens after surgery or radiotherapy to the lymph nodes in the armpit. It can develop months or years after treatment. If you only had a sentinel lymph node biopsy, your risk of lymphoedema is small. Women who had all or a large number of lymph nodes removed are more at risk. Having radiotherapy to the armpit as well as surgery also increases lymphoedema risk.

There are things you can do to help reduce your chances of developing lymphoedema.