Jennifer Deming, 60, was diagnosed with stage II, hormone receptor-positive, HER2-negative breast cancer in 2020. She opted for a double mastectomy. Still, she worried about the cancer coming back.
“I asked my surgeon what sort of breast changes I should look for, and he told me that if my cancer returned, I’d develop little red pimple-like spots,” says Deming, who lives in Chicago.
Just before Christmas 2024, Deming noticed small bumps on her chest. Panicked, she called her breast oncologist’s office. They asked her to email a photo. A few minutes later, a nurse called back and said Deming had shingles, a painful, blistering rash due to the same virus that causes chickenpox.
“Since I’d lost a lot of chest sensation after my mastectomy, I hadn’t noticed other symptoms, like itching or pain,” Deming says.
The nurse prescribed an antiviral medication, and she recovered. “It sounds strange, but I was reassured it was shingles. At least it wasn’t a recurrence of my breast cancer.”
When you undergo breast cancer surgery, you hope your breasts will recover and stay healthy. Most of the time, they do. But sometimes, you may notice changes. They can occur days or weeks after surgery, or may appear even months or years later. Sometimes, like Deming, it may be a change that’s completely unrelated to your breast cancer treatment.
“Concerns about breast changes come up a lot with my patients,” says Rachel Layman, MD, a breast medical oncologist at the University of Texas MD Anderson Cancer Center in Houston, Texas. “It’s normal to be nervous, even for years after treatment. But most of the time, breast changes don’t mean your cancer has recurred.”
Your Breasts’ New Normal
Most cases of breast cancer are first treated with surgery. That may be a lumpectomy — where just a portion of the breast is removed — or a mastectomy, which removes your entire breast. After that, you may also have radiation to destroy any remaining cancer cells.
If you’ve had a partial mastectomy or lumpectomy, your doctor will most likely recommend you get a mammogram of your affected breast about six months after radiation treatment ends. Usually, that mammogram will be normal.
“It reassures patients because they realize that what they see and feel isn’t cancer, but just how their breast is now,” says Layman.
After that, you’ll have repeat mammograms at least once a year. The original mammogram serves as a point of reference for your doctor. They look back on it to make sure your breast has healed and there are no signs that your breast cancer has returned. It can also reassure you, especially if you’ve had any breast changes.
Breast Changes After Treatment: What’s Normal
As your body and breasts adjust after treatment, you may experience some or all of the following changes:
Skin and texture changes
Scar tissue can make your breast feel firmer or even lumpy. “It has a different consistency than the tissue in your noncancerous breast,” points out Layman. You may also see dimples in the skin around the incision site, which should gradually disappear as the area heals.
What to do. You’ll get a better sense of how your breasts look and feel in the days and weeks following surgery. “Once you get your six-month mammogram, you can consider that your new breast baseline,” says Layman. Those texture changes are most likely here to stay.
Numbness and nerve pain
When breast tissue is removed, it can damage the nerves in your armpits and chest. This can lead to symptoms such as:
- Chest pain and tingling
- Shoulder pain
- Tingling or itching in your chest that extends to your armpit or down your arm
What to do. This sort of discomfort often gets better with time, says Layman. But if symptoms are severe or last a while, let your doctor know. They can prescribe a medication to treat nerve pain, such as gabapentin. Physical therapy can help, too.
Swelling
Swelling after breast cancer surgery is very normal. But it can pop up again weeks, months, and even years after surgery. This is called lymphedema.
“Lymph nodes and vessels can be damaged during surgery and radiation,” says Layman. “This affects your lymphatic system’s ability to drain fluid in the area, so lymph fluid can build up and cause swelling in your breast.”
While it can look alarming and definitely feel uncomfortable, it’s not dangerous, she says.
What to do. See your doctor if you notice sudden breast swelling, as it could indicate an infection, says Layman. But if you’re diagnosed with lymphedema, treatment is usually physical therapy to help control the fluid. Your physical therapist (PT) can:
- Show you simple exercises and stretches to help move out fluid
- Do lymphedema massage, a type of massage that helps to push extra lymph fluid out of your breast
Compression sleeves or elastic wraps may be prescribed to help manage your swelling.
Seromas
These are buildups of clear body fluids in a spot where breast tissue has been surgically removed. It usually shows up as a lump near the surgery site that feels tender when you touch it.
What to do. Most seromas resolve on their own within a couple of months, says Layman. But if yours is very painful or continues to grow, your doctor can surgically drain it.
When to See Your Doctor
Susan Cassidy, 67, had a double mastectomy followed by breast reconstruction to treat her stage II, hormone receptor-positive, HER2-negative breast cancer in 2020. “I figured if I got rid of both breasts, I wouldn’t have any issues,” says Cassidy, who lives in Fairfield, Connecticut.
Two years later, she was shocked to feel a small hard lump in what had been her noncancerous breast, near the scar line where she had her mastectomy flap. “I freaked out and made an urgent appointment with my doctor.”
A mammogram and ultrasound revealed the lump was due to fat necrosis. “Sometimes after a mastectomy, very small amounts of fat tissue are left behind,” says Layman.
“Since they don’t have any blood supply, the cells die, which triggers inflammation that causes a mass to form.” There’s no need to treat fat necrosis, she says, although some women opt to have the lump surgically removed.
In general, Layman says you should call your doctor’s office if you notice any of the following:
- A new breast lump
- New skin changes on your breast, such as new skin dimples or puckering, or changes in color
- Nipple fluid
- Pulling in of the nipple
- A new lump in your armpit
- Lumps on or under the skin of your chest wall, if you’ve had a mastectomy
- New thickening along or near your mastectomy scar
Most of the time, these findings turn out to be benign. “My patients develop a sort of memory as to how their breast normally feels post surgery. If something feels off or different, their health care team will want to know. We can evaluate them, and send them off for other tests like mammograms or ultrasounds if we think it’s necessary," Layman says.
Cassidy says she follows what she refers to as the two-week rule. “If I notice nerve pain, or a new bump or lump, I give it a week or two to see if it resolves on its own,” she says.
“Usually, it does. But if it doesn’t, I call my doctor’s office, and they usually get me in for an ultrasound within a few days. This way, I know my cancer hasn’t recurred, and it gives me peace of mind.”
Are There Red Flags?
If you’re a breast cancer survivor, you may worry about red-flag signs of breast changes that could signal recurrence. Any change to your breasts — whether it’s swelling, pain, or a new lump — is a reason to call your doctor, says Layman.
“We always want to see you for a physical exam, and possibly do imaging such as ultrasound, to be safe,” she says. Sometimes, your doctor may have you take a picture of a strange bump or any skin changes before you come in.
"We can compare it to a photo of your breast a few months after lumpectomy or mastectomy, to get a sense if there are any concerning changes.”
Call your doctor’s office right away if you do notice any of the following:
- Sudden breast swelling that appears to worsen
- Rapidly spreading rash
- New lump that pops up around your neck, collar bone, or armpit
- Sudden breast pain that quickly worsens
Any of these may indicate a breast cancer recurrence. Or, more likely, some sort of breast tissue or skin infection, says Layman. “My breast cancer patients are much more in tune with their bodies than they often give themselves credit for,” she says.
