In this article

What is breast cancer? A genetic link Symptoms How's the diagnosis confirmed?

Treatment/Recovery Early breast Cancer Postoperative recovery Possible complications

Prostheses Reconstructive surgery Adjuvant treatment Treating secondary (metastatic) breast cancer

Living with a mastectomy

Getting back to normal life after a mastectomy may seem impossible at first, but it will happen eventually. Many women lose confidence and self-esteem. There are worries about the diagnosis, recurrence of the disease and long-term health.

Surgery for breast cancer may be traumatic and take months, or even years, to come to terms with. You may experience a turmoil of emotions, including grief, anger, sadness, isolation and anxiety. You may also feel unattractive, even if your partner is loving and understanding, and go off sex for a while.

Be patient. Try to talk through your feelings with someone (ask your GP to refer you to a counsellor) and ask your family to be patient too. Scars fade and the shape of your breast or chest may improve with time - if it doesn't, help is at hand.

Cancerbackup can put you in touch with a counsellor or local support group.

After any kind of mastectomy, you may want to consider reconstructive surgery to restore the look for your breast(s).

Techniques for breast reconstruction have improved greatly over the years

Techniques for breast reconstruction have improved greatly over the years, and it's now possible to restore many women's breasts to a reasonably normal look and feel, or at least to a state a woman feels happy with. It's not vanity, just getting back to normal.

The aim is to use the woman's own body tissues to build the new breast. While it may be necessary to use an artificial implant, muscle, fat and skin can be taken from the chest wall, abdomen or back.

It's impossible to restore the breast to how it was before. It will always be different - scarred for example, or with different sensations - but most women are happy with the results.

When is it done?

Some doctors prefer to do reconstructive surgery at the same time as the cancer surgery. while others want to wait a year or more, especially if the woman is also undergoing radiotherapy, to make sure the skin has recovered completely.

If you want reconstruction after surgery, it's important you speak to your surgeon about this before the initial operation, as it could affect the way the operation is done.

It's also important to note any surgery carries risk. In addition to other problems, breast reconstruction can result in pain, scarring, infection, an irregular result, loss of the new breast and problems with implants.

What does it involve?

There are many ways of reconstructing the breast, which depend on factors such as how much breast tissue has been removed, what size and shape you are and your own personal preferences. If you've had a lumpectomy, insertion of a small implant to fill the gap may be most appropriate. You'll need to discuss with your surgeon what may be right for you. Breast Cancer Care has details of different methods of reconstruction and their risks.

Some of the techniques are the same as those used in cosmetic surgery, but it's usually more complex as the breast has been removed or disrupted.

The two main techniques involve:

• Inserting an implant under the skin or chest muscle
• Using a flap of tissue taken from elsewhere in your body

There has been some concern about possible health risks from breast implants, especially those made of silicone. UK experts have done an independent review of the safety of breast implants. Implants may not be suitable for some women, especially if they've lost a lot of skin during surgery.

Reconstruction using tissue flaps involves major surgery and can make large demands on a woman while the flaps are being 'developed' and moved, complete with their usual blood supply, from elsewhere on the body. But it's an option for women who have lost a lot of skin during their cancer surgery and those for whom implants aren't recommended.

It may not be suitable for women who are diabetic, heavy smokers, very overweight or who've had radiotherapy.

It's possible to reconstruct nipples on the new breast, but this is usually done later, once the breast has healed. It's cosmetic - while it may look like a nipple, it won't have any sensation or change in shape. If you'd rather not have another operation, other options include a stick-on version or a tattoo.

Don't rush into it

Before making a decision about reconstructive surgery, find out as much as you can, talk to your doctors and nurses and, if possible, talk to women who've gone through the operation themselves. There's no rush - it can be done years after your surgery.

Surgery is usually followed by adjuvant treatment.

Adjuvant treatment is therapy that's given following surgery to kill any stray cells which are otherwise undetectable. Adjuvant radiotherapy may be given to the breast (after lumpectomy) or chest wall (after mastectomy) to kill cells which may be left behind after surgery. The nearby glands may also be treated.

How long the radiotherapy lasts varies, but it's normally between three and six weeks. The main side-effects are tiredness and skin soreness, but your radiotherapist (clinical oncologist) will discuss this in more detail.

Adjuvant systemic therapy is drug therapy that's given to kill off stray cells which may have escaped the breast area. There are a number of options including chemotherapy, hormone therapy or trastuzumab (herceptin) and your oncologist will discuss the most appropriate treatment regime for you.

Generally, patients with hormone receptor positive cancers will be offered some form of hormone therapy – either tamoxifen for premenpausal women or, increasingly, in postmenopausal women, one of the aromatase inhibitors (anastrazole, letrozole or exemestane).

Chemotherapy will be recommended to some patients. Herceptin may be offered to women with Her2 positive cancers who've received chemotherapy.

Again, the pros and cons and potential side-effects will be discussed in detail by your oncologist. Don’t be afraid to ask questions.

Where the tumour has spread beyond the breast and armpit, the treatment approach is very individualised and focused on offering therapies that will help to control the disease while minimising side-effects and improving symptoms.

Hormones, chemotherapy and herceptin may be used in various combinations. Drugs called bisphosphonates (for example, zoledronic acid) may be used to relieve the symptoms of bone secondaries and short courses of radiotherapy can be very helpful for relief of symptoms such as pain.

Clinical trials

It's quite common to be invited to enter a trial comparing one treatment approach with a newer approach to see if this improves results or reduces side-effects.

All trials are very carefully scrutinised by ethics committees to ensure they meet current best standards of care. Overall, it's felt by breast cancer specialists that they're a good thing for their patients.

It's entirely up to you whether or not you decide to enter a trial and it's important to give it careful consideration and ensure you're fully informed before you give your consent.

Survival rates

It's difficult to pronounce breast cancer cured, because secondary breast cancer can appear ten or 20 years later after tiny cells lying dormant in the liver, bones or elsewhere become active.

After five years without disease the chances of a recurrence are very small

However, if breast cancer is going to come back it usually does so within the first two years, and after five years without disease the chances of a recurrence are very small.

Wtih better screening and new treatments, there has been a steady improvement in survival rates for breast cancer for the past 20 years.

• Women diagnosed in the early 1970s had a 52 per cent chance of surviving for five years
• Women diagnosed between 2001 and 2003 have an 80 per cent chance

Very long-term survival has also improved. It's estimated that 64 per cent of women diagnosed in recent years will live for at least another 20 years, compared with only 44 per cent of those diagnosed in the early 1990s.

But these are overall figures and any individual's person's chance of survival depends on the type of breast cancer and their age at diagnosis.

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This article was medically reviewed by Nicky Thorp in March 2009. She is a consultant clinical oncologist at Clatterbridge Centre for Oncology.

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