Breast cancer

What is Breast Cancer?

Cancer occurs when changes called mutations take place in genes that regulate cell growth. The mutations let the cells divide and multiply in an uncontrolled way.

Breast cancer is cancer that develops in breast cells. Typically, the cancer forms in either the lobules or the ducts of the breast. Lobules are the glands that produce milk, and ducts are the pathways that bring the milk from the glands to the nipple. Cancer can also occur in the fatty tissue or the fibrous connective tissue within your breast.

The uncontrolled cancer cells often invade other healthy breast tissue and can travel to the lymph nodes under the arms. The lymph nodes are a primary pathway that help the cancer cells move to other parts of the body.

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Before Breast Cancer Treatment

Symptoms

In its early stages, breast cancer may not cause any symptoms. In many cases, a tumor may be too small to be felt, but an abnormality can still be seen on a mammogram. If a tumor can be felt, the first sign is usually a new lump in the breast that was not there before. However, not all lumps are cancer.

Each type of breast cancer can cause a variety of symptoms. Many of these symptoms are similar, but some can be different. Symptoms for the most common breast cancers include:

. A breast lump or tissue thickening that feels different than surrounding tissue and has developed recently.

. Breast pain

. Red, pitted skin over your entire breast

. Swelling in all or part of your breast

. A nipple discharge other than breast milk

. Bloody discharge from your nipple

. Peeling, scaling, or flaking of skin on your nipple or breast

. A sudden, unexplained change in the shape or size of your breast

. Inverted nipple

. Changes to the appearance of the skin on your breasts

. A lump or swelling under your arm

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When to see a doctor

If you have any of these symptoms, it doesn’t necessarily mean you have breast cancer. For instance, pain in your breast or a breast lump can be caused by a benign cyst. Still, if you find a lump in your breast or have other symptoms, you should see your doctor for further examination and testing.

Causes

Doctors know that breast cancer occurs when some breast cells begin to grow abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. Cells may spread (metastasize) through your breast to your lymph nodes or to other parts of your body.

Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.

Researchers have identified hormonal, lifestyle and environmental factors that may increase your risk of breast cancer. But it's not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It's likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.

. Inherited breast cancer

Doctors estimate that about 5 to 10 percent of breast cancers are linked to gene mutations passed through generations of a family.

A number of inherited mutated genes that can increase the likelihood of breast cancer have been identified. The most well-known are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which significantly increase the risk of both breast and ovarian cancer.

If you have a strong family history of breast cancer or other cancers, your doctor may recommend a blood test to help identify specific mutations in BRCA or other genes that are being passed through your family.

Consider asking your doctor for a referral to a genetic counselor, who can review your family health history. A genetic counselor can also discuss the benefits, risks and limitations of genetic testing to assist you with shared decision-making.

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Risk factors

A breast cancer risk factor is anything that makes it more likely you'll get breast cancer. But having one or even several breast cancer risk factors doesn't necessarily mean you'll develop breast cancer. Many women who develop breast cancer have no known risk factors other than simply being women.

Factors that are associated with an increased risk of breast cancer include:

. Being female. Women are much more likely than men are to develop breast cancer.

. Increasing age. Your risk of breast cancer increases as you age.

. A personal history of breast conditions. If you've had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of breast cancer.

. A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.

. A family history of breast cancer. If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.

. Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.

. Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.

. Obesity. Being obese increases your risk of breast cancer.

. Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.

. Beginning menopause at an older age. If you began menopause at an older age, you're more likely to develop breast cancer.

. Having your first child at an older age. Women who give birth to their first child after age 30 may have an increased risk of breast cancer.

. Having never been pregnant. Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.

. Postmenopausal hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.

. Drinking alcohol. Drinking alcohol increases the risk of breast cancer.

Diagnosis

Diagnosing breast cancer

Tests and procedures used to diagnose breast cancer include:

. Breast exam. Your doctor will check both of your breasts and lymph nodes in your armpit, feeling for any lumps or other abnormalities.

. Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality.

. Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst.

. Removing a sample of breast cells for testing (biopsy). A biopsy is the only definitive way to make a diagnosis of breast cancer. During a biopsy, your doctor uses a specialized needle device guided by X-ray or another imaging test to extract a core of tissue from the suspicious area. Often, a small metal marker is left at the site within your breast so the area can be easily identified on future imaging tests.

Biopsy samples are sent to a laboratory for analysis where experts determine whether the cells are cancerous. A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer, and whether the cancer cells have hormone receptors or other receptors that may influence your treatment options.

. Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye. Unlike other types of imaging tests, an MRI doesn't use radiation to create the images.

Other tests and procedures may be used depending on your situation.

Once your doctor has diagnosed your breast cancer, he or she works to establish the extent (stage) of your cancer. Your cancer's stage helps determine your prognosis and the best treatment options.

Complete information about your cancer's stage may not be available until after you undergo breast cancer surgery.

Tests and procedures used to stage breast cancer may include:

. Blood tests, such as a complete blood count

. Mammogram of the other breast to look for signs of cancer

. Breast MRI

. Bone scan

. Computerized tomography (CT) scan

. Positron emission tomography (PET) scan

Not all women will need all of these tests and procedures. Your doctor selects the appropriate tests based on your specific circumstances and taking into account new symptoms you may be experiencing.

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Prevention

Breast cancer risk reduction for women with an average risk

Making changes in your daily life may help reduce your risk of breast cancer. Try to:

. Ask your doctor about breast cancer screening. Discuss with your doctor when to begin breast cancer screening exams and tests, such as clinical breast exams and mammograms.

Talk to your doctor about the benefits and risks of screening. Together, you can decide what breast cancer screening strategies are right for you.

. Become familiar with your breasts through breast self-exam for breast awareness. Women may choose to become familiar with their breasts by occasionally inspecting their breasts during a breast self-exam for breast awareness. If there is a new change, lumps or other unusual signs in your breasts, talk to your doctor promptly.

Breast awareness can't prevent breast cancer, but it may help you to better understand the normal changes that your breasts undergo and identify any unusual signs and symptoms.

. Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day, if you choose to drink.

. Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of the week. If you haven't been active lately, ask your doctor whether it's OK and start slowly.

. Limit postmenopausal hormone therapy. Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the benefits and risks of hormone therapy.

Some women experience bothersome signs and symptoms during menopause and, for these women, the increased risk of breast cancer may be acceptable in order to relieve menopause signs and symptoms.

To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.

. Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you need to lose weight, ask your doctor about healthy strategies to accomplish this. Reduce the number of calories you eat each day and slowly increase the amount of exercise.

. Choose a healthy diet. Women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer. The Mediterranean diet focuses mostly on plant-based foods, such as fruits and vegetables, whole grains, legumes, and nuts. People who follow the Mediterranean diet choose healthy fats, such as olive oil, over butter and fish instead of red meat.

Breast cancer risk reduction for women with a high risk

If your doctor has assessed your family history and determined that you have other factors, such as a precancerous breast condition, that increase your risk of breast cancer, you may discuss options to reduce your risk, such as:

. Preventive medications (chemoprevention). Estrogen-blocking medications, such as selective estrogen receptor modulators and aromatase inhibitors, reduce the risk of breast cancer in women with a high risk of the disease.

These medications carry a risk of side effects, so doctors reserve these medications for women who have a very high risk of breast cancer. Discuss the benefits and risks with your doctor.

. Preventive surgery. Women with a very high risk of breast cancer may choose to have their healthy breasts surgically removed (prophylactic mastectomy). They may also choose to have their healthy ovaries removed (prophylactic oophorectomy) to reduce the risk of both breast cancer and ovarian cancer.

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During Breast Cancer Treatment

Types of Breast Cancer

There are several types of breast cancer, and they are broken into two main categories: “invasive” and “noninvasive,” or in situ. While invasive cancer has spread from the breast ducts or glands to other parts of the breast, noninvasive cancer has not spread from the original tissue.

These two categories are used to describe the most common types of breast cancer, which include:

. Ductal carcinoma in situ. Ductal carcinoma in situ (DCIS) is a noninvasive condition. With DCIS, the cancer cells are confined to the ducts in your breast and haven’t invaded the surrounding breast tissue.

. Lobular carcinoma in situ. Lobular carcinoma in situ (LCIS) is cancer that grows in the milk-producing glands of your breast. Like DCIS, the cancer cells haven’t invaded the surrounding tissue.

. Invasive ductal carcinoma. Invasive ductal carcinoma (IDC) is the most common type of breast cancer. This type of breast cancer begins in your breast’s milk ducts and then invades nearby tissue in the breast. Once the breast cancer has spread to the tissue outside your milk ducts, it can begin to spread to other nearby organs and tissue.

. Invasive lobular carcinoma. Invasive lobular carcinoma (ILC) first develops in your breast’s lobules and has invaded nearby tissue.

Other, less common types of breast cancer include:

. Paget disease of the nipple. This type of breast cancer begins in the ducts of the nipple, but as it grows, it begins to affect the skin and areola of the nipple.

. Phyllodes tumor. This very rare type of breast cancer grows in the connective tissue of the breast. Most of these tumors are benign, but some are cancerous.

. Angiosarcoma. This is cancer that grows on the blood vessels or lymph vessels in the breast.

The type of cancer you have determines your treatment options, as well as your likely long-term outcome.

Inflammatory breast cancer

Inflammatory breast cancer (IBC) is a rare but aggressive type of breast cancer. IBC makes up only between 1 and 5 percent of all breast cancer cases.

With this condition, cells block the lymph nodes near the breasts, so the lymph vessels in the breast can’t properly drain. Instead of creating a tumor, IBC causes your breast to swell, look red, and feel very warm. A cancerous breast may appear pitted and thick, like an orange peel.

IBC can be very aggressive and can progress quickly. For this reason, it’s important to call your doctor right away if you notice any symptoms.

Triple-negative breast cancer

Triple-negative breast cancer is another rare disease type, affecting only about 10 to 20 percent of people with breast cancer. To be diagnosed as triple-negative breast cancer, a tumor must have all three of the following characteristics:

. It lacks estrogen receptors. These are receptors on the cells that bind, or attach, to the hormone estrogen. If a tumor has estrogen receptors, estrogen can stimulate the cancer to grow.

. It lacks progesterone receptors. These receptors are cells that bind to the hormone progesterone. If a tumor has progesterone receptors, progesterone can stimulate the cancer to grow.

. It doesn’t have additional HER2 proteins on its surface. HER2 is a protein that fuels breast cancer growth.

If a tumor meets these three criteria, it’s labeled a triple-negative breast cancer. This type of breast cancer has a tendency to grow and spread more quickly than other types of breast cancer.

Triple-negative breast cancers are difficult to treat because hormonal therapy for breast cancer is not effective.

Metastatic breast cancer

Metastatic breast cancer is another name for stage 4 breast cancer. It’s breast cancer that has spread from your breast to other parts of your body, such as your bones, lungs, or liver.

This is an advanced stage of breast cancer. Your oncologist (cancer doctor) will create a treatment plan with the goal of stopping the growth and spread of the tumor or tumors.

Breast Cancer Stages

Breast cancer can be divided into stages based on how large the tumor or tumors are and how much it has spread. Cancers that are large and/or have invaded nearby tissues or organs are at a higher stage than cancers that are small and/or still contained in the breast. In order to stage a breast cancer, doctors need to know:

. If the cancer is invasive or noninvasive

. How large the tumor is

. Whether the lymph nodes are involved

. If the cancer has spread to nearby tissue or organs

Breast cancer has five main stages: stages 0 to 5.

Stage 0 breast cancer

Stage 0 is DCIS. Cancer cells in DCIS remain confined to the ducts in the breast and have not spread into nearby tissue.

Stage 1 breast cancer

. Stage 1A: The primary tumor is 2 centimeters wide or less and the lymph nodes are not affected.

. Stage 1B: Cancer is found in nearby lymph nodes, and either there is no tumor in the breast, or the tumor is smaller than 2 cm.

Stage 2 breast cancer

. Stage 2A: The tumor is smaller than 2 cm and has spread to 1–3 nearby lymph nodes, or it’s between 2 and 5 cm and hasn’t spread to any lymph nodes.

. Stage 2B: The tumor is between 2 and 5 cm and has spread to 1–3 axillary (armpit) lymph nodes, or it’s larger than 5 cm and hasn’t spread to any lymph nodes.

Stage 3 breast cancer

. Stage 3A:

  . The cancer has spread to 4–9 axillary lymph nodes or has enlarged the internal mammary lymph nodes, and the primary tumor can be any size.

  . Tumors are greater than 5 cm and the cancer has spread to 1–3 axillary lymph nodes or any breastbone nodes.

. Stage 3B: A tumor has invaded the chest wall or skin and may or may not have invaded up to 9 lymph nodes.

. Stage 3C: Cancer is found in 10 or more axillary lymph nodes, lymph nodes near the collarbone, or internal mammary nodes.

Stage 4 breast cancer

Stage 4 breast cancer can have a tumor of any size, and its cancer cells have spread to nearby and distant lymph nodes as well as distant organs.

The testing your doctor does will determine the stage of your breast cancer, which will affect your treatment.

Treatment

Your doctor determines your breast cancer treatment options based on your type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones. Your doctor also considers your overall health and your own preferences.

Most women undergo surgery for breast cancer and many also receive additional treatment after surgery, such as chemotherapy, hormone therapy or radiation. Chemotherapy might also be used before surgery in certain situations.

There are many options for breast cancer treatment, and you may feel overwhelmed as you make complex decisions about your treatment. Consider seeking a second opinion from a breast specialist in a breast center or clinic. Talk to other women who have faced the same decision.

Breast cancer surgery

Operations used to treat breast cancer include:

. Removing the breast cancer (lumpectomy). During a lumpectomy, which may be referred to as breast-conserving surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue.

A lumpectomy may be recommended for removing smaller tumors. Some people with larger tumors may undergo chemotherapy before surgery to shrink a tumor and make it possible to remove completely with a lumpectomy procedure.

. Removing the entire breast (mastectomy). A mastectomy is an operation to remove all of your breast tissue. Most mastectomy procedures remove all of the breast tissue — the lobules, ducts, fatty tissue and some skin, including the nipple and areola (total or simple mastectomy).

Newer surgical techniques may be an option in selected cases in order to improve the appearance of the breast. Skin-sparing mastectomy and nipple-sparing mastectomy are increasingly common operations for breast cancer.

. Removing a limited number of lymph nodes (sentinel node biopsy). To determine whether cancer has spread to your lymph nodes, your surgeon will discuss with you the role of removing the lymph nodes that are the first to receive the lymph drainage from your tumor.

If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.

. Removing several lymph nodes (axillary lymph node dissection). If cancer is found in the sentinel lymph nodes, your surgeon will discuss with you the role of removing additional lymph nodes in your armpit.

. Removing both breasts. Some women with cancer in one breast may choose to have their other (healthy) breast removed (contralateral prophylactic mastectomy) if they have a very increased risk of cancer in the other breast because of a genetic predisposition or strong family history.

Most women with breast cancer in one breast will never develop cancer in the other breast. Discuss your breast cancer risk with your doctor, along with the benefits and risks of this procedure.

Complications of breast cancer surgery depend on the procedures you choose. Breast cancer surgery carries a risk of pain, bleeding, infection and arm swelling (lymphedema).

You may choose to have breast reconstruction after surgery. Discuss your options and preferences with your surgeon.

Consider a referral to a plastic surgeon before your breast cancer surgery. Your options may include reconstruction with a breast implant (silicone or water) or reconstruction using your own tissue. These operations can be performed at the time of your mastectomy or at a later date.

Radiation therapy

Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells. Radiation therapy is typically done using a large machine that aims the energy beams at your body (external beam radiation). But radiation can also be done by placing radioactive material inside your body (brachytherapy).

External beam radiation of the whole breast is commonly used after a lumpectomy. Breast brachytherapy may be an option after a lumpectomy if you have a low risk of cancer recurrence.

Doctors may also recommend radiation therapy to the chest wall after a mastectomy for larger breast cancers or cancers that have spread to the lymph nodes.

Breast cancer radiation can last from three days to six weeks, depending on the treatment. A doctor who uses radiation to treat cancer (radiation oncologist) determines which treatment is best for you based on your situation, your cancer type and the location of your tumor.

Side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also appear swollen or more firm. Rarely, more-serious problems may occur, such as damage to the heart or lungs or, very rarely, second cancers in the treated area.

Chemotherapy

Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells. If your cancer has a high risk of returning or spreading to another part of your body, your doctor may recommend chemotherapy after surgery to decrease the chance that the cancer will recur.

Chemotherapy is sometimes given before surgery in women with larger breast tumors. The goal is to shrink a tumor to a size that makes it easier to remove with surgery.

Chemotherapy is also used in women whose cancer has already spread to other parts of the body. Chemotherapy may be recommended to try to control the cancer and decrease any symptoms the cancer is causing.

Chemotherapy side effects depend on the drugs you receive. Common side effects include hair loss, nausea, vomiting, fatigue and an increased risk of developing an infection. Rare side effects can include premature menopause, infertility (if premenopausal), damage to the heart and kidneys, nerve damage, and, very rarely, blood cell cancer.

Hormone therapy

Hormone therapy — perhaps more properly termed hormone-blocking therapy — is used to treat breast cancers that are sensitive to hormones. Doctors refer to these cancers as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.

Hormone therapy can be used before or after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.

Treatments that can be used in hormone therapy include:

. Medications that block hormones from attaching to cancer cells (selective estrogen receptor modulators)

. Medications that stop the body from making estrogen after menopause (aromatase inhibitors)

. Surgery or medications to stop hormone production in the ovaries

Hormone therapy side effects depend on your specific treatment, but may include hot flashes, night sweats and vaginal dryness. More serious side effects include a risk of bone thinning and blood clots.

Targeted therapy drugs

Targeted drug treatments attack specific abnormalities within cancer cells. As an example, several targeted therapy drugs focus on a protein that some breast cancer cells overproduce called human epidermal growth factor receptor 2 (HER2). The protein helps breast cancer cells grow and survive. By targeting cells that make too much HER2, the drugs can damage cancer cells while sparing healthy cells.

Targeted therapy drugs that focus on other abnormalities within cancer cells are available. And targeted therapy is an active area of cancer research.

Your cancer cells may be tested to see whether you might benefit from targeted therapy drugs. Some medications are used after surgery to reduce the risk that the cancer will return. Others are used in cases of advanced breast cancer to slow the growth of the tumor.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.

Immunotherapy might be an option if you have triple-negative breast cancer, which means that the cancer cells don't have receptors for estrogen, progesterone or HER2. For triple-negative breast cancer, immunotherapy is combined with chemotherapy to treat advanced cancer that's spread to other parts of the body.

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

Alternative medicine

No alternative medicine treatments have been found to cure breast cancer. But complementary and alternative medicine therapies may help you cope with side effects of treatment when combined with your doctor's care.

Alternative medicine for fatigue

Many breast cancer survivors experience fatigue during and after treatment that can continue for years. When combined with your doctor's care, complementary and alternative medicine therapies may help relieve fatigue.

Talk with your doctor about:

. Gentle exercise. If you get the OK from your doctor, start with gentle exercise a few times a week and add more if you feel up to it. Consider walking, swimming, yoga or tai chi.

. Managing stress. Take control of the stress in your daily life. Try stress-reduction techniques such as muscle relaxation, visualization, and spending time with friends and family.

. Expressing your feelings. Find an activity that allows you to write about or discuss your emotions, such as writing in a journal, participating in a support group or talking to a counselor.

After Breast Cancer Treatment

Aftercare and Recovery

These are general guidelines for recovering from breast cancer surgery. Always follow your doctor's specific instructions for care after your operation.

. Drainage Device

After your surgery, you may be discharged from the hospital with an external drainage device in place. The drains will remove and collect fluid from the surgery site. Your doctor will show you how to care for the device before you leave the hospital. This usually includes emptying the drains, measuring the fluid, and keeping an eye out for any problems.

The amount of fluid that drains will gradually decrease. The fluid color may also change from a cherry red to a yellow-red and then to a straw color. Usually, the drainage system is removed within 1 to 3 weeks after surgery.

. Wound dressings

After your surgery you will have an adhesive dressing applied to your wound. You may have dissolvable stitches that don’t need to be removed, or non-dissolvable stitches that need to be removed seven to ten days after surgery. You may also have steristrips (narrow adhesive strips used to close a wound) that will need to be removed.

Sometimes a thick, firm dressing (pressure dressing) is also applied to help reduce swelling or bleeding initially after surgery. Pressure dressings are usually removed after a day or two.

. Getting Your Incision Wet

Keep your incision clean and dry for 1 week after surgery. You may need to take sponge baths rather than showers. Bathing in a bathtub is ok if you keep the incision area dry.

Small pieces of tape will remain over the incision. They usually fall off by themselves.

Don’t go swimming until your doctor and surgeon say it’s ok.

. Skin Care

The area may be black and blue right after breast cancer surgery. This will go away in a few days. You might be numb or uncomfortable or have tingling on the inner part of your upper arm or in your armpit. This is normal.

A warm shower feels nice, but wait at least a week after surgery.

When shaving under your arm or applying deodorant, look in the mirror to avoid irritating the incision.

As it heals, the incision may feel thick and tough. Massage the area with a mild lotion, vitamin E, or pure lanolin. Highly perfumed lotions and any product containing alcohol may be irritating. After several weeks, the scar will soften.

. Pain Relief

Your doctor will give you a prescription for pain medication after breast cancer surgery. Ask about taking over-the-counter pain relievers in addition to, or instead of, your prescription pain medicine.

Don’t take aspirin or products with aspirin for the first 3 days after the procedure. They can make you more likely to bleed.

. Exercises after Surgery

Daily stretching exercises can help you regain mobility, but talk to your surgeon about when to start them.

. Arm lifts. While standing or sitting on the edge of a chair, lift both arms over your head with your elbows close to your ears. Hold for a count of five and repeat.

. Arm swings. While standing, swing both arms forward and back from your shoulders (like a pendulum). Keep your elbows straight. Increase the distance of the swing each time. Repeat 10 times.

. Wall climbing. Stand facing a wall with your feet close to the wall. Put your arms out in front of you with your hands on the wall. Climb the fingertips of both hands up the wall, until your arms are stretched over your head. Climb your fingers back down the wall. Repeat 10 times, trying to reach higher each time.

. Driving

Ask your doctor before you get back behind the wheel. Most women can start driving again 10 to 14 days after surgery.

. Follow-Up Exams

Regular follow-up visits are important after breast cancer treatment. Your doctor will watch you closely to ensure that the cancer hasn’t returned. Checkups usually include exams of the chest, underarm, and neck.

From time to time, you'll get a complete physical and an annual mammogram. No other regular X-rays, scans, or blood tests are usually needed.

A woman who's had cancer in one breast has a higher-than-average risk of developing cancer in the other breast. You should continue to do monthly breast self-exams, checking both the treated area and your other breast. Report any changes to your doctor right away.

. Needles in Your Arm

It's best not to have blood taken, or an injection given, in the arm on the side of your body where you had breast cancer surgery. If you have to have blood drawn or get medication in this arm, tell the health care professional that you've had breast surgery.

When to Call the Doctor

Breast cancer surgery is generally safe, but as with any surgery, there are risks. Possible problems include:

. Infection

. A buildup of blood under your skin (hematoma)

. A buildup of fluid under your skin (seroma)

. Swelling in the arm (lymphedema)

. A bad reaction to anesthesia

Many women opt for breast reconstruction right after their cancer is removed. Problems that can stem from that operation include:

. Poor healing

. A leak or rupture of your breast implant

. Scar tissue around your implant

Talk to your doctor about the risks before your surgery. The medical staff will keep an eye out for problems while you're in the hospital. Once you’re home, watch for these symptoms:

. Infection. Look for redness or swelling of the incision with pus or foul-smelling drainage. You may have a fever. Usually, antibiotics can treat these infections.

. Lymphedema. Look for swelling of the arm or hand on the side of the surgery. This happens to some women after the lymph nodes under the arm are removed. It may go away on its own, but you may need to see a physical or occupational therapist. Treatments include:

. Draining the fluid

. Compression bandages to keep the swelling down

. Skin care

. Arm exercises

. Seroma. You may notice swelling from a buildup of fluid at the site of the surgery. Usually, your body absorbs this fluid. If the swelling doesn’t go down on its own, your doctor may need to use a needle to drain the area.

A small amount of swelling is normal for about a month after surgery. Sometimes, raising your arm on pillows will ease it.

You may have pain and stiffness in your shoulder as you recover. You may also have numbness or unusual sensations in the upper arm or armpit. These side effects usually go away over time.

Other physical problems to tell your doctor about are:

. Loss of appetite or weight

. Changes in menstrual periods

. Blurred vision

. Dizziness, coughing, or hoarseness

. Headaches

. Shortness of breath

. Digestive problems that seem unusual or that don't go away in 2 or 3 days

Breast cancer survival rate

Breast cancer survival rates vary widely based on many factors. Two of the most important factors are the type of cancer you have and the stage of the cancer at the time you receive a diagnosis. Other factors that may play a role include your age, gender, and race.

According to the ACS, a person who receives treatment for stage 0 or stage 1 breast cancer has a 99% chance of surviving for at least 5 years after being diagnosed, when compared to women who do not have cancer.

If breast cancer reaches stage 4, the chance of surviving another 5 years reduces to around 27%.

Regular checks and screening can help detect symptoms early. Women should discuss their options with a doctor.

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