Ask any breast cancer patient and you’ll probably tell them that the first few days after a diagnosis are a jumble of appointments as treatments and surgeries are scheduled. Patients are often overwhelmed by the number of decisions that must be made in the midst of their initial shock. Staying alive and getting the cancer out of her body is her top priority. Patients often do not know what questions to ask or what to expect during their recovery.
This is where oncology nurses come in. These nurses are in a unique position to help patients process the vast amount of information they are given. This information includes the side effects of mastectomy – and how those side effects, such as B. numbness in the chest, could affect their future quality of life.
Learn from experience
I share this from my experience not only as a 20 year old nurse but also as a breast cancer survivor. I was diagnosed with stage III breast cancer 5 years ago at the age of 39. My first concern was getting all the cancer out of my body. I was fortunate to be able to use my medical background to know what questions to ask in the initial spate of appointments. Within 2 weeks I started the first of 6 rounds of chemotherapy and scheduled a double mastectomy.
Thanks to my medical background, I knew that if my surgeon removed the breast tissue during my mastectomy, my nerves would be severed. Without further intervention, severing nerves would sever the connection between the skin over my breasts and my brain – and that could cause numbness in my chest area. It’s like the numbness you feel after a dental procedure, but more widespread.
Before my mastectomy, I asked my doctor a question many patients wouldn’t ask: Will I ever feel in my chest again? I knew the loss of feeling after the mastectomy could be permanent. However, many patients are not aware of these side effects. If her surgeon mentioned a loss of feeling, it was likely one of the many side effects that were quickly covered up.
What I didn’t know was the impact chest numbness would have on my quality of life. Until my feeling returned, I felt nothing. This numbness also compounded the physical and mental toll that surviving cancer had taken on me. A hug didn’t have the same effect, and I didn’t feel connected to my own body. This had a huge impact on my body image and self-esteem. Numbness in the chest can also affect safety; for example, knowing if you burn yourself while cooking, sunbathing or showering.
I also didn’t know it was possible to restore breast sensation with breast reconstruction. I was fortunate that my surgeon performed chest neurotization – surgical reconnection of the nerves with the aim of restoring sensation. Once the nerve connection is repaired, it’s possible to regain feeling over time. As a result, I eventually regained much of the feeling in my chest.
How breast neurotization works
During my breast reconstruction procedure, my surgeon used nerve allografts (human tissue transplanted) to reconnect nerves that were severed during my mastectomy. This procedure allows the nerves to regenerate over time, potentially restoring sensation. This technique can be performed during breast reconstruction including immediate reconstruction, delayed reconstruction and some revision surgeries.
Nerves regenerate slowly – at a rate of about 1 mm per day. After 3 months I started noticing some signs of nerve regeneration and the feeling continued to improve over the next 18 months.
Speaking of chest numbness
Oncology care is evolving with advances in breast cancer treatment, and the way we talk about breast deafness needs to evolve as well. Oncology treatment teams should be proactive in speaking with their patients about the realities of chest numbness, including the emotionally devastating, isolating, and disorienting feelings that can also occur.
Not every patient is a candidate for breast neurotization, but patients need to know that it can be an option. You don’t need to have personal experience with loss of sensation to educate your patients about the potential impact of chest numbness on quality of life and treatment options. This topic isn’t talked about enough in the preoperative period, but using your voice to speak up for your patients will be life-changing.
I am fortunate to now be cancer free and feeling like my old self, but I know that permanent chest numbness would have had a tremendously negative impact on my life. Many patients feel guilty about being bothered by chest numbness – they think they should just be grateful to be alive. But it’s normal and legitimate to want to feel whole again. And it’s possible – I’m living proof.
- Mitchell S, Gass J, Hanna M. How well informed do patients feel about their breast cancer surgery options? Results of a nationwide survey of women after lumpectomy and/or mastectomy. J Am Coll Surg. 2018;226(2):134-146.e3. doi:10.1016/j.jamcollsurg.2017.10.022
- Habibi K, Delay E, Sarfati I, Duteille F, Clough KB, Atlan M. Lessons from twenty-eight cases of post-breast reconstruction burns: an underestimated complication that needs to be included in consent information. Aesthetic Surgeon J. 2021;41(7):NP773-NP779. doi:10.1093/asj/sjab027