Breast prostheses and reconstruction

Before or after surgery you may think about how to restore your breast shape. You may consider a breast prosthesis or reconstruction. A breast prosthesis is a synthetic breast or part of a breast worn in a bra or under clothing to replace part or all of your breast. Breast reconstruction is an operation to make a new breast. Talk to your health care team about your options.

Chemotherapy

Chemotherapy may be used to help shrink the cancer before surgery, if the risk of cancer returning is high or if the cancer returns after surgery or radiation therapy. It may also be used if the cancer is HER2 positive or does not respond to hormone therapy.

Radiation therapy (radiotherapy)

Radiation therapy (radiotherapy) is recommended after breast-conserving surgery to help destroy any undetected cancer. It is also recommended if lymph nodes were removed from under the arm and there is a risk that the cancer will return to this area. Radiation therapy can sometimes be used after a mastectomy if there is a risk of the cancer returning to the chest area.

Hormone therapy

Hormone therapy uses drugs to reduce the levels of female hormones in the body. This helps to stop or slow the growth of hormone receptor positive cancer cells. The type of hormone therapy you have will depend on your age, the type of breast cancer and whether you have reached menopause.

Targeted therapy

Targeted therapy drugs attack specific targets inside cancer cells. The drugs that are currently available are only useful for HER2 positive breast cancer.

Palliative care

In some cases of breast cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of breast cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

Managing side effects

Treatment for breast cancer and even the cancer itself, can cause side effects. The types and severity of any side effects you may experience will depend on the type of treatment you have and may vary from person to person.

Side effects will vary depending on the type of treatment you have but most are temporary and there are ways to reduce or prevent them.

  

Outlined below are some of the side effects you may experience.

  

Lymphoedema

When lymph nodes have been damaged or removed, lymph fluid may not be able to drain normally, causing a build up in the tissues of part of the body, such as an arm or breast. This swelling is called lymphoedema.

Lymphoedema can occur during treatment or months or years after treatment. Look for swelling, heaviness or fullness in the fingers, wrist or whole arm, a feeling of tightness and aching in the affected area. Some people may also experience fever, redness or pain, caused by an infection called cellulitis. If you have any of these symptoms you should see your doctor as soon as possible as lymphoedema is easier to manage if it is diagnosed and treated early.

Cording

Cording (auxillary web syndrome) can happen weeks or months after surgery and is caused by hardened lymph vessels. It feels like a tight cord running from your armpit down the inner are and sometimes to the palm of your hand. You may feel and see raised cord-like structures across your arm and these may limit movement.

Cording usually improved over a few months and gentle stretching exercises during the first weeks after surgery can help.

Nerve pain

Mastectomy or surgery to remove lymph nodes can cause nerve pain in the arm. Mastectomy can also cause nerve pain in the chest wall. It may feel like pins and needs but usually settles within a few weeks. If pain persists, talk you’re your doctor about ways to manage it.

Some chemotherapy drugs can damage nerves in the hands and feet and this is called peripheral neuropathy. Peripheral neuropathy can cause pins and needles, numbness and, occasionally, pain. The symptoms are usually temporary but can be permanent. If you have any symptoms, let your health care team know so they can adjust your treatment. Your doctor will also be able to help you manage pain from permanent nerve damage.

Changes to memory and thinking

Some people diagnosed with breast cancer notice changes in how they remember information and the way they think. This is called cancer-related cognitive impairment. It is also referred to as “cancer fog” or “chemo brain”.

While the precise cause is unknown, studies show that think and memory changes may be caused by the cancer itself, cancer treatments, medication given for surgery such as anaesthetic, emotions like depression and anxiety, and treatment side effects like insomnia, fatigue and hormone changes.

For most people, issues with thinking and memory get better within the first year after finishing treatment but others might experience more long-term effects. Talk to your health care team about ways to cope with changes such as maintaining a healthy lifestyle or adjusting your daily routine.

If you have severe or lasting changes to your thinking and memory, you can see a neuropsychologist or clinical psychologist for cognitive rehabilitation.

Breast prosthesis

A breast prosthesis is a synthetic breast or part of a breast worn under clothing or in a bra to replace all or part of your breast. A breast prosthesis can be worn after breast-conserving surgery or a mastectomy.

Most breast prostheses have the shape and feel of a natural breast. They may weight the same or be lighter. Breast prostheses can be attached directly to the skin or inserted into specially made pockets in bras, sleepwear and activewear.

Hair loss

Hair loss is one possible side effect caused by cancer treatments. Not all cancer treatments will cause hair loss – it is mostly associated with chemotherapy and radiation therapy. Treatments like targeted therapy, hormone therapy and immunotherapy are more likely to cause hair thinning or slow growth of hair.

If you lose your hair during cancer treatment, you may like to wear a wig, scarf, hat or turban while it is growing back. Some people are happy to leave their head bare. Some hospitals and cancer care units provide wigs for free or a small free.

Menopause and changes to fertility

Chemotherapy can cause your periods to stop for a time and may affect your ability to become pregnant. If your periods stop permanently (known as early menopause), you will not be able to conceive children naturally. Talk to your doctor before treatment begins if you think you would like to have children in the future.

Symptoms of menopause can include, trouble sleeping, hot flushes, tiredness, mood swings, weight gain, and osteoporosis. Talk to your doctor about ways to relieve symptoms.

You will not necessarily experience all these side effects and you may experience others that are not discussed here. It is important that you talk to your treatment team about any changes to your body during and after treatment.

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:

• GP (General Practitioner) - looks after your general health and works with your specialists to coordinate treatment.
• Radiologist- interprets diagnostic scans (including CT, MRI and PET scans).
• Radiation oncologist - prescribes and coordinates radiation therapy treatment.
• Medical oncologist - prescribes and coordinates the course of chemotherapy.
• Breast care nurses- provide information and support to people affected by breast cancer during and after treatment.
• Surgeon- surgically removes tumours and performs some biopsies.
• Reconstructive (plastic) surgeon- performs any complex reconstructive surgery that restores or repairs the body's appearance and function.
• Lymphoedema therapist- educates people about lymphoedema prevention and management, and provides treatment if lymphoedema occurs.
• Other allied health professionals - such as social workers, pharmacists, and counsellors.