Leaving breast cancer treatment behind is like emerging from a cocoon. You are freed from the confinement of doctor appointments, tests, medications, and procedures. But you are also changed in a deep way.
After surgery, your body is different, requiring new habits and special care. Emotionally you have been changed as well. You, your mate, your friends, and family members must take the time to understand what you’ve been though. And your future has also been affected. To guard your hard-won health from now on, you must learn to be alert to the signs of recurrence.
The sections presented here address exercises for physical recovery, lifestyle changes that can help, the subtleties of emotional healing, and the details of monitoring for recurrence.
Exercises to Regain Flexibility & Strength
Breast surgery of any kind often means limited motion, stiffness, and pain. Unavoidable damage to lymph tubes when underarm lymph nodes are surgically removed is the chief cause of shoulder tightness and pain. Even lumpectomy involves removal of some lymph nodes; mastectomy may require removal of all nodes on that side.
After surgery, the natural urge to protect the painful side may make you reluctant to use your arm normally. Unfortunately, lack of use will actually cause muscles to tighten further. Simple exercises started as soon as possible after surgery can bring back your full range of motion and relieve pain and stiffness. Your doctor can recommend some and tell you when to start. If you have a lot of pain or mobility problems, or lymphedema (see below), your doctor can and should also refer you to a physical therapist trained in treating those issues.
Regarding lymphedema, be sure to check with your doctor before starting any exercise program — swelling could also be due to other causes (see below for more information).
Here are some sample exercises from Recovering From Breast Surgery(Hunter House, 1995) by physical therapist Diana Stumm:
Finger walk. Stand facing a wall, with your feet six to 12 inches away from the base of the wall. You can rest your forehead against the wall for balance; place the palms of your hands on the wall at shoulder-height. Slowly begin to walk the fingers of both hands up the wall. Go as high as you can without pain. Eventually, your goal is to have both arms fully extended overhead. Step back from the wall, lower your arms, and take a break. You can repeat the exercise up to five times in a row, up to twice a day.
Sideways arm stretch. This exercise is best done in front of a mirror, if possible. Sit in a straight-backed chair. Lift both hands to the top of your head, then grasp the wrist on the surgery side with the opposite hand. Your elbows should point out to the side and your head should be slightly lifted, not hanging down. Slowly and gently pull the surgery-side arm toward your head. Try to get the inner side of your upper arm to touch your ear — without moving your head toward your arm. Hold for a few seconds, then lower both arms and take a break. Repeat the exercise up to five times, up to twice a day.
For women with lymphedema
Women who have had underarm lymph nodes removed are at risk for dangerous arm and hand swelling on the surgery side. This condition, called lymphedema, can be aggravated by strenuous exercise or weight lifting. Ask your doctor about special programs that use massage and other techniques to relieve or prevent swelling.
Women with lymphedema are also at high risk for cellulitis, an infection that occurs under the skin. Any cuts on the surgery-side hand or arm should be watched carefully.
If you have had lumpectomy or mastectomy as part of your cancer treatment, you probably have concerns about the changes your body has been through. Having a breast altered or removed entirely has an impact on a woman’s physical health; surgery is also likely to affect a woman’s body image, and may even change the way she feels about sex. Learning how to care for and accept your body after surgery, and exploring these issues with your partner, close women friends, or an experienced therapist will help you come to terms with the effects of treatment.
Handling physical changes
Some women respond to mastectomy by having breast reconstruction surgery. Other women choose to buy and wear a prosthesis, or artificial breast form. Prosthetic breasts mimic the look, shape, and heft of a natural breast, and come in different skin tones and cup sizes. Wearing a prosthesis can improve your outward appearance, make your clothes fit better, and restore a sense of physical balance.
A variety of prosthetic styles are available. Most are made to slip into a pocket in a specially designed bra. Others use skin-safe, long-lasting adhesive to attach directly to the chest, and can be worn with a normal bra.
When shopping for a prosthesis, try samples on in the shop and walk around a bit. Ask whether you can return the prosthesis if you change your mind after you purchase it. And check with your insurance company about coverage — you may need a prescription from your doctor in order to be reimbursed.
Taking special care of your body after surgery
Most breast cancer surgeries remove some or all of the armpit lymph nodes. This puts a woman at permanent risk for a condition called lymphedema — the backup of lymph fluid in the surgery-side arm. Signs of lymphedema include a sleeve that starts to feel tight, rings or watches that no longer fit, or a feeling of heaviness in the arm on the surgery side.
Simple lifestyle changes can help prevent or alleviate lymphedema:
- Get in the habit of elevating your surgery-side arm when lying down. Keep an extra pillow in bed or on the couch to make it easier.
- Don’t carry your purse on the surgery side. This may take a little getting used to, but it’s important — a handbag shoulder strap can make slow lymph circulation even worse.
- Don’t carry anything at all that’s heavier than 15 pounds — including babies, pets, and grocery bags. Use a stroller, and ask for help when moving pets or loading groceries into the car.
- Make sure that all medical procedures using needles — such as injections, blood samples, or IVs — are done only on the unaffected side.
- If you are overweight, losing weight can reduce the severity of lymphedema, or help prevent it from developing. But ask your doctor about how you can safely lose weight; some forms of strenuous exercise may aggravate lymphedema.
You may also want to ask your doctor about seeing a physical therapist for specialized massage, called manual lymph drainage. Other effective treatments include wearing a shoulder-length elastic glove called a compression sleeve, or using a rented or purchased electric pump device that improves lymph flow. Untreated, lymphedema usually gets worse. If you have symptoms, talk to your doctor and take immediate steps to get relief.
Eating well for continued health
After you’ve survived a life-threatening disease, you’re likely to become much more aware of your health habits, including what you eat. Good nutrition plays a role in recovery by helping to rebuild damaged tissue, providing energy, and minimizing fatigue.
To reduce the risk of cancer the American Cancer Society recommends a diet centered around plant foods. Their guidelines specify eating five or more servings of fruits and vegetables a day, plus additional servings of other plant foods such as bread, pasta, beans, and rice. You should also limit high-fat foods, especially from animal sources (fatty meats and full-fat dairy products), and reduce the amount of alcohol you drink, if any.
Some animal studies show that foods containing omega-3 fatty acids may help prevent cancer growth, although more research is needed for proof of the same effect in people. These healthy fats can be found in certain fish (such as salmon and tuna) as well as in flaxseed, walnut, and canola oils.
Reclaiming your sexuality
A missing breast isn’t as physically disabling as a lost arm or leg. But when it comes to intimate encounters, a woman who has had a mastectomy may feel just as handicapped as someone with a missing limb. Once healed, though, a woman with one breast (or no breasts) is just as sexually healthy as any other woman.
Your biggest concern may be for your partner. But actually, the first person who has to learn acceptance of your changed state is you.
If discussing what your mastectomy means to you as a couple is difficult, consider seeing a therapist together. Airing your fears in front of each other, in a safe place, may be all it takes to reestablish open communication at home.
Talk can also be bolstered by action. A mate who is reluctant to touch or stroke you may just be waiting for your feedback. Try showing your mate that you aren’t in pain, and that it’s all right to touch the place where you had surgery.
Monitoring for Recurrence
If breast cancer comes back, research shows that it’s more likely to happen in the first two years after treatment than later on. However, the disease has been known to recur after many years. Cancer can come back in the same breast, the opposite breast, or in another part of the body.
Monitoring for recurrence involves paying regular visits to your doctor — more often at first, and less frequently as time goes on. Right after cancer treatment ends, a woman generally sees her doctor every three to four months. After she has been free of cancer for at least five years, doctor visits usually slow to once or twice a year. Because there is always some chance of recurrence, however slight, thorough screening and surveillance must continue indefinitely.
Checkups to monitor for cancer recurrence include a physical and visual exam of both breasts, as well as the chest, neck, and underarms. An abdominal exam is also done routinely, and yearly pelvic exams and blood tests are important. If you’re feeling well and have no symptoms, you shouldn’t need other tests. If anything suspicious does turn up, your doctor may want to order additional tests including bone scans, specialized blood tests, and X-rays, to help rule out a return of disease.
Doing your part
Despite any fears to the contrary, breast cancer won’t just sneak back into your life mysteriously — symptoms will develop. That’s why women find up to 90% of recurrences themselves. All women with a history of breast cancer should continue to do monthly breast self-exams. If you have had a mastectomy, be sure to examine the healed incision site, as well as the remaining breast, for lumps, swelling, redness, or other changes. Women who have had breast cancer should also continue to get yearly mammograms.
Cancer can also come back (or metastasize) in areas outside of the breast including the bones, liver, lungs, or brain. Be sure to report any of these problems to your doctor:
- Unexplained pain
- Unexpected weight loss
- Loss of appetite
- Unusual vaginal bleeding
- Changes in your menstrual cycle
- Blurred vision
- Coughing or hoarseness
- Persistent headache or backache
Digestive problems that don’t have a clear cause or don’t go away
Any of these symptoms could indicate a return of cancer, but they could also be signs of other, often minor health problems. Much of the time, cancer is not the problem, but you must see your doctor to be sure.
If cancer does return
- If cancer returns, a woman may feel as though all is lost. But treated right away, you and your doctor can gain control of recurrent breast cancer. If the cancer comes back in a breast that has been treated with lumpectomy and radiation in the past, the new tumor can be removed by mastectomy. If cancer returns in the chest wall or skin of a mastectomy site, it can be managed with chemotherapy or radiation.
If surgery, chemotherapy, or radiation don’t stop the spread of cancer, clinical trials offer some hope. Clinical trials test the newest treatments for women with all kinds of breast cancer, including recurrent.