What is a lumpectomy? How long does it take to recover from a lumpectomy? Who is a candidate for a lumpectomy? What are the additional treatments needed after a lumpectomy?.

Understanding Lumpectomy: A Breast-Preserving Surgical Procedure

Lumpectomy is a surgical procedure that removes a cancerous tumor from the breast, along with a small amount of surrounding healthy tissue. This breast-conserving surgery aims to preserve the majority of the breast while effectively treating the cancer. Led by experienced breast surgeons, Memorial Sloan Kettering Cancer Center (MSK) has been at the forefront of developing national guidelines for the use of lumpectomy.

Eligibility for Lumpectomy

Lumpectomy is typically recommended for individuals with early-stage breast cancers, such as stage I or stage II breast cancer, as well as those diagnosed with ductal carcinoma in situ (DCIS). Key factors that determine a patient’s candidacy for lumpectomy include the size of the tumor relative to the breast size, the location of the tumor within the breast, and the ability to receive radiation therapy after the surgery.

What Happens During a Lumpectomy?

During a lumpectomy, the surgeon removes the cancerous tissue and a small margin of healthy tissue surrounding it. In cases where the cancer is not palpable during a physical exam, a technique called radioactive seed localization may be used to precisely identify the tumor’s location.

Lymph Node Involvement and Lumpectomy

For patients with invasive breast cancer, one or more lymph nodes from the underarm area, known as sentinel nodes, are typically removed during the lumpectomy. These nodes are examined for the presence of cancer cells, which can help determine the stage of the disease and guide further treatment decisions.

Potential Need for Re-Excision

In some cases, a second surgery called a re-excision lumpectomy may be necessary if the initial pathology results indicate that cancer cells are present at the margins of the removed tissue. The surgeon will then remove an additional margin of tissue to ensure clear margins.

Recovery and Ongoing Treatment After Lumpectomy

Recovery from a lumpectomy can vary, but most patients are able to return home on the same day as the procedure. Additional treatments, such as radiation therapy, may be recommended after the lumpectomy to further reduce the risk of cancer recurrence. MSK offers comprehensive support services to assist women in their recovery and ongoing care.

Frequently Asked Questions

What is a lumpectomy? A lumpectomy is a surgical procedure that removes a cancerous tumor from the breast, along with a small amount of surrounding healthy tissue, while preserving the majority of the breast.

Who is a candidate for a lumpectomy? Lumpectomy is typically recommended for individuals with early-stage breast cancers, such as stage I or stage II, as well as those diagnosed with DCIS. The size and location of the tumor, and the ability to receive radiation therapy, are also key factors in determining candidacy.

What is radioactive seed localization? Radioactive seed localization is a technique used to precisely locate and remove small breast cancers that are not palpable during a physical exam. A radiologist implants a tiny radioactive seed in the breast to mark the exact location of the tumor, which the surgeon then uses to guide the lumpectomy procedure.

What is a re-excision lumpectomy? A re-excision lumpectomy refers to a second surgery that some women may need if the initial pathology results indicate the presence of cancer cells in the margins of the removed tissue. The surgeon will then remove an additional margin of tissue to ensure clear margins.

How long is the recovery from a lumpectomy? Recovery from a lumpectomy can vary, but most patients are able to return home on the same day as the procedure. The healing time can range from a few days to a few weeks, depending on the individual case.

Do I need additional treatment after a lumpectomy? Yes, in most cases, a lumpectomy is followed by radiation therapy to the breast to further reduce the risk of cancer recurrence. Other treatments, such as chemotherapy or hormonal therapy, may also be recommended based on the individual’s case.

What support does MSK offer to women recovering from a lumpectomy? MSK provides comprehensive support services, including access to a multidisciplinary team of breast cancer experts, educational resources, and supportive care programs, to assist women in their recovery and ongoing care after a lumpectomy.

Breast Cancer: Lumpectomy | Memorial Sloan Kettering Cancer Center

MSK’s breast surgeons offer consultations in Manhattan and at our outpatient locations in New Jersey and Westchester County and on Long Island. Shown here: Breast surgeon Deborah Capko, who cares for women at MSK Basking
Ridge.

What Is a Lumpectomy?

Lumpectomy is a surgery to remove cancerous breast tissue along with a rim of normal tissue surrounding it called a surgical margin. The procedure preserves the rest of the breast as well as sensation in the breast. Your doctor may also refer to it as a wide local excision, segmental resection, or partial mastectomy. Memorial Sloan Kettering breast cancer surgeons have been leaders in the development of national guidelines for the use of lumpectomy.

If you have invasive breast cancer and are younger than 70 years of age, a lumpectomy is always followed by radiation treatments to the breast.

At Memorial Sloan Kettering, our breast surgeons perform lumpectomy as an outpatient surgical procedure, meaning that you can return home on the same day as your procedure. We offer lumpectomies in New Jersey at MSK Monmouth, as well as at our state-of-the-art Josie Robertson Surgery Center in Manhattan.

Other treatments you may need, including radiation therapy, are available at our many convenient locations in New Jersey, Long Island, and Westchester, as well as in New York City.
 

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Here you will find more in-depth information on lumpectomy, along with answers to some common questions.

• Who is a candidate for a lumpectomy?
• Are lymph nodes removed during a lumpectomy?
• What is radioactive seed localization?
• What is a re-excision lumpectomy?
• What is lumpectomy recovery like?
• Will I need a surgical drain after lumpectomy?
• How will a lumpectomy change the appearance of my breast?
• Do I need additional treatment after a lumpectomy?
• What support does MSK offer to women recovering from a lumpectomy?

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Lumpectomy is typically recommended for women with newly diagnosed, early-stage breast cancers such as:

• stage I breast cancer
• stage II breast cancer
• DCIS (ductal carcinoma in situ)

There are a few other factors that determine whether you are a good candidate:

• your tumor is small relative to your breast size
• your tumor is in one area of your breast
• you’re able to receive radiation treatments after lumpectomy

For women with larger tumors, MSK’s breast cancer team also offers several approaches that can make lumpectomy possible.

• MSK’s medical oncologists can sometimes use chemotherapy to shrink the tumor first. This is called neoadjuvant chemotherapy.
• In addition, our plastic surgeons may be able to perform partial breast reconstruction, also known as oncoplastic surgery, during your lumpectomy. When possible, this approach allows us to achieve a good cosmetic outcome for you without the need for a mastectomy.

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Women with invasive breast cancer typically have one or more lymph nodes taken from the underarm area during a lumpectomy. These nodes, called the sentinel nodes, are the first lymph nodes to which cancer cells would travel if they were to leave the breast. This is done so that your doctor can check to see if the cancer has spread.

Women with DCIS undergoing lumpectomy do not need to have lymph nodes removed.

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Radioactive seed localization is a technique used to locate and remove small breast cancers that are detected on a mammogram or ultrasound but cannot be felt by your surgeon during a breast exam.

The procedure can take place up to a week before your lumpectomy. A radiologist places a tiny radioactive seed, about the size of a grain of rice, in your breast to mark the exact location of the cancer. The implanted seed contains a small amount of radiation, which helps your surgeon find the cancer at the time of your surgery using a handheld radiation-detection device.

The seed is removed by your surgeon during your lumpectomy.

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A re-excision lumpectomy refers to the second surgery some women have when their pathology results come back positive for cancer cells in the margins (the healthy tissue around the tumor that is removed during a lumpectomy).

Re-excision means the surgeon reopens the surgical site to remove an additional margin of tissue, with the goal of getting a margin that is cancer-free. Sometimes this practice is called “clearing the margins.”

At MSK, our surgeons have been leaders in developing guidelines to spare women from this second surgery in cases where it is not needed.

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Recovery from a lumpectomy is different for every woman. Healing time after surgery can range anywhere from a few days to a week.

• After a lumpectomy without a lymph node biopsy, you’re likely to feel well enough to return to work after two or three days. You can usually resume normal physical activities, like going to the gym, after one week.

• After a lumpectomy with a lymph node biopsy, you may need to take up to a week off from work to recover.

As you are healing, you may feel several different sensations in your breast. Some common examples include tenderness, numbness, and twinges. These sensations usually come and go, and will lessen over time, usually within the first few months after surgery. As you continue to heal, you may feel scar tissue along your incision site. It will feel hard. This is common and should soften over the next several months.

Learn more about what to expect before, during, and after lumpectomy with no lymph node biopsy and lumpectomy with lymph node biopsy.

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A surgical drain is a rubber drainage tube inserted during surgery to collect excess fluid that accumulates in the area where the tumor was removed. The drain is connected to a plastic bulb that can suction up the fluid.

At MSK, we do not leave in surgical drains after a lumpectomy or after a lumpectomy with lymph node biopsy.

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In many cases, lumpectomy causes very little scarring or changes to the breast. If the surgery is more involved, there are several ways to enhance the appearance of the breast. Options include a breast lift, breast reduction surgery, tissue rearrangement, and, in some cases, cosmetic plastic surgery on the other breast to make them look the same.

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Cancer doctors typically recommend that women under 70 who opt for a lumpectomy also receive radiation therapy to the affected breast. This is to kill any stray breast cancer cells that remain after surgery and to prevent the cancer from coming back. This approach, also known as breast conservation therapy, has been show to be equally as effective at treating early-stage breast cancer as mastectomy.

MSK’s radiation therapy teams are highly experienced in caring for women with breast cancer. We are one of just a few centers with a dedicated and specialized radiation team focused solely on treating breast cancer.

Learn more about our approach to radiation therapy for breast cancer.

Many women also benefit from drug therapies such as chemotherapy, targeted therapy, or hormone therapy. The goal of all of these treatments is to reduce the risk of breast cancer recurring (coming back) or metastasizing (spreading).

Your doctor’s recommendations for drug therapy are based on the molecular characteristics of your breast cancer.

Learn more about drug therapies for breast cancer.

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MSK’s quality-of-life specialists provide comprehensive follow-up care to help you recover from a lumpectomy. Many services are available at our New Jersey, Long Island, and Westchester County locations as well as at our Evelyn H. Lauder Breast Center in Manhattan.

• Wellness therapies from integrative medicine specialists can relieve emotional or physical symptoms after surgery or for potential side effects.
• Rehabilitation and exercise therapies can help you heal and recover your strength, flexibility, and stamina.
• Find emotional support through our Counseling Center, online support groups, or patient-to-patient support program, which connects you with other breast cancer survivors who understand your challenges and concerns. Our social workers are available across our treatment locations to provide emotional support and guidance. They can also help with some of the practical aspects of having cancer, such as transportation assistance and the impact on your job.

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What is it, Recovery & Side Effects

This page was reviewed under our medical and editorial policy by

Daniel Liu, MD, Plastic and Reconstructive Surgeon.

This page was reviewed on February 8, 2022.

If you’re diagnosed with breast cancer, you may be working with your cancer care team—a team of providers and specialists—on a treatment plan. One of these treatments may be a lumpectomy. Learn about what a lumpectomy is, why one may be recommended, and what to expect during surgery and aftercare.

A lumpectomy is a surgical procedure that’s performed when you have cancer and need to have some of the cancerous tissue and nearby areas removed. The goal of this procedure is to extract cancer tissue while still maintaining breast tissue.

You may also hear this procedure called by a few other names, such as:

• Breast-conserving surgery (BCS)
• Quadrantectomy
• Partial mastectomy
• Segmental mastectomy

These terms mean slightly different things depending on how much breast tissue is removed. This surgery is different from a mastectomy, which involves surgically removing the entire breast.

You may have a part of your chest wall removed as well during a lumpectomy if the cancer is detected near this area. Your care team may also choose to remove some of the lymph nodes underneath your arm if these are concerning areas for cancer.

Why are lumpectomies performed?

A lumpectomy is performed for patients who are diagnosed with breast cancer. It’s a form of treatment that may be a good option in the early stages of cancer. The goal of this surgery is to prevent cancer from spreading to the rest of the body.

Many patients decide to have a lumpectomy because they want to keep as much of their breast as possible. It’s less invasive than a mastectomy, but patients who have a lumpectomy also need to have radiation therapy or another treatment.

When compared with a mastectomy, your chances of long-term survival can be the same with a lumpectomy followed by radiation if:

• You have a small cancer (less than 4 cm) in only one breast, or cancers that are close together and can be treated at the same time
• Your margins (surrounding tissue) are clear 

Three factors to consider before deciding

There are several issues to take into consideration when deciding whether or not to have a lumpectomy.

1. Are you a candidate? Not everyone who has breast cancer is a good candidate for a lumpectomy. This depends on your overall health status, the type of cancer, or other factors that you may discuss with your care team.
2. What is your individual treatment plan? It’s also important to realize that you’re unique, just like your specific cancer treatment plan. How much of your breast tissue is removed during a lumpectomy depends on several things, including the tumor’s size and location, and the size of your breast.
3. How important is maximizing your breast tissue? The benefit of having this surgery means you’re able to keep most of your breast, but it also means that your care team may recommend radiation therapy as well. In most cases, radiation follows a lumpectomy, but you may also need to undergo chemotherapy or hormone therapy. If you elect to have a lumpectomy along with radiation instead of having a mastectomy, it doesn’t affect your overall recovery or survival rate of breast cancer.

What are the risks?

All surgeries come with a level of risk, and a lumpectomy is no different. Breast swelling is common after surgery but should be temporary. You may have pain, and you may have a scar or dimple where your tumor was taken out. You may even feel a “tugging” feeling in the breast. Breast asymmetry is expected following lumpectomy and radiation therapy, but the degree of cosmetic deformity varies widely among patients. Partial breast reconstruction may be offered at the time of lumpectomy or thereafter to fix contour deformities.

After this type of surgery, you may feel a type of nerve pain called post-mastectomy pain syndrome (PMPS). This affects 20 percent to 30 percent of patients, according to the American Cancer Society. You may feel a shooting or burning pain in your chest wall, armpit or in an arm. Unfortunately, this doesn’t go away, but many patients say the pain isn’t severe.

Some patients may also experience swelling in the arm, known as lymphedema. Alert your care team as soon as possible if you experience swelling, tight skin or a feeling of heaviness in your affected arm, so that treatment may start as soon as possible. Caught early, lymphedema may be reversed with treatment, but infection may develop if it progresses.

How to prepare for a lumpectomy

A lumpectomy is usually performed as an outpatient procedure in a surgery center. Usually, an overnight stay in a hospital isn’t necessary, and most patients resume regular daily activities within two weeks. Consider finding someone to help you out while you’re recovering.

You’ll likely have appointments with your doctor to review what to expect before, during and after surgery. It may help to take notes or bring along someone who is able to do this for you or ask questions. It’s also important to review all the medications you’re currently taking. Some of these, such as blood thinners, need to be stopped before surgery. You may or may not need to stop eating or drinking for a few hours before surgery.

What to expect during the procedure

During a lumpectomy, the surgeon’s goal is to remove as much cancer as possible, and some healthy tissue may need to be removed as well. This tissue is sent for testing. Some lymph nodes under the arm may also be extracted.

When the surgery is finished, a pathologist studies the tissue samples under a microscope. If the pathologist doesn’t see any cancer at the edge of the tissue, it means the tissue has clear, or negative, margins. If there are cancer cells present at the edges, it means there are close, or positive, margins. Your doctor will then inform you of these results and what treatment looks like going forward.

Follow-up care/results

Expect written instructions from your care team about how to manage your surgical site after discharge, along with contact information in case you have questions or concerns.

Most lumpectomy patients should be able to return to their daily routines about two weeks after surgery.

Make sure you understand how to care for your site and know how to change the dressing. If you have a drain, you’ll need to know how to empty it and keep it clean.

You’ll receive instructions on when and how to bathe after surgery, and when you may wear a bra again.

It’s also important to discuss infection prevention and pain management, along with any numbness in your breast or arm. Your care team may provide instructions on appropriate activity levels and prescribed exercises to prevent stiffness in your arm.

Signs of a possible infection at the surgical site after a lumpectomy include:

• Pain
• Skin that’s warm to the touch
• Fluid discharge
• Redness
• Swelling
• Fever

Other signs of a problem include:

• Fluid collecting near the wound and around the armpit that doesn’t go away on its own after a few weeks
• Blood collecting around the wound site that causes pain and swelling (called a hematoma), which may go away on its own after a few months
• Swelling in your arm or hand that persists

Consult your doctor if you experience any of these issues. You may need oral or intravenous antibiotics.

individual recovery and treatment program in Moscow

Breast cancer (BC ) is one of the most common oncological diseases in the world. It is diagnosed in every fifth patient diagnosed with oncology. In Russia, breast cancer ranks first among all types of cancer in women. Most often, women aged 40–60 years get sick, but in recent years this border has shifted towards patients under the age of 40 years.

Types of operations for breast cancer

Mastectomy is a radical operation that involves the complete removal of breast tissue. In some cases, both the tissues surrounding the mammary gland and the lymph nodes associated with it are removed.
Organ-preserving operations involve partial removal of breast tissue with a tumor. Such operations may require the removal of tissue surrounding the mammary gland, but to a lesser extent than with a mastectomy. Among such operations, for example, lumpectomy, which is the removal of a small focus of cancer. There is also a quadrantectomy – an operation during which ¼ of the breast is removed. There are also options for partial or segmental mastectomy, which involve the removal of more than ¼ of the breast.
When choosing a surgical technique, the stage of the process, histological and immunohistochemical characteristics of the tumor, age, and size of the mammary glands are taken into account.

Complications after surgery

The rapid start of rehabilitation can reduce or prevent many complications of the early postoperative period. The process should take place under the constant supervision of a doctor – you need to schedule regular scheduled visits to him.
After a mastectomy, post-mastectomy syndrome may develop, which is characterized by such manifestations as:

• post-mastectomy defect (including cosmetic)
• cicatricial changes in the axillary region
• brachioplexitis (brachial plexus disease) and/or neuropathy
• swelling of the upper limb
• psycho-emotional problems: anxiety, mental exhaustion, severe depression.

Treatment of breast cancer after surgery

Surgical treatment is not always enough to stop the tumor process. A number of patients are prescribed additional therapy. It can be radiation and drug therapy. The goal is to act on the remaining cancer cells and reduce the risk of recurrence, or to contain the growth of the tumor or reduce its size.

Pre-rehabilitation

This stage begins immediately after the diagnosis. Pre-rehabilitation accelerates the recovery of organ functions, reduces the length of stay in the hospital after surgery and reduces the likelihood of complications, as well as reduces the risk of death.

Pre-rehabilitation should include:

• therapeutic exercises aimed at strengthening the muscles of the upper shoulder girdle, as well as general physical training (aerobic and anaerobic exercise). This combination improves overall fitness and helps build muscle while improving quality of life
• psychological assistance
• informing the patient about the disease and treatment options.

Rehabilitation after breast tumor removal surgery

There are three stages in rehabilitation:

1. Preparatory stage. Aimed at improving general well-being and strengthening the muscular corset, improving the functional state with the help of therapeutic exercises
2. Early recovery phase. It is aimed at maintaining the range of motion in the shoulder joint, reducing postoperative edema. May include therapeutic exercises, massage and physiotherapy (procedures within the framework of the clinical recommendations of the Ministry of Health of the Russian Federation – magnetotherapy, electrotherapy, compression therapy)
3. Late recovery phase. Reconstructive treatment of the consequences of surgery to improve the quality of life of a woman. Therapeutic exercises and decongestant therapy in case of development of lymphatic edema and for the prevention of their occurrence. At this stage, the patient also undergoes psychotherapy.

Terms of rehabilitation

The duration of the recovery period depends on what operation was performed, the type of further therapy, as well as on the general state of health before the operation.

After organ-preserving surgery, it takes about two weeks to return to the usual way of life. It will take at least a month to recover from a mastectomy. But these terms do not imply a late stage: if breast reconstruction is performed, then the rehabilitation time increases by up to several months.

In the process of recovery, it is important to eat right, get enough rest, avoid overload, follow the doctor’s advice and perform the exercises recommended by him, with which you can restore flexibility and mobility to the joints, improve overall physical condition.

What is important in the postoperative period

In order to recover faster and return to normal life, you need to pay attention to the following aspects:

• the mammary gland must be protected from pressure and injury
• the weight and volume of the lost tissues must be replaced with a reconstructive operation or a postoperative prosthesis
• reducing the load on the arm on the operated side – it is not recommended to lift things more than 2-3 kg
• regular performance of special exercises, which are selected individually.

Precautions

Not only the condition of the wound and the postoperative scar needs attention, but also the arm on the side where the operation was performed.

Often, the removal of lymph nodes during mastectomy provokes lymphostasis or lymphedema, and in simple terms – swelling of the upper limbs. This condition can occur both in the first year after the operation, and after a few years. How to recognize a complication? First, there is a feeling of discomfort, fullness and heaviness in the arm from the operated side. At the next stage, visible swelling may appear, leading to an increase in the volume of the arm. This condition is dangerous with recurrent skin diseases (such as erysipelas).

Lymphedema (lymphostasis) is a likely serious consequence of surgery that can lead to disability. If you notice any of the symptoms of this condition, you should contact a rehabilitation doctor as soon as possible and start anti-edematous treatment.

Prophylactic compression stockings are of great importance in preventing the development of lymphedema. Compression underwear helps relieve swelling, reduce pain and improve quality of life. A rehabilitation doctor will help you choose the right model of compression underwear.

The arm on the side of the mammary gland, on which the operation was performed, requires special care. It is necessary to observe a sparing regime – do not lift heavy objects, and clothes and jewelry should not squeeze it. At night, you should try not to press your hand and not lie down on it. And if swelling has already appeared, then during sleep it is recommended to give the arm an elevated position to improve the outflow of lymph.

To ensure painless and safe recovery from breast cancer, skin damage must be avoided. Key recommendations for the prevention of postoperative complications:

• avoid significant temperature fluctuations. It is not recommended to visit the sauna, bath, take hot baths
• temporarily refuse a manicure in the salon and prevent damage to the skin of the upper limb
• Reduce sun exposure and be sure to use sunscreen with SPF. Seasonality does not affect the activity of UVA rays harmful to the skin, which penetrate even through glass.

Permanent changes

After surgery, the breast changes forever. After 2-3 months, it is necessary to pick up an exoprosthesis and everyday underwear.

Which prosthesis you can choose from:

• Silicone. An external weighted prosthesis made of silicone is needed to mimic natural breast tissue. It can improve posture, prevent drooping shoulders and balance problems
• Silicone free prosthesis is a lightweight prosthesis made of foam or fiber filler. Non-silicone dentures can be worn during exercise, swimming and in hot weather.

It is important to wear the prosthesis at all times so that body deformations do not occur. With intermittent wearing, there is a risk of poor posture, curvature of the spine, lowering of the shoulders and displacement of internal organs. This can cause pain.
The bra must securely fix the exoprosthesis. Make sure that it does not pinch the blood and lymph flow. Mastectomy bras for women have stretchy spandex pockets on the inside to help hold the prosthesis in place.

Diet and diet

There are no reliably studied diets recommended for women after breast cancer treatment. There are generally accepted and fairly simple rules. Diet – small portions several times a day. Food is best steamed, boiled, baked. Most of the plate should be occupied by vegetables, protein is also very important – it helps maintain muscle mass. Protein sources other than meat, fish, dairy, and eggs include beans, lentils, nuts, and seeds.
Healthy whole grains, fruits, berries. Required in the diet of unsaturated fats, such as olive oil or nuts. It is also necessary to establish a stable drinking regime at the rate of about 35 ml per kilogram of body weight.

It is recommended to avoid foods such as:

• caffeinated foods and drinks
• alcohol
• raw or undercooked meat, fish or poultry
• raw or soft-boiled eggs
• unpasteurized milk products or juices

Exercise after surgery

It is important to talk to your doctor before starting any exercise to find the right program for you. Therapeutic gymnastics helps to reduce pain, relax overstrained muscles of the neck and shoulders, and restore muscle tone. Recommended exercises that increase and maintain range of motion in the shoulder joints. Strength training and therapeutic swimming are added later.

In the first months after surgery, it is better to exercise under the supervision of a physiotherapist. It is important to pay attention to signs that may indicate problems with lymph circulation. If even a slight edema appears, it is necessary to consult a doctor who will help to avoid serious consequences.

If the lymph nodes have been removed, it is not recommended to keep the hand in one position for a long time, Pilates, yoga, which use statistical exercises with a load on the hands, as well as participation in sports games that involve sudden movements and a high probability of getting injury.
You cannot exercise with weights on the upper limbs for 6 months after the operation, even if there is no visible swelling.

Mental health care

The support of family and friends is essential in the healing and recovery process. A woman needs the attention of loved ones, she wants to feel needed and not feel isolated from society and relatives.

After surgery, women often experience psychological problems associated with a sense of loss of femininity. Immediately after the operation, unstable mood, feelings of inferiority, shame can be observed, which leads to a desire to limit communication with people and social isolation. Along with the realization of a successful outcome of the operation, the idea of ​​\u200b\u200bself, self-esteem changes. At this time, patients become aware of the consequences of the operation and may experience a sense of their own inferiority.

Memory and attention disorders, emotional instability are often observed. This is a consequence of psychological trauma after diagnosis and complex treatment. Psycho-emotional disorders can interfere with a fulfilling life, making it difficult for recovery processes.

When undergoing rehabilitation, you can contact a psychologist who will help you cope with a difficult period in your life.

Pregnancy after breast cancer

Hormonal changes during pregnancy, namely the increase in estrogen levels, may be a cause for concern for a woman who has had breast cancer. However, the researchers conclude that treated women with a diagnosis of breast cancer should not be afraid of pregnancy for fear of relapse. According to studies, pregnancy in such cases does not affect the risk of recurrence of the tumor.
The study, published in December 2022 in the journal Obstetrics & Gynecology, tracked the pregnancies of 30,021 California women aged 18 to 45 who were diagnosed with breast cancer from 2000 to 2012. The authors compared these women with a control group of 1,659 healthy women. There were no significant differences in birth outcomes and neonatal health outcomes.

Follow-up

During remission, a patient with cancer needs to undergo follow-up examinations prescribed by a doctor 4 to 1 time per year.
After the initial treatment, a preventive examination should be carried out 1 to 4 times a year, depending on the effect of rehabilitation during the first 5 years. In the future, you need to visit a doctor at least once a year.

Onco Wiki – How to recover from breast surgery?

Today, when breast cancer can be considered as a complex, difficult, but a stage of life, one must understand how to complete it correctly, how to make the return to normal life a stepwise, understandable process.

What types of rehabilitation are there?

The following types are distinguished:

1. Prophylactic;
2. Recovery;
3. Support;
4. Palliative.

Let’s talk about each of them in more detail.

First, oddly enough, rehabilitation should begin simultaneously with treatment. This is the so-called preventive rehabilitation. It includes measures aimed at reducing the number of complications associated with the disease or its treatment. That is why in specialized departments there are necessarily doctors-rehabilitators or specialists in physical therapy who come to patients before the operation or on the first day after it and tell them which exercises and in what volume it is better to do in each specific situation. Of course, rehabilitation also includes psychological counseling. In specialized clinics, as a rule, there are also psychologists or oncopsychologists and consulting psychiatrists and psychotherapists who can prescribe the necessary medicines.

Rehabilitation is called restorative or restorative when a full functional return to the pre-illness and treatment level is expected. But supportive and palliative rehabilitation have other goals. The goal of supportive rehabilitation is to restore functional independence as much as possible. Palliative rehabilitation is aimed at achieving maximum comfort for the patient and relatives caring for him.

This material will focus on preventive and restorative rehabilitation. You can read about palliative care in the relevant section.

What is included in rehabilitation after breast surgery?

The initial scope of our actions depends on the degree of changes that have occurred due to the tumor. If we are talking about early breast cancer, when there are no symptoms from the side of the tumor, then only the correct information about the possible options for the amount of treatment is important here. But the tumor can be large, cause constant or periodic pain, ulcerate, bleed. Then the oncologist can involve the surgeon or independently prescribe the performance of wound dressings or the wearing of supportive underwear. Of the drugs, anti-inflammatory, analgesic, antibacterial drugs can be prescribed.

Mandatory preventive rehabilitation includes:

1. Early activation (attempts to sit down, stand up, walk to the ward bathroom 2 hours after the operation).
2. Performing exercises* recommended by a physiotherapist or rehabilitation specialist. You can start with 2-3 multiple repetitions and gradually increase the range of motion and the number of sets.
3. Wearing postoperative underwear.
4. Selection of exoprosthesis.

*in exceptional cases (expected high risk of bleeding, individual characteristics), exercise may be delayed for several days.

A well-chosen set of exercises does not harm the patient, but only promotes wound healing, helps the scar form in the right place and have the right degree of elasticity.

We like the set of exercises on the official MSKCC website, you can use it.

Rehabilitation after breast resections of any nature (including oncoplastic, sectoral, radical) includes wearing postoperative underwear. It can be your bra without wires or sports top. Due to compression, the cavity after removal of the tumor will heal better and faster, with the help of linen support, you can slightly reduce the pressure on postoperative sutures, which means that scars will form more accurately.

Rehabilitation after removal of the mammary gland without reconstruction includes the selection of a special exoprosthesis. The latter is selected taking into account the size of a healthy breast and materials that are comfortable for the patient. Exoprostheses are silicone and textile, more or less heavy. For wearing on the beach, there are special swimsuits with pockets for the prosthesis.

What is post-mastectomy syndrome?

PMES – post-mastectomy syndrome – is characterized by pain of any kind, which persists after the suture is completely healed. In fact, the symptoms described can also occur after resection of the mammary gland, i.e., its incomplete removal.

Risk factors include:

• Previous episodes of acute pain in the early postoperative period;
• Young age;
• Radiotherapy to the axilla;
• Volume intervention in the armpit.

The pain is usually burning, neuropathic (hyperesthesia – hypersensitivity or paresthesia – impaired, distorted sensitivity), similar to “electrical” or shooting sensations in the scar area and on the inner or back surface of the shoulder. Most likely, they are associated with direct damage to the nerve during the operation or arise due to the development of a traumatic neuroma (growth of cells surrounding the nerve). Also, a rough scar can “draw” the nervous tissue of the axillary region and / or chest wall into itself.

Although available data on the dynamics of these symptoms is limited, one long-term observational study still found that within 9 years, half of the women with postmastectomy syndrome were pain free, while the other half remained.

How is PMES treated?

To date, there are no data from prospective studies on the benefits of any specific methods of correcting PMES. But exercise therapy often helps to reduce the severity of the described symptoms. Other methods may also be prescribed by a doctor, including applying cold or applying diclofenac or lidocaine (topically), transcutaneous electrical stimulation of nerve endings (the independent use of these methods is strictly contraindicated!) Of the drugs, pregabalin and gabapentin, which have neurostabilizing properties, inhibitors reuptake of serotonin (for example, duloxetine, also recommended for myalgia and arthralgia while taking aromatase inhibitors).

Refractory, that is, resistant to various types of treatment, PMES can be corrected by the administration of botulinum toxin A. The use of this drug in the situation of PMES is based on data on the preventive effect of botulinum toxin A in relation to postoperative pain after removal of the mammary gland and simultaneous reconstruction.

What are phantom sensations in the mammary gland?

After removal of the mammary gland, an average of 1 out of 10 patients for several years may notice discomfort in the missing organ, sometimes even pain.

There is evidence that phantom pains are slightly more common in girls who experienced discomfort in the mammary glands before the operation, including before the start of the menstrual cycle. No reliable association and clear risk factors for this complication have been described. Preventive rehabilitation is necessary, including an understanding of the scope of the operation before it is performed, psychological readiness for the expected scope of the surgical intervention.

What if there is necrosis of the nipple?

Necrosis of the nipple-areolar complex is a complication that can occur after subcutaneous mastectomy with its preservation. Necrosis occurs due to insufficient blood supply to the tissues after the “transfer” of the nipple-areolar complex to a new location. In a systematic review including 12,358 patients, the overall complication rate was 22%, of which the rate of partial or complete necrosis of the nipple was about 6%. Risk factors that increase the likelihood of necrosis of the nipple included large breast size, ptosis (sagging) of the mammary glands, smoking, prior radiation therapy.

Rehabilitation consists in competent management of such a wound by a surgeon, timely removal of necrotic tissues. In the case of deep necrosis, the removal of the nipple-areolar complex is required at the first stage with its further reconstruction after the scar has healed. Rarely, in case of wound suppuration, removal of the installed prosthesis and delayed breast reconstruction may be required.