Page last updated: October 2024
The information on this webpage was adapted from Understanding Breast Cancer - Information for people affected by cancer (2024 edition). This webpage was last updated in October 2024.
Expert content reviewers:
This information is based on Australian clinical practice guidelines for early breast cancer and international guidelines for advanced breast cancer. It was developed with the help of a range of health professionals and people affected by breast cancer:
- Dr Diana Adams, Medical Oncologist, Macarthur Cancer Therapy Centre, NSW
- Prof Bruce Mann, Specialist Breast Surgeon and Director, Breast Cancer Services, The Royal Melbourne and The Royal Women’s Hospitals, VIC
- Dr Shagun Aggarwal, Specialist Plastic and Reconstructive Surgeon, Prince of Wales, Sydney Children’s and Royal Hospital for Women, NSW
- Andrea Concannon, consumer
- Jenny Gilchrist, Nurse Practitioner Breast Oncology, Macquarie University Hospital, NSW
- Monica Graham, 13 11 20 Consultant, Cancer Council WA
- Natasha Keir, Nurse Practitioner Breast Oncology, GenesisCare, QLD
- Dr Bronwyn Kennedy, Breast Physician, Chris O’Brien Lifehouse and Westmead Breast Cancer Institute, NSW
- Lisa Montgomery, consumer
- A/Prof Sanjay Warrier, Specialist Breast Surgeon, Chris O’Brien Lifehouse, NSW
- Dr Janice Yeh, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC
It will take time to recover from the physical and emotional changes caused by your treatment. Side effects can vary – some people will experience just a few, while others will have more.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for breast cancer can help you make sense of what should happen.
It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
Common side effects
Lymphoedema
Lymphoedema is the swelling (oedema) that develops when lymph fluid builds up in the tissues of part of the body, such as an arm or breast.
When lymph nodes have been damaged or removed, lymph fluid may not be able to drain properly and builds up in the tissues.
Some breast cancer treatments may cause lymphoedema (e.g. surgery to remove lymph nodes and radiation therapy to the armpit). Many people who are at risk, however, never develop lymphoedema.
Lymphoedema can affect people at any time – during active treatment or months or even years afterwards.
Regular screening check-ups may be recommended for some people, so ask your treatment team if this might be an option for you. Signs to look for include:
- the swelling of part of your arm or your whole arm
- a feeling of tightness, heaviness or fullness in the fingers, wrist or the arm, and
- aching in the affected area.
These signs may begin gradually or come and go. Some people experience pain, redness or fever, which can be caused by an infection called cellulitis in the area with lymphoedema.
If you have any of these symptoms, see your doctor as soon as possible. Lymphoedema is easier to manage when diagnosed and treated early.
Cording
Cording (axillary web syndrome) can develop weeks or months after any type of breast surgery. Caused by hardened lymph vessels, cording feels like a tight cord running from your armpit down the inside of the arm, sometimes to the palm of your hand.
You may see and feel raised cord-like structures across your arm, chest or breast, which may limit how you move. Gentle stretching exercises in the first weeks after surgery can help improve movement.
Massage, physiotherapy, or low-level laser treatment by a lymphoedema practitioner may also help reduce pain and tightness. Cording usually improves over a few months.
Nerve pain
Mastectomy, SLNB and ALND can cause nerve pain in the arm or armpit, and mastectomy can cause nerve pain in the chest wall. This may feel like pins and needles, tingling, or stabbing pain. It usually settles within a few weeks.
If nerve pain is ongoing, ask your doctor about ways to manage it. Some chemotherapy drugs can damage nerves in the hands and feet. This is called peripheral neuropathy or chemotherapy-induced peripheral neuropathy (CIPN).
It can cause weakness, numbness, pins and needles and, occasionally, burning or shooting pain. These symptoms usually improve over a matter of months, but they can be permanent. If you have any of these symptoms, tell your health care team.
Your doctor will help you manage pain from any permanent nerve damage. A physiotherapist and occupational therapist can help you improve or manage symptoms, and a psychologist or counsellor can teach you coping strategies to manage any ongoing pain.
Hair loss
If you lose your hair during chemotherapy, you may choose to wear a wig, scarf, turban or hat while your hair is growing back. Or you might feel comfortable leaving your head bare.
You could try out a few options over time and see what feels like the right thing for you. Generally, hair starts to grow back after your treatment ends.
Some treatment centres offer cold caps (also called scalp cooling), which may prevent total head hair loss, but this depends on the chemotherapy drugs used.
Ask your treatment team if cold caps might be an option for you.
Learn more
Thinking and memory changes
Some people with breast cancer notice changes in how they think and remember information. This is called cancer-related cognitive impairment or may be referred to as “chemo brain”, “cancer fog” or “brain fog”.
The exact cause is unknown, but studies suggest these changes may be caused by the cancer, emotions such as anxiety and depression, cancer treatment, anaesthetic given for surgery, and side effects such as fatigue, insomnia, pain and hormone changes.
For most people, thinking and memory problems get better within the first year of finishing treatment. Others may have long-term effects.
If you have severe or lasting changes to your thinking and memory skills, you can see a clinical psychologist or neuropsychologist for cognitive rehabilitation.
Speak to your health care team about the services available at your hospital or from a psychologist.
Breast prostheses
A breast prosthesisis a synthetic breast or part of a breast that is worn in a bra or attached to the body with adhesive. It helps give the appearance of a breast shape and can be used after breast surgery.
- Temporary prosthesis – In the first month or two after surgery, you may choose to wear a temporary light breast prosthesis called a soft form. This will be more comfortable next to the scar. A free bra and soft form are available through Breast Cancer Network Australia as part of the My Care Kit. To order a kit, speak to your breast care nurse.
- Permanent prosthesis – When you have recovered from treatment, you can be fitted for a permanent breast prosthesis. A permanent breast prosthesis is mostly made from silicone gel and has the shape, feel and weight of a natural breast. It is recommended that you see a trained fitter who can help you choose the right prosthesis. To find a fitter near you, call Cancer Council 13 11 20 or ask your breast care nurse for recommendations.
Feelings of loss and change
It’s common to feel emotional after a cancer diagnosis. You may feel a sense of grief or loss – for your health and wellbeing, your dreams or freedoms, even what you can wear.
Grief can feel like waves of sadness or being teary, and usually settles over time.
The busyness of cancer treatment may mean you do not feel grief until it is over. If concerned, call Cancer Council 13 11 20 to talk to someone about how you are feeling.
More about emotions and cancer
Changes to body image and sexuality
Breast cancer can affect how you feel about yourself (self-esteem) and make you feel self-conscious. You may feel less confident about who you are and what you can do. These feelings are common; give yourself time to adapt.
If you are finding it hard to adjust to changes, ask for support. Most cancer centres have psychologists who may be able to help.
The Look Good Feel Better program can help you to manage the appearance-related effects of cancer treatment and boost self-esteem.
Breast and chest appearance
You may find that having a breast reconstruction or wearing a breast prosthesis improves your self-confidence. Or you may prefer to not have a reconstruction and “go flat”.
You may be able to have an areola and nipple tattooed onto the breast after a mastectomy and breast reconstruction. Or you may choose a decorative tattoo to cover scars.
For some people, this is a way to take control of their body and express themselves.
Low libido
Breast cancer and its treatment (particularly hormone treatment) can also reduce your desire for sex (libido). You may miss the pleasure you felt from the breast or nipple being stroked or kissed during sex. This may be the case even if you have a reconstruction.
If breast stimulation was important for arousal before surgery, you may need to explore other ways of becoming aroused. Some cancer treatment centres have sexual health clinics and other resources that may be able to help.
Vaginal dryness
Some treatments for breast cancer (particularly hormone therapy) can cause vaginal dryness, which can make penetrative sex painful.
For most people, sex is more than arousal, intercourse and orgasms. It involves feelings of intimacy and acceptance, as well as beingable to give and receive love. Even if some sexual activities may not always be possible, there are many ways to express closeness.
After treatment you should not use any hormone-based contraceptives (“the pill” or hormone implants or injections). It is best to use condoms, diaphragms or intrauterine contraceptive devices (IUDs).
Menopause and infertility
Chemotherapy can cause your periods to stop for a short time, or it may cause them to stop permanently (early menopause). Symptoms of menopause include:
- hot flushes
- trouble sleeping
- vaginal dryness
- reduced sex drive (libido)
- tiredness
- dry skin
- mood swings
- weight gain, and
- osteoporosis.
Talk to your doctor or breast care nurse about how to relieve symptoms. If vaginal dryness does not respond to simple measures, talk to your doctor about vaginal oestradiol. Several non-hormonal medicines work well for hot flushes.
If chemotherapy causes menopause, you will not be able to have children naturally. Talk to your doctor before treatment starts, as there may be ways to reduce the risk of early menopause or preserve your fertility.
If you find out you might not be able to get pregnant and have a child, you may feel a great sense of loss. Talking to a counsellor or someone in a similar situation may help.
For information about counselling services and support groups in your area, call Cancer Council 13 11 20.
Looking after yourself
Cancer can cause physical and emotional strain, so it’s important to look after your wellbeing. Cancer Council has free booklets and programs to help you during and after treatment. Call 13 11 20 to find out more.
Alternative therapies are therapies used instead of conventional medical treatments. These are unlikely to be scientifically tested, may prevent successful treatment of the cancer and can be harmful.
Cancer Council does not recommend the use of alternative therapies as a cancer treatment.
Eating well
Healthy food can help you cope with treatment and side effects and maintain a healthy weight.
Many people gain weight during and after breast cancer treatment, which studies show increases the risk of cancer coming back.
A dietitian can explain how to manage any special dietary needs or eating problems.
If you choose to drink alcohol, the guidelines recommend no more than 10 standard drinks a week and no more than four standard drinks on any one day.
Learn more
How staying active can help
You may think it’s important to rest during treatment and recovery, but research shows that exercise benefits most people at this time.
There is also strong evidence that exercise can reduce the risk of breast cancer returning.
Being active can also help manage side effects such as tiredness, improve circulation, boost mood, and speed up recovery. Exercise reduces the risk of weight gain, which is associated with some breast cancer treatments.
The right exercise for you depends on what you are used to, how you feel, and your doctor’s advice. See an accredited exercise physiologist or physiotherapist for help in developing an exercise program to suit you.
Learn more
Work and money
Cancer can change your financial situation, especially if you have extra medical expenses or need to stop working. Getting professional financial advice and talking to your employer can give you peace of mind.
You can also check whether any financial assistance is available to you by asking a social worker at your hospital or treatment centre or calling Cancer Council 13 11 20.
Learn more
Relationships
Having cancer can affect your relationships with family, friends and colleagues in many different ways. Cancer is stressful, tiring and upsetting, and this may strain your relationships.
The experience of cancer may also result in positive changes to your values, priorities or outlook on life.
Give yourself time to adjust to what’s happening, and do the same for those around you. It may help to discuss your feelings with each other.
Learn more
Complementary therapies
Complementary therapies are designed to be used alongside conventional medical treatments.
Therapies such as massage, relaxation and acupuncture can increase your sense of control, decrease stress and anxiety, and improve your mood.
Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.
Learn more
Life after treatment
After your treatment ends, you will have regular appointments to monitor your ongoing health.
Your doctors will see how you are going on hormone therapy (if this is part of your ongoing treatment), help you to manage any long-term side effects, and check that the cancer hasn’t come back or spread.
When a follow-up appointment or test is approaching, many people find that they think more about the cancer and may feel anxious (“scanxiety”). Talk to your treatment team or call Cancer Council 13 11 20 if you are finding it hard to manage this anxiety.
Between follow-up appointments, let your doctor know immediately of any symptoms you notice or health problems.
What do check-ups involve?
During these check-ups, you will usually have a physical examination. You will also be able to discuss how you’re feeling and mention any concerns you may have.
Check-ups after breast cancer treatment are likely to happen every 3–6 months for two years. They will become less frequent after that if you have no further problems.
You are likely to have a mammogram and, if needed, an ultrasound every year. You won’t need a mammogram if you’ve had a double mastectomy.
If there is a concern the cancer may have come back, you may have a bone scan and a CT, PET or MRI scan.
After five years with no sign of cancer, women aged 40 and over can continue to have a free mammogram through the national breast cancer screening program.
What if the cancer returns?
Sometimes, breast cancer does come back after treatment, which is called a recurrence. This is why regular check-ups are important. In most cases, early breast cancer will not come back (recur) after treatment.
Although the risk is higher with locally advanced breast cancer, many people will not experience a recurrence. There are some things that increase the risk that cancer may come back. These include:
- if the cancer was large or the grade was high when first diagnosed
- if it was found in the lymph nodes, or
- if the surgical margin was not clear.
Your risk may also be increased if the cancer was hormone receptor negative or if adjuvant treatment (e.g. radiation therapy, chemotherapy, hormone therapy) was recommended after surgery but was not started or completed.
This does not mean the cancer will definitely come back or spread. Regularly looking at and feeling your breasts to know what is normal (being “breast aware”) can help find cancer in the treated or other breast.
If you have had a double mastectomy with or without a reconstruction, you should also regularly look at and feel your new shape and get to know your “new normal”. Tell your specialist, breast care nurse or GP if you notice any changes.
Breast cancer can also return in other parts of the body, such as the bones, liver or lungs. Most symptoms will not be a recurrence, but if you notice any changes to your health, see your doctor and let them know that you have had breast cancer.
It is important to continue taking the drugs your doctor prescribes, even months or years after your treatment. Talk to your doctor before you stop taking any drugs, as these drugs may be helping to stop the cancer returning.