Your care
Survivorship
Survivorship is everything that follows active breast cancer treatment — scheduled follow-up, managing late effects, and knowing which new symptoms warrant prompt review. Dr Fiona Tsang-Wright (GMC 4549831), Consultant Oncoplastic and Reconstructive Breast Surgeon, offers private survivorship follow-up in London and Buckinghamshire at the Women's Health Centre – Harley Street (27–29 Harley Street), Women's Health Centre - King's Road, and The Chiltern Hospital; NHS consultant at Bucks Breast Unit, Buckinghamshire Healthcare NHS Trust.
This page is for patients who have completed (or nearly completed) their primary breast cancer treatment, on the NHS or privately, and are looking for continuing care — particularly where the original team is not directly available, where private follow-up is preferred, or where new questions arise that the original team did not address.
What survivorship usually involves
For most patients with early-stage breast cancer treated with current standards, survivorship covers:
1. Surveillance imaging
Surveillance mammography
Of the remaining breast tissue is standard for the first five years after treatment. However, in some centres after three years, for patients aged 50 and over who are recurrence-free, surveillance is typically every two years after breast-conserving surgery and every three years after mastectomy (NICE NG101, updated April 2025, reflecting the Mammo-50 trial). Patients under 50 continue with annual mammography for at least five years, or until they are 50. Mammography of the mastectomy side is not routinely offered.
MRI
In selected cases — particularly for patients with very dense breasts, BRCA carriers, and selected post-treatment situations.
Clinical examination
At intervals.
The aim of surveillance is not to look for distant spread — modern surveillance for that is symptom-based rather than imaging-based — but to catch any new local or contralateral disease at the earliest treatable stage.
2. Ongoing hormone therapy (where applicable)
For oestrogen-receptor-positive cancers, hormone therapy (tamoxifen or aromatase inhibitors) is taken for 5–10 years after the primary treatment.
Side effects (hot flushes, joint aches, bone-density changes) are managed alongside.
A baseline DEXA scan is performed at the start of aromatase inhibitor therapy, with repeat scans typically every 1–2 years. Adjuvant bisphosphonates (zoledronate infusions or oral alendronate) are offered routinely to postmenopausal patients on AIs, both to protect bone and for the modest anti-cancer benefit (NICE NG101).
3. Symptom monitoring
Awareness of any new lump, skin change, nipple change, or other concerning feature in either breast — and prompt review where one arises.
4. The longer arc
Lymphoedema
Can develop months or years after axillary surgery or radiotherapy. Early signs — heaviness, tightness, or swelling in the arm or hand on the operated side, or recurrent skin infections — should prompt referral to a specialist lymphoedema service (Macmillan and the British Lymphology Society maintain directories). Skin care, exercise, and compression garments are the mainstays of treatment; early referral substantially improves outcomes.
For most patients, most of survivorship is uneventful: annual imaging, hormone therapy, and the slow return to normal life.
What the practice offers in survivorship
The practice provides continuing care for patients in survivorship in three main ways:
Continuing the surgical follow-up
For patients who had their surgery elsewhere and want continuing care closer to home, or with a single named consultant rather than a rotating team:
Annual or six-monthly clinical review.
Coordination of surveillance imaging (mammogram, ultrasound, MRI as appropriate).
Liaison with the original treating team where needed.
A consistent point of contact for any new concerns.
Delayed reconstruction
For patients who had a mastectomy in the past and would now like to consider reconstruction:
A consultation to discuss what is possible — implant-based, autologous (DIEP, PAP, latissimus dorsi, LAP), or refinement of an existing reconstruction.
Joint planning with a plastic-surgery colleague where microsurgical reconstruction is considered.
For patients who initially had aesthetic flat closure, options for reconstruction years later — see aesthetic flat closure for the conversation about changing your mind.
For more on delayed reconstruction options, see the glossary entry.
Risk-reducing options for the contralateral breast
For patients with a prior cancer who have since:
Had a positive genetic test (BRCA, PALB2, or other high-risk gene).
Acquired new family-history information.
Developed concerns about the unaffected breast that warrant assessment.
A consultation about contralateral risk-reducing mastectomy is one of the recurring conversations in survivorship, often years after the original cancer.
Life after mastectomy or breast cancer surgery — body image, support, and emotional recovery
The clinical pathway is one half of survivorship. The other half is the human side: how the body looks and feels afterwards, how you relate to it, how you cope with what has happened, and where to find people who understand. This part of survivorship is sometimes harder than the active treatment, and is often less well-prepared for.
Body image after breast surgery
The body looks different after breast cancer surgery. The specifics depend on what was done — lumpectomy, mastectomy with or without reconstruction, aesthetic flat closure — but every operation leaves changes that take time to integrate.
Common patterns patients describe:
First few weeks
The dominant feeling is often relief at being through the operation, layered with caution about looking at the scar, dressing in privacy, or being seen by a partner. Most patients describe some version of “I haven’t really looked yet” in the first month.
Months 1 to 3
The scar settles, swelling subsides, the reconstruction (if there is one) takes its final shape, and the practical adjustments — different bras, different clothing choices, getting used to a prosthesis if that’s the route — become routine. This is often when the emotional adjustment lands.
Months 3 to 12
Most patients have settled. Some describe a sense of grief about the previous body that comes and goes; some are surprised by how quickly the new normal becomes normal; many find that what they expected to mind, they don’t, and what they didn’t expect, they do.
Beyond a year
The long-term picture is overwhelmingly positive for most patients. The surgery becomes a part of personal history rather than a daily presence.
Being seen by people who have been through it.
A peer-support conversation — through a charity, a survivorship group, or an informal connection — does something a clinical conversation cannot.
Looking when you’re ready, not before.
There is no clinical reason to study your scars on day one. Most patients look properly at around 4 to 6 weeks, when the swelling and the bandages are settling. Some prefer to be alone the first time; some prefer to look with their partner or with the breast care nurse.
Being honest about what you don’t like
Including with your reconstructive team. Many adjustments and refinements are possible months or years after the original operation. If something about the result is bothering you and you’ve been told it’s “fine”, a second opinion from a reconstructive surgeon is reasonable.
Letting yourself feel ambivalent.
It is possible to be glad you survived the cancer and sad about what you’ve lost. Both are real; neither contradicts the other.
Things that help:
If body-image distress is interfering with daily life — sleep, work, intimacy, the ability to enjoy things — that is a treatable problem. Specialist psycho-oncology services exist within the NHS and through private routes; the breast care nurse or your GP can refer you. See “Mental health and counselling support” below.
Coping with mastectomy specifically
Mastectomy carries an emotional load that lumpectomy and other breast-conserving operations often don’t. Even patients who chose mastectomy for clear reasons — and who are happy with the medical decision — describe an adjustment that can be heavy in the first months.
Some patterns that are common and not pathological:
Phantom sensations
Feeling the breast that isn’t there, including occasional pain, itching, or warmth. This is a nerve phenomenon, not a sign of anything wrong, and it usually settles over months. Persistent phantom pain is treatable; raise it at follow-up.
A sense of imbalance
Particularly for patients with a mastectomy on one side without reconstruction. The contralateral breast feels heavier; the body is briefly lopsided. A well-fitted prosthesis restores the balance for most patients within weeks.
Wardrobe and visibility
What to wear, what shows, what doesn’t. Most patients work this out within a few weeks; specialist mastectomy lingerie services help. The practice can recommend local fitters.
Intimacy and partner relationships
Patients describe a wide range. Some find it harder than expected; some find it returns more quickly than expected. Honest conversation with the partner — and, where helpful, a couples counsellor — is the most reliable support. Breast Cancer Now has a dedicated booklet on intimacy and relationships after breast cancer.
Family conversations
Particularly with children. Age-appropriate honesty is the consensus advice; specific guides are available through Macmillan and Breast Cancer Now for talking to children of different ages about the changes to your body.
Life after mastectomy — practical adjustments
A non-exhaustive list of the practical things patients tell us they wish someone had mentioned earlier:
Bra fitting
Your size is likely different. A specialist mastectomy bra fitter (NHS or private) is worth the appointment; the right bra makes the prosthesis or reconstruction far more comfortable.
Sleeping position
You may not be able to sleep on the operated side for several weeks. A pregnancy pillow or rolled-up duvet helps.
Driving
See the after surgery page for the specific timelines. Practise an emergency stop in a stationary car before driving on the road.
Hairdressing, swimming, gym, sex
There are specific timelines for each, on the after surgery page. Most resume by 6 to 8 weeks; the longer recoveries are after autologous reconstruction.
Travel
Long-haul flying after surgery has a small additional clot risk. See the after surgery page for the timeline.
Work
Phased returns are common and helpful. Most patients negotiate a 50-to-80% schedule for the first 2 to 4 weeks back, depending on the role.
Sun protection
Fresh scars (the first 12 months) burn easily. High-factor SPF on the scar whenever exposed.
Tattoos, piercings, MRI safety
Discuss specifics with the team if any of these are part of your life.
For autologous reconstruction patients (DIEP, PAP, latissimus dorsi, others), the abdominal or back donor site has its own recovery story — see the after-surgery page for the specific timelines.
Support groups in London and the UK
Peer support is one of the strongest predictors of psychological recovery in breast cancer. The right group depends on geography, age, life stage, and personal preference; below are the routes the practice most often recommends.
National helplines and online communities (free, accessible from anywhere):
Breast Cancer Now Helpline
0808 800 6000 — staffed by specialist breast care nurses; covers any breast cancer question, not only emergencies.
Breast Cancer Now Forum
Online community, a few thousand active members, threads by topic (DCIS, reconstruction, BRCA, secondary breast cancer, side effects, etc.).
Macmillan Cancer Support
0808 808 00 00 — covers all cancer types; specialist nurses, financial advisors, and a wide network of online and in-person groups.
Breast Cancer Care UK Younger Women Together
A peer-support programme specifically for women diagnosed under 45.
OUTpatients
Peer support for LGBTQ+ people with cancer, including breast cancer; UK-wide.
Maggie’s Centres
Maggie’s at the Royal Free, Maggie’s at Charing Cross — drop-in support, courses, group sessions, and one-to-one psychological support. Free; no appointment needed.
The Haven
(Future Dreams House, Kings Cross) — daily classes, peer-support groups, and complementary therapies specifically for breast cancer.
Macmillan support centres
At the major London hospitals (Royal Marsden, UCLH, Barts) — open to anyone with a cancer diagnosis regardless of where they were treated.
Cancer Information and Wellbeing Service (Macmillan-supported), Buckinghamshire
At the Cancer Care and Haematology Unit, Stoke Mandeville Hospital (Aylesbury) and the Sunrise Unit, Wycombe Hospital; open to anyone affected by cancer (01296 838 340).
Local breast cancer support groups
In many London boroughs and across Buckinghamshire — your breast care nurse will have the current list for your area.
London-specific in-person groups (worth ringing the contact number to confirm current schedule before attending):
Mental health and counselling support
Anxiety, low mood, intrusive thoughts about recurrence, and difficulty sleeping are all common after a breast cancer diagnosis — and they are treatable. The treatment is the same as for any anxiety or depression: talking therapy (CBT or psychodynamic), medication where appropriate, time, and the structural support of people who understand.
Routes to access:
GP
For any persistent low mood, anxiety, sleep problem, or change in functioning. Talking therapy is available on the NHS via IAPT (free, self-referral or GP referral).
Macmillan
Counselling and psychological support specifically for cancer patients, free, no waiting list at most centres.
Maggie’s Centres
Psychological support specifically for cancer patients; drop-in or by appointment.
Private counselling
If a quicker start, a longer course, or a specific specialist is wanted. Most major insurers cover psycho-oncology counselling. The British Psychological Society Directory and the BACP Therapist Directory are reliable starting points.
Specialist psycho-oncology services
The larger NHS cancer centres have dedicated psycho-oncology teams; referral via the breast care nurse or oncology team. Privately, several London centres offer psycho-oncology specifically.
If at any point you are having thoughts of self-harm or you don’t feel safe, the right routes are: call 111 for urgent mental health support, call Samaritans on 116 123 any time, or attend A&E. Cancer is hard; reaching out for that level of help is a normal response to an extreme situation, not a sign of weakness.
Returning to work, exercise, and the rest of life
Most patients are back at work, back at the gym, and back to a recognisable version of normal life within 3 to 6 months — sooner for lumpectomy, slightly longer for major reconstruction or chemotherapy. The shape of “back to normal” is different for everyone:
Some patients want to return to exactly what they did before; others use the diagnosis as a prompt to change something — work pattern, exercise habit, life balance.
Some find the post-treatment period an opening to do things they had been deferring; some find it a period of grief and slow recovery before life resumes.
A few find that the diagnosis fundamentally changes priorities — relationships, careers, where they live. This is a real pattern; it is not pathological, and it does not need to be argued out of.
There is no right way to do survivorship. The clinical pathway is what we can specify; the rest of life after breast cancer is up to you.
Where private survivorship care fits
Most NHS breast units have structured survivorship pathways — annual mammograms, breast care nurse contact, a route back into the system if anything changes. For many patients, this is exactly right and there is no need to do anything different.
Private survivorship care is sometimes preferred when:
The original NHS team has closed
The formal follow-up loop (typically after 5 years), but the patient wants continuing specialist contact.
The patient has moved
Geographically since the original treatment and the original team is no longer accessible.
The patient values continuity of consultant
Seeing the same person at every visit, rather than the team approach.
The patient has specific concerns
The NHS pathway does not have time to address — for example, a deeper conversation about delayed reconstruction or contralateral risk.
For patients who had their original treatment privately, continuing private follow-up with the same team is usually the simplest path and is what the practice offers as standard.
What about distant recurrence?
The hard reality of breast cancer survivorship is that recurrence — particularly distant recurrence — does occur, even in patients with apparently curable early-stage disease at the time of original treatment. Modern surveillance does not include routine staging scans for asymptomatic patients; the evidence supports symptom-based investigation rather than scheduled scans.
Things to be aware of and report promptly:
- New persistent bone pain that does not have an obvious explanation.
- Persistent unexplained breathlessness or cough.
- Persistent unexplained weight loss.
- New neurological symptoms — persistent headache, vision changes, weakness.
- Any lump in either breast, the chest wall, or the lymph node areas.
Most of these symptoms turn out to be unrelated to breast cancer — but in survivorship they warrant assessment rather than dismissal. The route is via the breast care nurse team or directly through the practice.
Lifestyle in survivorship
Beyond the medical pathway, several lifestyle factors are associated with better long-term outcomes after breast cancer:
Regular exercise
Strongly associated with reduced recurrence risk, particularly for ER-positive cancers. The current guidance is at least 150 minutes of moderate aerobic activity per week, plus strength training.
Healthy weight maintenance
Obesity is associated with worse outcomes; weight loss after a cancer diagnosis is associated with improved outcomes for some patients.
Limited alcohol intake
Alcohol is associated with raised breast cancer incidence and may be associated with raised recurrence risk.
These are not “must do” items; they are evidence-based things that modestly improve the long-term picture for many patients. The right balance is individual.
What to do next
For continuing care or for a specific survivorship question, contact Sarah or Nadiya, Dr Tsang-Wright’s PAs, at [email protected] or 07785 274 744. Bring any relevant histology reports, imaging on disc, and treatment letters from your original team.
For NHS survivorship care, your original team is the route. Where that is no longer accessible, ask your GP for guidance on local breast follow-up services.