Physician Advisory Council

Most breast cancer patients undergo surgery of some kind. For some, this may include mastectomy; others may have breast conservation surgeries, like a partial mastectomy or lumpectomy.

The type of surgery depends on several different factors. Just as no two patients are alike, surgical plans and treatment are different for each person. At MD Anderson, patients work with their care teams to determine the proper treatment for them.

Just as the type of surgery patients need varies, so does the care and screening each patient needs after breast cancer surgery. To learn about recovery and follow-up care, we spoke with Matthew Piotrowski, M.D., a breast surgeon at MD Anderson The Woodlands.

What should breast cancer patients know about recovery from surgery?

Don’t be alarmed about any lumps you feel in your breasts for about the first four weeks after surgery.

Now that tissue has been removed, there may be a lack of blood flow to portions of the breast and small areas of tissue may harden. These lumps and bumps may be massaged out to help with scarring. Scarring is a normal part of the healing process that typically takes over a year.

If your surgery includes removal of lymph nodes, it’s especially important to keep the area active and complete specific exercises to get your full range of motion back. Many patients are diligent about doing these arm exercises for about two months but stop after that. Then, after about six months, they notice they don’t have the range of motion they had when they were doing the exercises. So, it’s important to stay with it. I recommend continuing these exercises for a full year.

What screening and follow-up care should patients have after breast-conserving surgery?

After healing from breast-conserving surgery, patients typically have radiation therapy. Six months later, they will have a baseline mammogram performed on the side they had surgery. Breast surgery changes the appearance of the breast on both the inside and outside. Therefore, we need to establish a new baseline to look for abnormalities in breast imaging. After that baseline mammogram, we follow up once a year, assuming there are no imaging abnormalities.

What about patients who had a mastectomy or nipple-sparing mastectomy?

Follow-up imaging is only needed if you feel something abnormal after a mastectomy. Patients will still need physical exams every three to six months for the first five years after treatment to monitor for any signs of recurrence. After five years, I recommend physical exams on an annual basis.

If you’ve had one breast removed, you still need to get imaging on the other side. If you have a genetic mutation, such as BRCA1 or BRCA2, that puts you at an increased risk for breast cancer and have kept one breast, I recommend alternating an MRI and a mammogram every six months.

Does the type of breast reconstruction change recommendations?

The type of plastic surgery you undergo doesn’t change these recommendations.

But we encourage patients to practice breast awareness because you’ll experience significant changes after surgery and radiation. Learn what your breast now feels like and what any abnormalities feel like. If there’s a change, let your care team know. That’s one of the things I stress with my patients: Even if you’re not scheduled for a mammogram soon, let us know if you feel something change or notice something different.

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