After completing breast cancer treatment, you and your loved ones might worry about the possibility of the cancer returning, known as recurrence. Breast cancer can recur (return) if treatment doesn’t eliminate all cancer cells. Even after a double mastectomy — a surgery that removes all breast tissue from both breasts — there is 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.

What Factors Influence Breast Cancer Recurrence Risk?

Several factors can increase the risk of breast cancer recurrence after a mastectomy. Recurrence is more likely if these factors were present at the time of diagnosis:

• Cancer found in the axillary lymph nodes (the lymph nodes in your armpits)
• Diagnosis before age 35
• Diagnosis of stage 3 breast cancer
• Aggressive types of breast cancer, such as triple-negative breast cancer (TNBC) or inflammatory breast cancer
• Tumors larger than 5 centimeters
• Obesity, defined as having a body mass index (BMI) of 30 or higher

About 5 in every 100 women who undergo a mastectomy for breast cancer will experience a local recurrence within 10 years of their initial diagnosis.

Your cancer care team can help you understand your individual risk of breast cancer recurrence based on your unique risk factors.

How Common Is Breast Cancer Recurrence After Mastectomy?

About 5 in every 100 women who undergo a mastectomy for breast cancer experience a local recurrence — meaning the cancer returns in the chest area — within 10 years of their initial diagnosis. This is about the same recurrence rate as people who had a lumpectomy (breast-conserving surgery) with radiation therapy as their initial treatment.

The risk of a distant recurrence (also called metastasis, meaning the cancer has spread to another part of the body) is also comparable 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, the risk of recurrence is about 6 percent within five years after a mastectomy. If cancer is found in nearby lymph nodes, the risk or recurrence increases to around 25 percent. Radiation therapy can significantly reduce this risk, sometimes bringing it down to about 6 percent, though individual results may vary.

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
• Regional recurrence — In nearby lymph nodes
• Distant recurrence — In other parts of the body, such as bones, liver, lungs, or brain

Depending on where breast cancer recurs, you may notice symptoms on your chest or more general symptoms such as headaches, weight loss, or a persistent cough.

The symptoms may be different based on where the cancer recurs. Here are some symptoms to watch for:

1. Changes Around Your Mastectomy Scar

Although all of the 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.

2. New Lumps on Your Chest

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. Most of the time, the lump is not painful.

3. Skin Changes

In addition to monitoring your mastectomy scar, you should also pay attention to the skin on your chest. Breast cancer recurrence may cause discolored or inflamed skin on your chest.

4. Nipple Discharge

If you’ve had a nipple-sparing mastectomy (a mastectomy where the skin and nipple are preserved), breast cancer recurrence may cause nipple discharge. Although the breast tissue is removed during this treatment, nipple discharge is possible if there’s a small amount of remaining breast tissue. It’s important to always report nipple discharge to your health care team.

5. Swollen Lymph Nodes

If you have a regional breast cancer recurrence after a mastectomy, you may notice swollen lymph nodes in one or more areas around the area of your original cancer, 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

6. Persistent Pain

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 also 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.

7. Fatigue

Fatigue (extreme tiredness) may be a symptom of metastatic breast cancer. When cancer is growing, it can make you feel tired if the cancer affects your hormone levels or your immune system.

Attend all follow-ups with your cancer care team and work with them on ways to lower your risk for breast cancer recurrence.

Many common health conditions can also cause fatigue. However, you should let your health care team know if you’re feeling more tired than usual.

8. Shortness of Breath or Coughing

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 sites that breast cancer spreads to, so it’s important to tell your health care team about any new symptoms related to shortness of breath or coughing.

9. Unexplained Weight Loss

Losing weight unintentionally can be a symptom of breast cancer metastasis. Cancer can cause weight loss because cancer cells burn more energy than healthy cells. Additionally, breast cancer metastasis can cause you to lose your appetite, making you eat less.

10. Jaundice

If breast cancer spreads to your liver, it can cause jaundice — yellowing of your skin and the whites of your eyes. Jaundice is usually a symptom of a problem with your liver, gallbladder, or pancreas. It’s important to talk to your health care provider right away if you notice jaundice.

11. Severe Headaches or Seizures

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

• Severe headaches that don’t go away
• Vision problems
• Seizures

While these symptoms don’t definitely mean you have metastatic breast cancer, it’s important to report these symptoms to your health care provider right away.

Talk With Your Health Care 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 for the first five years after your breast cancer treatment.

During regular follow-ups, your health care team will monitor you for signs and symptoms of breast cancer recurrence or metastasis. Your health care team can also help you make sure you’re doing everything you can to lower your risk for breast cancer recurrence.

If your breast cancer returns, it’s important to know that you have treatment options.

Meet Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, 73,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you talked about your risk of recurrence with your oncologist? Do you pay attention to potential symptoms? Share in the comments below, or start a conversation by posting on your Activities page.