After your complete breast cancer treatment, you and your loved ones might worry about the possibility of the cancer returning, known as recurrence. Breast cancer can recur if some cancer cells remain after treatment, including cells too small to detect. Even after a double mastectomy, surgery to remove both breasts, there’s still a possibility of recurrence.

Continue reading to learn more about the risk of recurrence after a mastectomy and the signs and symptoms you should watch for.

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How Common Is Breast Cancer Recurrence After Mastectomy?

Breast cancer recurrence rates vary widely, depending on the factors above, as well as on what treatments a person receives and how their cancer responds to treatment.

A small number of people who undergo a mastectomy for breast cancer experience a local recurrence, meaning the cancer returns to the skin or tissue of the chest wall, within 10 years of their initial diagnosis.

Some studies suggest this is about the same recurrence rate as people who had a lumpectomy (breast-conserving surgery) with radiation therapy as their initial treatment. Other studies find that breast cancer is less likely to recur in the same location after mastectomy.

The risk of a distant recurrence, also called metastasis, when cancer has spread to another part of the body, is also similar in people who have had a mastectomy or a lumpectomy with radiation therapy.

The chance of recurrence is further influenced by whether the cancer was found in nearby lymph nodes and the type of follow-up treatments received. If no cancer is detected in the lymph nodes, there’s a relatively low risk of recurrence after a mastectomy. If cancer is found in nearby lymph nodes, the risk of recurrence is higher, although radiation therapy can significantly reduce it.

Since your risk of recurrence will depend on details about your breast cancer and the treatments you receive, your oncologist is the best person to talk to about your risk of recurrence. Although the risk of breast cancer recurrence after a mastectomy is relatively small, it’s still important to know what symptoms to look out for.

11 Symptoms of Breast Cancer Recurrence After Mastectomy

Breast cancer can return in different areas after a mastectomy, including:

• Local recurrence — In the chest area where the breast was removed or right on the scar
• Regional recurrence — In nearby lymph nodes
• Distant recurrence — In other parts of the body, such as bones, liver, lungs, or brain

Your breast cancer recurrence symptoms may be different based on where the cancer recurs. Some symptoms to watch for are described below.

Although nearly all of your breast tissue is removed during a mastectomy, local breast cancer recurrence is still possible. If this happens, you may notice changes to the scar tissue from your surgery. These changes may appear as a new area of thickening on or near the scar as well as skin discoloration or itching on the scar.

After a mastectomy, breast cancer can return in the tissue that lines your chest wall or in your skin. If this occurs, you may notice a new lump on your chest with no other significant symptoms. Most of the time, the lump is not painful.

In addition to monitoring your mastectomy scar, you should also pay attention to the skin on your chest. Breast cancer recurrence may cause discolored, inflamed skin or a rash or patch of skin that looks red, purple, brown, or darker than the surrounding skin.

If you’ve had a nipple-sparing mastectomy (a mastectomy where the skin and nipple are preserved), nipple discharge can occur. Because it can also be a sign of breast cancer recurrence, talk to your doctor if you notice it.

Although most breast tissue is removed during this treatment, nipple discharge is possible if a small amount remains. Your oncology team can help you figure out what’s causing your nipple discharge.

Breast cancer recurrence may cause swollen lymph nodes in nearby areas, including:

• Armpit
• Around your collarbone
• Neck

Swollen lymph nodes can cause other symptoms, such as:

• Difficulty swallowing
• Chest pain that doesn’t go away
• Pain or swelling in your arms or shoulders

New pain that doesn’t go away or improve may be a symptom of breast cancer that’s spread to another part of your body.

Bone pain is a common symptom of metastatic breast cancer because the bone is one of the most common places breast cancer spreads. You may feel pain in your chest, back, or hips.

Pain in these areas is common for many people, so you shouldn’t panic at the first sign of pain. Pay attention to how long the pain lasts and any factors that make the pain better or worse, especially if you don’t know what caused the pain.

It’s also important to note that several breast cancer treatments can cause bone pain as a side effect, including chemotherapy, targeted therapies, and hormone therapies. Aromatase inhibitors are especially known for causing bone and joint pain.

Fatigue may be a symptom of metastatic breast cancer. Cancer can make you feel tired.

Many common health conditions can also cause fatigue. Let your healthcare team know if you’re feeling more tired than usual.

If breast cancer spreads to your lungs, it can cause difficulty breathing or a cough that doesn’t go away. The lungs are one of the most common places breast cancer spreads, so it’s important to tell your healthcare team about any new shortness of breath or coughing.

Losing weight unintentionally can be a symptom of breast cancer metastasis. Cancer can cause weight loss by changing your appetite, causing inflammation, or interfering with your metabolism. If you’re losing weight without trying, talk to your doctor.

If breast cancer spreads to your liver, it can cause jaundice, which causes yellowing of your skin and the whites of your eyes. Jaundice is usually a symptom of a problem with your liver, gallbladder, or pancreas. Talk to your healthcare provider right away if you notice jaundice.

Breast cancer that spreads to the brain can cause problems, such as:

• Severe headaches that don’t go away
• Vision problems
• Seizures
• Difficulty walking
• Slow or unclear speech

Remember, none of these symptoms are proof that you’ve developed recurrent breast cancer. Each of these symptoms may also be caused by other health conditions.

Talk With Your Healthcare Team

If you notice any new or unusual symptoms you think may be caused by breast cancer recurrence, talk to your oncology team right away.

Even if you don’t have any new symptoms, it’s important to follow up with your cancer care team regularly as recommended. Visits may continue for years, though they’ll become less frequent after about five years.

During regular follow-up care, your healthcare team will monitor you for signs and symptoms of breast cancer recurrence or metastasis. They can also help you take steps to lower your risk for breast cancer recurrence.

If your breast cancer returns, it’s important to know that you have treatment options. Your healthcare team can help you understand which treatments may be appropriate based on your cancer and overall health. Talk with your oncology team about what to expect and any questions or concerns you have.