Preparing for Life After Breast Cancer Surgery
- “Bachelorette” star Katie Thurston, 35, has completed her long‑awaited double mastectomy and is now focused on recovery amid her ongoing metastatic breast cancer journey.
- Ahead of surgery, she underwent occupational therapy to prepare for potential lymphedema, a possible side effect of breast cancer surgery.
- “Lymphedema is a disorder in which the lymph fluid– which is basically interstitial fluid that leaks out from our tissue continuously– cannot recirculate properly and stay stagnant in the tissue,” says Dr. Dung Nguyen, the Director of Breast Reconstruction at the Stanford Women’s Cancer Center.
- Thurston underwent a double mastectomy, a procedure that removes both breasts and is often followed by breast reconstruction, which often uses tissue from the lower stomach.
- “We’re taking the same kind of tissue that will be in a tummy tuck, that tissue is removed and brought up to make the breast,” Dr. Andrea Pusic, Chief of Plastic and Reconstructive Surgery at Brigham and Women’s Hospital, explains.
- Thurston is already embracing the next phase of healing, while experts like Dr. Dung Nguyen remind patients that early monitoring for lymphedema is essential: “Over time, lymphedema can spread onto the chest wall as well.”
After weeks of preparing for surgery, she’s already turning her focus to what comes next, just as she has at every step of her treatment.
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“Lymphedema is a disorder in which the lymph fluid – which is basically interstitial fluid that leaks out from our tissue continuously – cannot recirculate properly and stay stagnant in the tissue,” says Dr. Dung Nguyen, the Director of Breast Reconstruction at the Stanford Women’s Cancer Center.
“We measured my arms, tested my strength and range of motion before surgery so we could monitor how things were changing afterward,” Thurston explained.
Thurston’s husband, Jeff Acurri, shared a touching photo of Thurston moments before her breast cancer surgery.
“This beautiful badass went in for her surgery, a double mastectomy,” Acurri captioned the post.
After her procedure, Thurston was all smiles and eager for the next phase in her cancer journey: post-surgery recovery.
Preparing for the Possibility of Lymphedema and Restoring Breast Sensation After Breast Cancer Surgery
Lymphedema – chronic swelling that can develop after breast cancer surgery or radiation – occurs when lymph vessels are damaged and can no longer move fluid effectively. This buildup typically causes swelling in the arm and hand on the same side as the treated breast.
Women who have multiple lymph nodes removed and/or receive radiation are at higher risk, and lymphedema can appear shortly after treatment or even years later. That’s why early monitoring is essential.
“If a woman has breast cancer on the right side, she should look for signs and symptoms of lymphedema in her right arm — from the hand all the way up to the axilla,” Dr. Nguyen tells SurvivorNet.
“Over time, lymphedema can spread onto the chest wall as well.”
Although there is no cure, early treatment can prevent progression.
Lymphedema is categorized into four stages, with options ranging from compression garments, physiotherapy, and exercise to surgical approaches such as lymph node transfer or lymphovenous bypass.
WATCH: Treating Lymphedema
For severe, stage‑3 lymphedema, Dr. Nguyen explains that the first step is often “debulking” the dense fibrous tissue using dry liposuction.
After a year to 18 months of healing, patients may become candidates for procedures that help re‑establish lymphatic drainage, including lymph node transfer or lymphovenous bypass.
Restoring Breast Sensation
Many women choose breast reconstruction after mastectomy, using either implants or tissue from another part of the body. But restoring sensation to the breast is a critical goal.
WATCH: Restoring Sensation After a Mastectomy
“Restoring sensation to the patient’s breast is the final frontier of breast reconstruction,” Dr. Nguyen said.
A surgical approach focuses on preserving key sensory nerves during mastectomy. Surgeons can then reconnect, or neurotize, the patient’s nipple and skin using those nerves. This technique, known as breast reinnervation, is still being studied, but has shown promising results and may offer women a better chance of regaining meaningful sensation after surgery.
Expert Resources for Breast Cancer Patients Weighing a Mastectomy Procedure
Katie’s Ongoing Breast Cancer Treatment Journey
When it comes to breast cancer surgery, there’s no one-size-fits-all approach. Choosing between a lumpectomy and a mastectomy is a deeply personal decision—one that depends on a range of medical and emotional factors.
“As a breast surgeon, my job is to help patients understand that their long-term survival with mastectomy is equivalent to that with lumpectomy and radiation,” says Dr. Sarah Cate, Chief of Breast Surgery at Stamford Hospital.
Still, many women request a double mastectomy (removal of both breasts), believing it offers the best protection against recurrence. But that’s not always the case. The size of the tumor, its genetic profile, and a patient’s family history all play a role in determining the most appropriate surgical path.
WATCH: Decisions Surrounding Breast Reconstruction
“Mastectomy has very specific indications,” Dr. Cate explains.
“Some of the things that would predict a mastectomy are things like a large tumor size to breast ratio, or having cancer in more than one area of the breast, or having a genetic mutation.”
Katie Thurston, who recently shared her breast cancer journey publicly, is preparing for a double mastectomy. While this procedure is often part of treatment, it’s also used preventatively for women at high risk of developing breast cancer.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removal of the tissue,” says Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System.
“The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
WATCH: What Goes Into a Double Mastectomy
Today, most women choose to undergo some form of reconstruction, which can significantly extend the duration of surgery—especially when tissue is transferred from another part of the body.
“When you take tissue from another part of the body and transfer it to fill in the empty space where the breasts are, this is a very long operation,” Dr. Port says.
“It can take anywhere from six to 12 hours because it’s really like having a tummy tuck and then transferring the tissue and grafting the tissue, connecting the vessels, so those tissues have blood flow to live in,” Dr. Port adds.
For women with a strong family history or a known genetic mutation—such as BRCA1 or BRCA2—the decision to undergo a preventative mastectomy may be the most effective way to reduce their risk.
“Risk-reducing mastectomies are an operation where we take women at, usually, very high risk for getting breast cancer,” Dr. Port explains. “For genetic mutation carriers, who are the ones at the highest risk, there’s unfortunately only one way to actually prevent breast cancer.”
WATCH: Getting a Preventive Mastectomy
Women who test positive for a BRCA mutation typically face two options.
“One is what’s called high-risk surveillance, which means we check them every six months or so—mammograms, MRIs—with the hope that if, God forbid, they develop breast cancer, we pick it up early,” Dr. Port says. “But that’s not prevention, that’s early detection.”
“Early detection is a goal, it’s not a guarantee. For the woman who wants to be more proactive about actually preventing breast cancer, or as we say, reducing her risk, unfortunately, the only way to do that is to remove the actual tissue at risk, and that is the breast tissue,” she adds.
Katie’s Ongoing Treatment
Thurston previously shared that her treatment regimen includes three key medications:
- Kisqali (ribociclib): Approved by the FDA in 2017, this targeted therapy is used in combination with endocrine therapy to treat HR+/HER2- breast cancer. It works by slowing the progression of cancer, offering a more tolerable alternative to traditional chemotherapy.
- Lupron (leuprolide): A hormone therapy injection that lowers estrogen levels in the body, helping to prevent the cancer from growing.
- Letrozole: An aromatase inhibitor that reduces the body’s estrogen production, commonly used in postmenopausal women with hormone-sensitive breast cancer.
Treatment Options for Advanced Breast Cancer
Metastatic breast cancer (also called stage 4) means cancer cells have spread from the breast to other parts of the body, which may include the bones, liver, lungs, brain, and beyond.
Breast cancer spreads through the bloodstream or lymphatic system. The blood carries cancer cells to different body parts, where they grow as new tumors.
As the cancer spreads to other body parts, patients may experience additional symptoms depending on where the cancer has spread. Examples include:
- Bones: Severe bone pain or fractures
- Lungs: Difficulty breathing, chest pain, new cough
- Liver: Yellowing of the skin (jaundice), abdominal pain, nausea, and/or vomiting
- Brain: Headaches, memory loss, changes in vision, seizures
WATCH: Treatment options for metastatic breast cancer.
Although stage 4 breast cancer is not curable, several treatment options exist that can extend the life of patients. Treatment options depend on the stage, type of primary breast cancer, and whether hormone receptors are positive.
Treatment can include a combination of:
- Chemotherapy: Oral or IV medications that are toxic to tumor cells
- Hormonal therapies: Drugs that lower estrogen levels or block estrogen receptors from allowing the cancer cells to grow
- Targeted therapies: Drugs that target your tumor’s specific gene mutations
- Immunotherapy: Medications that stimulate your immune system to recognize and attack cancer cells
- Radiation: The use of high-energy rays to kill tumor cells and shrink tumors
- Surgery: To remove a cancerous tumor or lymph nodes (uncommon with stage IV; more common in stages I, II, and III)
- Clinical trials: Studies of new medications, treatments, and other therapies offer hope for better outcomes.
Questions to Ask Your Doctor
If you’re considering a mastectomy, it can be helpful to go into the conversation with your doctor prepared. Here are some key questions to ask as you weigh your options. SurvivorNet’s proprietary AI tool, “My Health Questions,” can also support you along the way by providing evidence‑based answers aligned with cancer treatment guidelines and informed by oncologists across multiple specialties.
- What can I do to prepare for a double mastectomy?
- What happens before and after the procedure?
- For reconstruction, what are the benefits of using implants over my own tissue and vice versa?
- What should I know about implants?
- What will recovery look like after the procedure?
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