Opinion: Post-Mastectomy Chest Numbness: Oncology Nurses Are Key to Patient Education

Jessica de Paz, BSN

Ask any patient with breast cancer and they’ll likely you tell you that the initial days following a diagnosis are a blur of appointments as treatments and surgeries are planned. Patients are often overwhelmed with the number of decisions that must be made amid their initial shock. Staying alive and getting the cancer out of their body is their top priority. Patients often don’t know what questions to ask or what to expect during their recovery.

That’s where oncology nurses come in. These nurses are in a unique position to help patients process the vast amount of information being given to them. Among that information are the adverse effects of mastectomy—and how those adverse effects, such as chest numbness, might affect their quality of life in the future.

Learning From Experience

I share this from my experience not only as a nurse of 20 years, 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 during the initial flurry 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 my nerves would be cut when my surgeon removed the breast tissue during my mastectomy. Without further intervention, the severing of nerves would interrupt the connection between the skin over my breasts and my brain—and that could lead to numbness across my chest area. It’s like the numbness that you feel after a dental procedure, but more widespread.

Before my mastectomy, I asked my doctor a question many patients wouldn’t know to ask: Am I ever going to feel sensation in my chest again? I knew that post-mastectomy sensation loss could be permanent. Many patients, however, are not aware of this adverse effect. If their surgeon did mention sensation loss, it was likely one of the many adverse effects that were quickly covered.

What I didn’t know was the impact that chest numbness would have on my quality of life. Until my sensation started to return, I felt nothing. That numbness also compounded the physical and mental toll cancer survivorship 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 tremendous effect on my body image and self-esteem. Chest numbness can also impact safety; for instance, knowing if you’re being burned while cooking, sunbathing, or showering.

I also didn’t know that it was possible to restore chest sensation as a part of breast reconstruction. I was fortunate that my surgeon performed breast neurotization—surgically reconnecting nerves with the goal of restoring sensation. If the nerve connection is repaired, it’s possible to get feeling back 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 (donated human tissue) to reconnect the nerves that had been cut during my mastectomy. This procedure enables 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 approximately 1 mm per day. I started to notice some signs of nerve regeneration after 3 months, and the sensation continued to progressively improve over the next 18 months.

Talking About Chest Numbness
Oncology nursing continues to evolve with advancements in breast cancer treatment, and the way we talk about chest numbness must evolve, too. Oncology care teams should be proactively talking with their patients about the realities of chest numbness, including the emotionally devastating, isolating and disorienting feelings that may also occur.

Not every patient will be a candidate for breast neurotization, but patients need to know that it may be an option. You don’t need to have personal experience with sensation loss to educate your patients on the potential quality of life impacts of chest numbness and treatment options. This topic isn’t talked about nearly enough in the pre-operative stage but using your voice to advocate for your patients will change lives.

I’m fortunate to now live cancer-free and feel like my old self, but I know that if my chest numbness had been permanent, it would have had a tremendously negative impact on my life. Many patients feel guilty for being burdened by chest numbness—they think they should just be grateful to be alive. But it’s normal and valid to want to feel completely whole again. And it’s possible—I’m living proof.

References

1. Mitchell S, Gass J, Hanna M. How well informed do patients feel about their breast cancer surgery options? Findings from 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
2. Habibi K, Delay E, Sarfati I, Duteille F, Clough KB, Atlan M. Lessons learned from twenty-eight cases of burns following breast reconstruction: an underestimated complication requiring inclusion in consent information. Aesthet Surg J. 2021;41(7):NP773-NP779. doi:10.1093/asj/sjab027