Occasionally the texture, sensitivity and shape of the breast, and the pigmentation of the skin, may alter. This may be a permanent reaction to radiotherapy. In a small number of patients the breast can feel firmer, larger or more tender than the other side due to retained fluid. This usually settles over several months.
If you receive radiotherapy to your armpit as part of your treatment for breast cancer, or if you have had surgery to this area, there is a risk of developing lymphoedema.
This is a swelling of your arm on the side where the cancer has been treated. It is caused by damage to, or removal of, the lymph glands under your arm that are normally responsible for draining fluid. Some patients first notice lymphoedema when they receive an injury to the arm that results in swelling and delayed healing.
Others may notice a more gradual swelling of the arm, which may also extend to the wrist and hand.
Lymphoedema may not occur until months or years after treatment for breast cancer, and taking some special care of your hand and arm on the side where you have had treatment may help to reduce the risk of this developing.
This is discussed in the section “Care of the arm during and after your treatment” but your oncologist or breast care nurse can give you further information.
Other very rare long-term effects may include:
- nerve pain
- weakness or numbness in the arm and hand
- breathlessness due to lung damage
- weakening of the ribs within your treatment area
However, due to improvements in the planning of your treatment and the way in which the radiotherapy is given, these long-term effects occur less often than they previously did.
Most patients who receive radiotherapy to the breast experience minimal side effects and no long term damaging effects.
What I can do to help?
Skin care We recommend that you take special care of your skin during and up to six weeks after your radiotherapy as the skin reaction may continue after treatment has finished.
- Keep the area cool. You may find that using a hair dryer or fan set on a “cold” setting applied over the treatment area may help.
- Wear loose, preferably cotton, clothing that does not rub the skin and will allow air to circulate. You may find a “cropped top” is more comfortable than your normal bra. If have had a mastectomy it is better to wear a temporary lightweight prosthesis.
- Do not expose the treated area to the sun for long periods. Whilst in the sun the treated area should be covered completely or a high protective factor sun cream (25 or above) should be applied. If you are having radiotherapy to the neck area, care should be taken when exposing your back to the sun. Do not use a sunbed, as this could worsen the reaction.
- Do not soak the area in the bath or under a long hot shower. You may wash the treated area using a simple, unperfumed soap applying gently with your hands rinsing the area well with warm water. Avoid using flannels or sponges. Pat the area dry with a soft towel or let the skin dry naturally. Be careful to pay extra attention to skin folds such as those under the arm and breast.
Do not use talcum powder, bubble baths, bath salts, shower gels or body lotions in the treated area as they tend to be highly perfumed and can dry or irritate the skin. You may be given a moisturising cream from the radiographers or nurses to soothe the skin, or your oncologist may prescribe a cream if needed.
- You may find you will not perspire as much as usual due to the effects of the treatment. The underarm hair will be lost on the side being treated. This may be permanent. Do not use any method of removing hair under your arm during your radiotherapy. Do not use a deodorant.
Care of the arm during and after treatment
This is only applicable to those patients who have had surgery to examine the lymph glands in the armpit and/or those patients who are receiving radiotherapy to the lymph glands under the arm.
The aim of this care is to avoid breaks in the skin, or injury to the arm and hand whenever possible, as these may lead to infection. There are a number of ways we recommend you do this:
- Offer your other arm for all injections, taking of blood pressure or any infusions e.g. blood transfusions.
- Wear gloves to protect your hand when gardening or using harsh detergents.
- Wear gloves when using the oven to prevent burns to the hand or arm.
- Use a thimble when sewing.
- Use an electric razor or depilatory cream for removing underarm hair.
- Avoid lifting or carrying heavy cases or shopping bags with the affected arm.
If you do develop cuts, scrapes or animal bites to the arm or hand wash the area well with warm water and apply an antiseptic cream.
If the cut fails to heal, or you notice any swelling or redness developing in the arm please contact your breast care nurse or GP.
If you would like further information about lymphoedema or advice on treatment, please speak to your specialist team who will be happy to help you.