Cancer bereavement Support Understanding and Coping Strategies for patients and caregivers Explore different ways on navigating grief following a cancer diagnosis. Discover expert insights, coping mechanisms, and support resources to help you through this challenging experience. Prioritize self-care and find solace in community understanding. After a breast cancer diagnosis, we often feel as though the world is crumbling around us. The shock of hearing such news about a loved one can be overwhelming, leaving us grappling with a whirlwind of emotions ranging from fear and sadness to anger and confusion. Learning to cope with the realities of the diagnosis is a journey filled with uncertainty and challenges. It requires resilience, strength, and a willingness to navigate through the unknown. Yet, amidst the darkness, there is also hope – hope for moments of joy amidst the struggle, and for the unwavering support of family, friends, and medical professionals. Each step forward, no matter how small, is a testament to our determination to confront and overcome the obstacles that lie ahead. Articles Our blog serves as a beacon of knowledge, offering valuable insights, personal stories, and practical advice Podcast Tune in to insightful discussions featuring experts, survivors, and caregivers sharing invaluable insights, practical tips, and heartfelt stories.

Discover empowering on-demand movement classes designed for breast cancer thrivers. Heal, strengthen, and thrive with expert-led exercises tailored to support your journey. Access flexible, self-paced classes today On Demand Classes On Demand Classes On Demand Classes On Demand Classes Flexible Practice for Busy Lives Pilates Fire Ceremony Expressive Art Forest Bathing Meditation Reiki Circle of Care Qi Gong Restorative Yoga Diep Flap Yoga Breathwork Pilates Fire Ceremony Expressive Art Forest Bathing Meditation Reiki Circle of Care Qi Gong Restorative Yoga Diep Flap Yoga Breathwork Pilates Fire Ceremony Expressive Art Forest Bathing Meditation Reiki Circle of Care Qi Gong Restorative Yoga Diep Flap Yoga Breathwork Meditation Movement Classes Expressive Art Empower Your Experience Empower Your Experience Empower Your Experience Empower Your Experience Thriving Through Movement Thriving Through Movement Thriving Through Movement Thriving Through Movement On-Demand Movement Classes for Thrivers Unlock the power of movement with our on-demand classes designed for breast cancer thrivers. Whether you’re looking to strengthen your body with Pilates, restore balance with gentle Yoga, or deepen your practice with DIEP Flap Yoga, our expert-led sessions provide the flexibility and support you need on your healing journey. Start thriving today! Practice Now Restorative yoga is a gentle practice focused on deep relaxation and healing, making it ideal for breast cancer survivors and those undergoing treatment. By using props for support, restorative yoga helps release tension, restore energy, and promote emotional healing. It can alleviate stress, improve sleep, and enhance flexibility, supporting physical and mental well-being during recovery. This practice fosters peace and balance, empowering individuals to reconnect with their bodies and promote healing. #RestorativeYoga #BreastCancerWellness #HealingThroughYoga #StressRelief #MindBodyConnection #SurvivingBreastCancer #EmotionalHealing #QiGong #BreastCancerWellness #EnergyHealing #MindBodyConnection #SurvivingBreastCancer #EmotionalHealing #StressRelief Pilates is a low-impact exercise that focuses on strengthening the core, improving flexibility, and enhancing posture, making it a great practice for breast cancer survivors. It helps build endurance, restores balance, and promotes physical rehabilitation, especially post-surgery or treatment. Pilates can reduce stress, improve body awareness, and foster overall well-being, supporting both physical and emotional healing throughout the recovery journey. #PilatesForBreastCancer #BreastCancerRecovery #CoreStrength #PostSurgeryWellness #PhysicalRehabilitation #SurvivingBreastCancer #HealingThroughMovement Pilates is a gentle yet powerful exercise method that helps breast cancer survivors, thrivers, and those living with metastatic breast cancer (MBC) rebuild strength, improve flexibility, and restore balance. Designed to enhance core stability, posture, and overall well-being, Pilates offers a low-impact way to support physical and emotional healing after surgery, treatment, or recovery. #RestorativeYoga #BreastCancerWellness #HealingThroughYoga #StressRelief #MindBodyConnection #SurvivingBreastCancer #EmotionalHealing #QiGong #BreastCancerWellness #EnergyHealing #MindBodyConnection #SurvivingBreastCancer #EmotionalHealing #StressRelief DIEP Flap Yoga is a specialized practice tailored for individuals recovering from breast cancer surgery, specifically DIEP flap reconstruction. This gentle yoga focuses on restoring mobility, improving posture, and promoting healing in the body after surgery. By combining mindful movement with breathwork, DIEP Flap Yoga helps alleviate tension, reduces stress, and enhances emotional well-being. It supports the recovery process by fostering strength, flexibility, and a deeper connection to the body, empowering individuals to reclaim their health and balance. #DIEPFlapYoga #BreastCancerRecovery #PostSurgeryWellness #HealingThroughYoga #SurvivingBreastCancer #MindfulMovement #BreastCancerSupport Yoga with chair assistance offers a gentle yet empowering way for breast cancer survivors, thrivers, and those living with metastatic breast cancer (MBC) to experience the benefits of yoga with added support. Using a chair for stability, this practice helps improve balance, flexibility, strength, and relaxation while being accessible to all levels and abilities. Qi Gong is a gentle, meditative movement practice that helps breast cancer survivors, thrivers, and those living with metastatic breast cancer (MBC) restore balance, reduce stress, and enhance overall well-being. Rooted in traditional Chinese medicine, Qi Gong combines slow, intentional movements, breathwork, and mindfulness to promote energy flow (Qi) and support physical and emotional healing. EXPRESSIVE ARTS EXPRESSIVE ARTS EXPRESSIVE ARTS EXPRESSIVE ARTS ART GALLERY View classes Breast Cancer Conversations MBC Webinar Series Meditation Reflections Meditation On Demand Discover Watch Over 600 Videos On-Demand: Breast Cancer Thrivers Unite! Welcome to our On-Demand Video Library, your ultimate destination for breast cancer resources and inspiration.

Your mental health during breast cancer treatment is vital. Explore our resources for dealing with mental struggles accompanying a breast cancer diagnosis. Breast Cancer & Mental Health

A breast cancer diagnosis is life-changing for patients and their families. The SBC community will support you through every step of your treatment journey. Home Page Breast Cancer 101 Lifestyle & Wellness Resources Programs Content Library Podcast: Breast Cancer Conversations Download the App Subscribe to the Newsletter Donate to a Program More Newly Diagnosed with Breast Cancer. Now What? What brings you to this website is most likely a breast cancer diagnosis. Perhaps you found a lump, noticed swelling or experienced pain; maybe you are awaiting test results; or you just heard the words that you've been diagnosed with breast cancer; or perhaps you are experiencing a recurrence. Whatever the reason, I want you to know that you will be supported and that our Surviving Breast Cancer (SBC) community is here for you! We are here to help! A breast cancer diagnosis disrupts our lives and throws us into a whirlwind of doctors appointments, follow ups, tests, scans, and the like. Each and every one of us have unique experiences, and what our SBC platform and community provides is education, support, and resources for you as a complement to your medical care. We are not medical professionals, nor provide medical advice. But what we do offer is content, stories, and community when you need it most! What I mean by that is you are welcome to dive in to absolutely everything we offer today, or, you can take bite size approaches to get the information and support when you feel ready for it. We've listed a few links and resources to help get you started and to hopefully make things a bit less overwhelming. Download. Questions to Ask Your Surgeon Download PDF Questions to Ask Your Radiologist Downlod PDF Questions to Ask Your Oncologist Download PDF Burning Questions Latest News Who Should I Tell? Learning that you have been diagnosed with breast cancer can set you into a whirlind of uncertainty and that is to be expected. There is probably a lot of information you do not yet know. At this time, you may want to start thinking about who you should tell. While this can also be difficult for loved ones, family, and friends to hear, you are actually in the process of cultivating your support team! Remember, you do not need to tell everyone all at once. Perhaps starting with close family, let friends know how they can help support you during this time. It is a personal decision on how private or public you want to be and completely your choice in how much information you choose to share. You may want to have seperate conversations with your children depending on their ages. We also recommend speaking with your medical team about your treatment options and getting a plan in place for when you may need to take time off from work or be out of the office. Should I Get A Second Opinion? You may consider receiving a second opinion from another medical oncologist or breast surgeon. In some cases, people get multiple opinions before making any decisions on their care and medical treatment plan. Women in our Breast Cancer Support Group often share that it is important for them to feel comfortable with your doctors; that there is a rapport and trust. After all, your medical team is going to be your primary caregiver throughout treatment so it is important you feel comfortable with the person, able to ask questions, and feel confident in your plan of action. Your Medical Care Team may consist of one or several of the following: Breast Oncologist Breast Surgeon Breast Plastic Surgeon Radiation Oncologist Social Worker Psychologist What Treatment Options Do I Have? Thanks to continued research taking place in Breast Cancer, people diagnosed today have a variety of treatment options and are able to live long healthy lives. Treatment options will be tailored to your specific diagnosis and dependent on the stage of your breast cancer (1-4) and it's characteristics. For example, is it HER2 positive or negative, is it triple negative meaning it is estrogen receptor negative, progesterone receptor negative and HER2 negative. Your oncologist will also take into consideration how advance the cancer is. During this phase you may be getting more tests and scans. During this phase, you may also consider genetic testing. Genetic testing is helpful for a multitude of reasons including helping to make surgery decisions. If you end of testing positive for a genetic pre-disposition to developing breast cancer, your surgeon may recommend a full double mastectomy. Traditional standard of care includes: Surgery (not always required if you are diagnosed with metastatic stage IV breast cancer, that is, your cancer has spread beyond your breast to your bones, lungs, liver, or brain) Radiation (not always required) Chemotherapy (not always required) Hormonal Therapy (not always required) Oftentimes people will also consider integrative therapies as a complement to the standard treatments which also has been shown to reduce some of the side effects of treatment: Acupuncture Yoga Meditation Additionally speak to your oncologist about Clinical Trials and if you would be a candidate. Will I Need Chemotherapy? Not everyone diagnosed with breast cancer will need chemotherapy. There are several factors that go into this determination and should be a conversation you have with your oncologist. For example, your doctor will take into consideration the stage of cancer that you have (i.e., stage 1, 2, 3, 4) and the characteristics of your tumor, (i.e., if it is hormonal positive or negative) etc. In some instances, chemotherapy will be an option for people prior to surgery. This is called neo-adjuvant chemo. Other times, chemotherapy may be prescribed after surgery which is referred to as adjuvant chemotherapy. . Join our community SBC offers a safe space to build community. We provide reliable information and offer what you most need during the diagnosis: understanding. English Español

Learn about the latest advances in breast cancer treatment, including life-saving developments in pharmaceuticals and detection. Advances in Breast Cancer Treatments

Breast Health Understanding Your Breast Health is the first step in being breast-aware and knowing your body so that you can proactively advocate for yourself when you sense that something is not quite right. Despite how well we eat, exercise, and maintain a healthy life-style, it is still possible to develop breast cancer. This information serves as strategies to empower you and reduce the risk of developing breast cancer. If you develop breast caner, know that it is not your fault. The founder of Surviving Breast Cancer was a vegetarian since the age of 16 later to become a vegan. Out of the blue she was diagnosed with breast cancer at the young age of 34. We don't have all of the answers nor know why some people get breast cancer while others do not. What we do know are tools we can use to be breast aware, get screened, and understand our family history. >

Looking for a distraction from treatment? Join our Breast Cancer Book Club for great reads and greater support from other breast cancer patients and survivors. Breast Cancer Book Club Where we read books that have nothing to do with cancer! Our Current Book Pick of the Month Hidden in Plain View: A Secret Story of Quilts and the Underground Railroad by Jacqueline L. Tobin Upcoming Events Multiple Dates Breast Cancer Book Club – A Monthly Escape Into Stories, Connection, and Joy Sun, Feb 01 Zoom Meetings More info RSVP Multiple Dates Breast Cancer Book Club – A Monthly Escape Into Stories, Connection, and Joy Sun, Mar 01 Zoom Meetings More info RSVP The Breast Cancer Book Club™ is a monthly virtual book club for breast cancer patients and survivors. Unlike the traditional support group, where breast cancer is the usual topic of discussion, this book club is designed to take our minds OFF of cancer, while still providing opportunities for support and connection! When do we meet? The Book Club meets the first Sunday of every month at 11 am ET. You are welcome to join each month or pick and choose your month based on your availability and the book we are reading. How do I know what book to read? During our Sunday virtual Book Club, we will announce the next book the group will be reading. Once announced, the information will be published on our website. You can purchase the book and join the discussion the following month. Membership Membership is free! Those who join the Breast Cancer Book Club™ are encouraged to follow our Instagram Account as well as get involved in the weekly discussions through our private online group. Who are the moderators? Our Breast Cancer Book Club™ is spearheaded by Dr. Jandie Schwartz, D.O. , Fellow Breast Surgical Oncology, University of Pittsburgh Medical Center (UPMC) and is supported by Dr. Carole Weaver, Ph. D. and best selling Author as well as the team at Survivingbreastcancer.org How do I sign up ? It's easy! Each month, we will have that month's book club published on our Event's Page . Just RSVP and you will receive the zoom link to attend the meeting. Support Our Book Club! Your donation enables us to provide books to those diagnosed with breast cancer at no cost to the patient. We firmly believe in access to services and resources and breaking down those financial barriers. thank you for your support. DONATE TO THE BOOK CLUB Join the Breast Cancer Book Club Community~ Membership FREE Come Join Us The First Sunday of Every Month at 11 AM ET June 2025: A Good Girl’s Guide to Murder by Holly Jackson May 2025: The Let Them Theory by Mel Robbins April 2025: A Walk in the Woods by Bill Bryson March 2025: Empire of Shadows by Jacquelyn Benson February 2025: 101 Essays that will change the way you think, by Brianna Wiest January 2025: The Courage to Be Disliked: The Japanese Phenomenon That Shows You How to Change Your Life and Achieve Real Happiness November 2024: Migrations by Charlotte McConaghy October 2024: Heartland by Sarah Smash. September2024: Murder Your Employer by Rupert Holmes JAugust 2024: Happy Place by Emily Henry July 2024: Still Life by Louise Penny June 2024: The Main Character by Jaclyn Goldis May 2024: None of this is True by Lisa Jewell April 2024: The Women by Kristin Hannah March 2024: Trust, by Hernan Diaz February 2024: Romantic Comedy by Curtis Sittenfeld January 2024: Remarkably Bright Creatures by Shelby Van Pelt December 2023: Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones by James Clear November 2023: West With Giraffes by Lynda Rutledge. October 2023: Sisters: A Novel by Daisy Jonshon September 2023: Group: How One Therapist and a Circle of Strangers Saved My Life August 2023: One Italian Summer: A Novel by Rebecca Serle July 2023: Everyone in My Family Has Killed Someone: A Novel by Benjamin Stevenson June 2023: The Paper Palace: A Novel by Miranda Cowley Heller May 2023: Lessons in Chemistry, by Bonnie Garmus April 2023: American Spy by Lauren Wilkerson March 2023: Somebody’s Daughter by Ashley C. Ford February 2023: Our Missing Hearts, by Celeste Ng January 2023: Atlas of the Heart A Novel by Celeste Ng December 2022: Atlas of the Heart, by Brené Brown November 2022: It All Comes Back to You, by Beth Duke October 2022: The Maid by Nita Prose September 2022: The Twentieth Wife, by Indu Sundaresan August 2022: The Reading List, by Sara Nisha Adams July 2022: All's Well, by Mona Awad June 2022: The Mists of Avalon, by Marion Zimmer Bradley May 2022: The Lions of Fifth Avenue, by Fiona Davis April 2022: The Push, by Ashley Audrain March 2022: A Woman of No Importance, by Sonia Purnell February 2022: The Spanish Love Deception, by Elena Armas January 2022: Algorithms to Live By: The Computer Science of Human Decisions, by Brian Christian December 2021 The Last Thing he Told Me by Laura Dave November 2021: Life is So Good October 2021: Life Is So Good, by George Dawson and Richard Glaubman September 2021: The Flatshare, by Beth O'Leary August 2021: Quiet: The Power of Introverts in a World That Can’t Stop Talking, by Susan Cain July 2021: The Nightingale, by Kristin Hannah June 2021: The Vanishing Half, by Brit Bennett May 2021: A Man Called Ove, by Fredrik Backman April 2021: American Dirt, by Jeanine Cummins March 2021: Is This Anything, by Jerry Seinfeld February 2021: The Red Tent, by Anita Diamant January 2021: Joyful, by Ingrid Fetell Lee December 2020: Where the Crawdads Sing, by Delia Owens November 2020: A Most Beautiful Thing, by Arshay Cooper November 2020: A Most Beautiful Thing, by Arshay Cooper Breast Cancer Book Club™ List Pick Your Own Book

Surviving Breast Cancer believes in the healing power of movement. Enjoy free movement classes to help manage the physical and mental effects of breast cancer. Movement Days Creative and expressive movement, in the form of mind, body, and spirit exploration, holds the power to heal. Survivingbreastcancer.org offers free, monthly, online classes in restorative yoga, yoga for breast cancer, and Zumba. Enjoy weekly guided meditation, breathwork, and other mindfulness practices, as well as monthly expressive writing and art therapy workshops. All are welcome, including caregivers and supporters of those diagnosed. Move your body and mind with us every Movement Monday! Attend an Event Multiple Dates Restorative Yoga: A Monthly Journey Into Calm, Comfort & Inner Healing Mon, Jan 19 Online Event More info RSVP Multiple Dates Pilates for Breast Cancer Recovery Fri, Jan 30 Online Event More info RSVP Multiple Dates Pilates for Breast Cancer Recovery Fri, Feb 06 Online Event More info RSVP Multiple Dates Yoga Stretching for DIEP Flap Tue, Feb 10 Online Event More info RSVP Multiple Dates Restorative Yoga: A Monthly Journey Into Calm, Comfort & Inner Healing Mon, Feb 16 Online Event More info RSVP Multiple Dates Yoga Stretching for DIEP Flap Tue, Mar 10 Online Event More info RSVP Multiple Dates Restorative Yoga: A Monthly Journey Into Calm, Comfort & Inner Healing Mon, Mar 16 Online Event More info RSVP Achieving Growth SBC On Demand Classes Have access to our programs anytime, anywhere Heal & Move: Gentle Qigong for Breast Cancer Recovery This supportive class uses gentle movements & breathwork to promote healing, manage side effects, & find inner peace during breast cancer recovery. Suitable for all levels. Breast Cancer Recovery Yoga: Gentle Poses with Chair Support (Improves Flexibility & Reduces Lymphedema) This restorative yoga class is designed specifically for breast cancer patients and survivors. Join certified instructor Kim O´Brien for a gentle sequence of poses using a chair for added comfort and support. Pilates Snack Short on Time? Try an Exercise Snack! In our fast-paced lives, carving out time for fitness can feel overwhelming. But staying active doesn't have to mean hour-long workouts or trips to the gym. With exercise snacks—quick, low-impact movement breaks you can do anytime, anywhere—you can boost your energy, improve circulation, and support your overall wellness. Whether you're managing fatigue from breast cancer treatment or just juggling a busy schedule, these short bursts of movement make it easier to stay consistent with your physical health goals. DIEP flap Yoga Restorative Yoga Pilates Multiple Dates Restorative Yoga: A Monthly Journey Into Calm, Comfort & Inner Healing Mon, Jan 19 Online Event Step into a space of deep relaxation and gentle healing with our Restorative Yoga class, offered year-round by SurvivingBreastCancer.org. Designed for all experience levels, this cozy, nurturing practice invites you to slow down, breathe deeply, and reconnect with your body. +19 more RSVP Multiple Dates Pilates for Breast Cancer Recovery Fri, Jan 30 Online Event Did you know that Pilates can specifically address post-surgical tightness and lymphatic health? From restoring range of motion after a mastectomy to strengthening the "powerhouse" following flap reconstruction, Pilates offers a low-impact solution to post-treatment side effects. See All RSVP Multiple Dates Pilates for Breast Cancer Recovery Fri, Feb 06 Online Event Did you know that Pilates can specifically address post-surgical tightness and lymphatic health? From restoring range of motion after a mastectomy to strengthening the "powerhouse" following flap reconstruction, Pilates offers a low-impact solution to post-treatment side effects. RSVP Multiple Dates Yoga Stretching for DIEP Flap Tue, Feb 10 Online Event Join us for our Online DIEP Flap Yoga Classes, a gentle, supportive, and guided movement series created specifically for individuals preparing for or recovering from DIEP flap breast reconstruction surgery. See All RSVP Multiple Dates Restorative Yoga: A Monthly Journey Into Calm, Comfort & Inner Healing Mon, Feb 16 Online Event Step into a space of deep relaxation and gentle healing with our Restorative Yoga class, offered year-round by SurvivingBreastCancer.org. Designed for all experience levels, this cozy, nurturing practice invites you to slow down, breathe deeply, and reconnect with your body. See All RSVP Multiple Dates Yoga Stretching for DIEP Flap Tue, Mar 10 Online Event Join us for our Online DIEP Flap Yoga Classes, a gentle, supportive, and guided movement series created specifically for individuals preparing for or recovering from DIEP flap breast reconstruction surgery. See All RSVP Multiple Dates Restorative Yoga: A Monthly Journey Into Calm, Comfort & Inner Healing Mon, Mar 16 Online Event Step into a space of deep relaxation and gentle healing with our Restorative Yoga class, offered year-round by SurvivingBreastCancer.org. Designed for all experience levels, this cozy, nurturing practice invites you to slow down, breathe deeply, and reconnect with your body. RSVP Articles 1 2 3 4 5 Email info @survivingbreastcancer.org with your background, interests, and class offerings. Interested in Becoming a Movement Instructor?

Surviving Breast Cancer offers guidance on sex after breast cancer, helping survivors navigate intimacy, relationships, and emotional healing. Breast Cancer & Intimacy Sex After Breast Cancer In a previous blog and podcast we opined on the difficulties of maintaining relationships with loved ones, family, spouses, partners, etc. following a breast cancer diagnosis. Now we look at the adversarial effects of breast cancer towards sexual intimacy. Many, although not all, women find that breast cancer treatment, I.e. surgery, radiation, chemotherapy, estrogen eliminating hormonal therapy, severely hampers intimate sexual relations. Poor self image, physical exhaustion, painful treatment, and emotional distress all tend to weigh in negatively regarding sex drive. But overall recovery from breast cancer is partially dependent on overcoming the above referenced issues and participating in warm loving sexual acts. Sex can thus play a pivotal role. As we have mentioned in previous posts, single women who have been diagnosed worry how breast cancer will affect their relationship prospects, and also about how and when to tell those prospective lovers about their condition. The most uncomfortable stuff to talk about is probably your sex life and the changes that have taken place with your illness. You may not know what needs fixing or how to fix it, but you know things are different. Many women report having less sex than before their illness, for several reasons: • The breast cancer experience slows down your body. It takes longer to do lots of things, including getting interested in and starting and finishing sexual intercourse. • Sex may be uncomfortable or even painful if you've been thrown into sudden onset menopause. No surprise that you tend to have less sex, for now. Many women may have had little or no sex from the time of diagnosis through treatment. Most people have wild ideas about what goes on in other people's bedrooms. Give yourself a break: The carefully researched book Sex in America (by Michael, Gagnon, Laumann, and Kolata) tells us that Americans have a lot less sex than the movies, television, and the guys in the locker room would have you believe. The averages reported in that book are: • seven times a month between ages 30 and 40 • six times a month between ages 40 and 50 • five times a month between ages 50 and 60 For people over 60, the numbers continue to decline. But although you may assume that no one in their 70s and 80s has a sex life, that's just not so. Don't let the myths about other people's sex lives get in the way of what's happening in yours. And remember that there are exceptions to every pattern. If your sex life is not working the way you want it to, your doctor or nurse may be able to referee these issues with your partner and you. You can cue your doctor in advance, since he or she has most likely already touched on delicate issues with you. Maybe he or she can be the tour guide for the two of you. If your partner is there when you talk with the doctor who's managing your care, you and your partner both get a chance to air and dispel fears, and replace myths and false information with facts. Help from a pro Not all doctors and nurses are comfortable discussing sexual issues and practices. Most doctors don't routinely ask about your sex life. And patients don't usually begin to discuss their love life with a doctor who hasn't mentioned it. Nobody's talking! Someone has to break the pattern. A trained social worker, sex therapist, psychologist, or psychiatrist can help you open up communication with your partner and get around to talking about intimacy and sex issues. A support group may be more helpful than you might realize. Women in these groups often share advice that extends to the bedroom, including ways to increase sexual pleasure that are explicit and specific for women who've had breast cancer. Meeting needs in other ways Most marriages have problems that don't get fixed. Marriage is a package deal, and in marriages that work, the good things outweigh the bad. But as a survivor, you may find that breast cancer highlights the problems in your marriage. Can you live with those problems? Can you enjoy your marriage even as you contemplate what's missing? Can you capture the missing pieces in other ways? Give serious thought to your needs and how to meet them. Other ways to meet your needs: • Fantasy can enrich your life. Countless women read to fill the vacuum (romance novels are enormously popular). • Join a book club, a church or synagogue, or a group that meets to discuss investments, movies, or local politics. • Do more with individual friends, like walking, shopping ("retail therapy"), or travel. • Make a bigger deal of birthdays and anniversaries. • Expand your involvement in community or spiritual activities. • Get politically active in the breast cancer movement: camaraderie for a cause close to your heart. Having a serious illness almost always takes some kind of toll on your sex life. But breast cancer can bring all thoughts of intimacy and sexuality to a screeching halt. Treatments can bring on temporary -- and sometimes permanent -- premature menopause, making intercourse painful. Chemotherapy and radiation often lead to crushing fatigue. You may want to stay in bed, but you don’t want to use it for anything but sleep. The medications you take, as well as the emotional effects of the disease, can lead to depression. And of course, from the changes wrought by surgery to the hair loss and puffiness of chemotherapy, breast cancer can have a devastating effect on your body image and your ability to feel sexy. The sexual side effects of breast cancer can linger long after treatment stops. A 2007 follow-up report on young breast cancer survivors, conducted by researchers at the University of California-Berkeley, found that some women reported persistent sexual difficulties five years after their treatment had ended. And according to the National Cancer Institute, about one out of every two women who’ve undergone breast cancer treatment experiences long-term sexual dysfunction. That’s the bad news. But the good news is there is sex after breast cancer! > Sex and self-image Breast cancer changes the way you see your body. “Women sometimes feel very disconnected from their bodies when they go through this,” says Jean Carter, PhD. Carter is a licensed psychologist and the sexual health counselor for the sexual health program at Memorial Sloan-Kettering Cancer Center. “Your body’s been through so much and it’s worked to get well,” she says. ”But there have been sacrifices.” One thing you need to know early on is that your partner still finds you attractive and desirable. That’s rough on the days when you look in the mirror and can’t imagine ever feeling sexy again, much less looking sexy to someone else. It’s important to prepare yourself and your partner for what you’ll see. If you haven’t yet had surgery, ask your breast center if they have photographs of women after the kind of surgery you’ll undergo. Look at them with your partner and talk about what to expect. There's no denying that the sexual side effects of breast cancer can linger long after treatment is over, but there is sex after breast cancer. Lumpectomies, Mastectomies, Breast Reconstructions and Thoughts on Body Image. It was created by women in a cancer survivors’ group at Penn State. “The way your partner looks at your incision for the first time,” says Lillie Shockney, RN, “you’ll remember that forever.” Shockney is administrative director of the Johns Hopkins Breast Center and a breast cancer survivor herself. “If he has no clue what to expect and has a puzzled look on his face, the woman may interpret it as ‘He thinks I’m ugly, he thinks this is awful.’ Showing photographs can take the surprise away.” Communication is important. Talk with your partner about what you’re comfortable with, and what you’re not. “Both partners may be waiting for the other one to make the first move,” says Shockney. “She’s waiting for him to tell her he wants sex, and he’s waiting for her to touch him.” Your partner may be afraid of hurting you, or afraid that you’ll think he’s pushing you to have sex when you’re not ready simply by asking about it. If your breasts were major erogenous zones for you before surgery, you may be feeling particularly bereft after a mastectomy or even a lumpectomy . Shockney suggests taking the pressure off by exploring and discovering other areas of your body, rather than trying to “force it” in areas where you still have performance or body image issues. “For some women, the diminished arousal in areas of a newly constructed breast or scar tissue might serve as a painful reminder that their sex life has changed,” Shockney says. Instead, think of areas like shoulders, ears, and knees as new hot spots for intimate touch. If you’re still not comfortable with your new body, that’s what lingerie is for! There’s nothing wrong with getting a little help. A soft, satin nightie can be sexy and arousing. At the same time, it can help to conceal areas you’re still shy about. Or you can get even more creative. “I asked a patient to try using a feather boa to help her feel sexy, and at the same time keep her scars from being so evident. She loves it!” says Shockney. “It’s all about finding what you’re comfortable with.” Coping with changes But even as you get comfortable with the “new you” in the mirror, other parts of your body may be causing you problems in the bedroom. You may go through temporary menopause because of chemotherapy. Or if you have estrogen-receptor positive breast cancer, you may be taking hormonal therapy that can leave you in a menopausal state for years. The resulting vaginal dryness and other symptoms may make it painful to even think about having sex. “A lot of women I see are afraid to have sex,” Carter tells WebMD. “They’re really struggling. And it’s a shame, because there are wonderful, simple strategies to improve your sexual experience that, taken together, can work wonders.” Vaginal moisturizers. These aren’t lubricants, which are meant to be used during sex. Instead, they’re like the moisturizers you use on your face and hands, to benefit the tissues themselves. “They’re introduced as a suppository into the vagina adding moisture back into the vaginal space and giving it that natural elasticity,” says Carter. “It’s meant to be absorbed, and it helps the vagina to have more health and moisture for several days.” Lubricants. You definitely still want a lubricant for use during intercourse, says Carter. But lubricants should be combined with regular, ongoing use of vaginal moisturizers for best results. “If you’re feeling a rubbing or burning sensation during intercourse,” Carter says, “you don’t have enough lubrication. If it’s a stretching , painful sensation like the skin is going to split, you don’t have enough moisture.” Exercises. The classic Kegel exercises -- tightening and releasing the sphincter muscle as you do when you urinate -- that so many women use during pregnancy are also great for making intercourse easier. “If intercourse has been painful,” Carter says, “you may tighten up in anticipation of the pain. If you do Kegels right before intimacy , you fatigue the vaginal muscles and it is more open.” Vaginal dilators. A sex therapist, like Dr. Carter, can teach you how to use these dilators, which help gently stretch the vaginal tissue. Over and over again,” Carter says, “I’ve seen women who are completely hormonally deprived be able to have comfortable, enjoyable intimacy by using these strategies. A lot of the time, it’s so easy to fix. It astonishes me how often women come into my office and ask, ‘Why didn’t anyone tell me this? Shockney advises her patients to shake up their previous sexual habits. She tells them they may have been a silent player in bed before. But now she wants them to speak up. She tells them, “Say, ‘This feels good. This doesn’t feel good.’ Don’t rely on grunting for him to figure it out. That’s not the best way to communicate.” She also tells her patients, “If you’ve never watched an x-rated movie, try one -- just one. It may jump-start things, and you’ll be amazed at how active you’ll become. Or try various sex toys. So what if you never did these things before. You never had breast cancer before, either! I’ve had women come to me and say ‘I thought my sex life was great before, and then I thought I was going to lose it. But now it’s better than ever. TOPICS COVERED IN THIS EPISODE -People who refuse aspects of therapy including radiation. -What to expect when going in for radiation-Planning appointment -What is radiation and why would I need it? -Radiation and skin care -Proton Beam Radiation (the science behind protons; a number of clinical trials exploring proton beam radiation in the breast cancer community to minimize cardiac toxicity). -Risks association with radiation, but we still sign the consent. As a young breast cancer survivor, I ask Dr. Jimenez to explain the 10, 20 and 50 year plan for women who go through treatment. HEALTH RISKS -Cardiac toxicity -Field of cardio oncology partners and have mapped out the ideal -Herceptin and anthracyclines. After 5 years of survivorship, you should have a cardiac stress test. -Getting a baseline with an ultrasound of the heart so if there are changes, doctors can track them. -Our job (in Radiation Oncology) in follow up is to open up and make sure that referrals are made. How is your nutrition? Are you exercising? Did you schedule your next mammogram? QUOTES: "Your providers are your providers for life". "You are never a bother, it is our job and privilege to take care of you! " What's the Difference between Diet and Nutrition? On Breast Cancer Conversations, the Podcast Listen Now Looking for more ways to support your healing journey? View Programs

Breast cancer reconstruction surgery poses many questions and concerns for patients. Discover information on life-saving surgical options for breast cancer. Surgery Options Questions to ask your Surgeon Download PDF What should I expect during a consultation for breast reconstruction? During your breast reconstruction consultation, be prepared to discuss: Your surgical goals Medical conditions, drug allergies and medical treatments Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use Previous surgeries Your plastic surgeon will also: Evaluate your general health status and any pre-existing health conditions or risk factors Examine your breasts and take measurements of their size and shape, skin quality and placement of nipples and areolae Take photographs Discuss your options and recommend a course of treatment Discuss likely outcomes of breast reconstruction and any risks or potential complications Be sure to ask your plastic surgeon questions. It's very important to understand all aspects of your breast reconstruction. To help, we have prepared a checklist of questions to ask your breast reconstruction surgeon that you can take with you to your consultation. It's natural to feel some anxiety, whether it's excitement for your anticipated new look or a bit of preoperative stress. Don't be shy about discussing these feelings with your plastic surgeon. What options are available for breast reconstruction? If you've decided to have breast reconstruction, you'll still have many things to think about as you and your doctors talk about what type of reconstruction might be best for you. There are many different reconstruction techniques available. Take the time to learn about the breast reconstruction options and consider talking to others who have had that procedure before you make a decision. Breast reconstruction with implants Implant-based breast reconstruction may be possible if the mastectomy or radiation therapy have left sufficient tissue on the chest wall to cover and support a breast implant. For patients with insufficient tissue on the chest wall, or for those who don't desire implants, breast reconstruction will require a flap technique (also known as autologous reconstruction). The most common method of tissue reconstruction uses lower abdominal skin and fat to create a breast shape. There are several techniques that can be used for implant-based breast reconstruction. Make sure to discuss with your plastic surgeon which is appropriate for you. Immediate breast reconstruction above the pectoral muscle This procedure is performed in combination with the mastectomy and results in an immediate breast mound. After the mastectomy has been performed by the breast surgeon, the plastic surgeon will place the breast implant, wrapped in a biological mesh known as acellular dermal matrix (ADM), to help the implant maintain correct anatomic position, above the pectoralis muscle. With this procedure, recuperation may be more rapid because the muscle in the chest has not been elevated. Further, the breast implant itself is not influenced by the contraction of the muscle. Complications, while rare, may include skin loss, excess bleeding, infection, malposition of the implant so that asymmetry occurs, wrinkling or rippling of the implant, possible fluid collection underneath the implant and/or unfavorable scarring. This procedure may also require secondary autologous fat transfer to eliminate upper pole wrinkling and rippling over time, which will occur over secondary procedures. Immediate breast reconstruction under the pectoral muscle This procedure is also performed as a combination with the mastectomy and results in an immediate breast mound. The incision generally is performed through the mastectomy site. Once the mastectomy is completed, the plastic surgeon will elevate the pectoralis major muscle. This will allow the muscle to retract upward and allow a pocket to be developed underneath the muscle and at the bottom of the normal breast position. Delayed breast reconstruction utilizing tissue expander. The initial portion of this procedure entails the breast surgeon performing a standard mastectomy and possible axillary dissection. In many instances, a drain will be placed between the muscle and the skin of the mastectomy. Once these procedures have been performed, the plastic surgeon will divide the lower pole of the chest wall muscle, elevate the chest wall muscle and the lateral chest muscle together upwards towards the collarbone. After that is done, the muscle and tissue below is elevated together to form the pocket for the breast expander at the base of the breast or the inframammary crease. The pocket is made large enough for the expander to be placed and the muscle closed. Occasionally, there is a need for placement of a small amount of acellular dermal matrix (ADM) to assist in the closure of the muscle. There are two types of breast tissue expander ports. One, similar to a chemotherapy port, is placed separate from the tissue expander, usually along the rib cage. This will require a separate small incision for the port. The second type is a port that is contained within the expander itself. In both instances, the ports will be used to inflate the tissue expander over several visits with saline solution. The port is accessed with a small needle and saline is injected into the expander through the port site Tissue expansion usually occurs weekly according to patient tolerance. The volume of the tissue expanders commonly exceeds the weight of the mastectomy tissue. Once the final tissue expansion, or stretching, is completed there will be a time of passive expansion where little to no volume is added to the tissue expanders. This allows the muscle and skin to stretch and relax. The length of time will vary from patient to patient. Once this is completed, a second outpatient procedure will be necessary to remove the tissue expander and place the permanent breast prosthesis. Complications, while rare, may include skin loss, exposure of the expander, excess bleeding, infection, malposition of the implant so that asymmetry occurs, wrinkling or rippling of the implant, possible fluid collection underneath the implant, pain at the injection site, muscle spasms with expansion and/or unfavorable scarring. Lymphedema 101 On Breast Cancer Conversations, the Podcast Listen Now A biodegradable acellular dermal matrix (ADM) will be placed at the bottom of the breast or inframammary crease and attached to the muscle. The breast implant will be placed under the ADM and your own muscle. This allows the breast implant to settle in a normal position, and the ADM stretches into a pleasing, rounded lower breast shape. It is not uncommon to have drains placed with this procedure. They may be removed anywhere from 48 hours to 2 weeks after surgery. This procedure is a one-staged procedure, which allows the desired shape to result without any further surgical intervention. The muscle on top of the implant will help prevent the development of upper pole wrinkling. Complications, while rare, may include skin loss, excess bleeding, infection, malposition of the breast implant so that asymmetry occurs, wrinkling or rippling of the implant, possible fluid collection underneath the implant and/or prosthesis deflation. Immediate breast tissue expander placement The surgical process for saline breast tissue expanders and breast expanders following mastectomy are the same. Expanders with saline have been used for decades but recently, a new type of expander using air, which allows for more patient control, have been introduced. Expanders have some of the same complication rates and risks as the other types of breast reconstruction, which include infection, seroma, hematoma, extrusion and/or expander deflation. The expander is placed into a submuscular or subcutaneous space with no external filling ability. The expander will fill with compressed air contained within the expander itself. The patient will do self-controlled expander fills utilizing an external automatic activation device at home and will achieve similar results to the standard saline filled tissue expansion devices. It will be necessary to monitor the incisions and progress on your own and contact the physician if you feel there is something wrong. The advantage of the expander it that it may decrease doctor visits and decrease total expansion time. Immediate breast reconstruction utilizing latissimus dorsi muscle. This procedure is performed as a secondary operation immediately during the mastectomy or delayed after radiation. The latissimus muscle is a very large vascular muscle in the back that is attached at the base of the arm, extends onto the chest from the arm past the shoulder blade and attaches close to the spinal column. The latissimus muscle stretches to the tip bone and hallway into the axilla or armpit area and is supplied mostly by artery in the axilla. The latissimus flap is frequently used when the amount of soft tissue is limited secondary to surgery, the pectoralis muscle is absent, partially removed or damaged secondary to radiation. It entails undermining the skin on the back and releasing some of the skin allowing it to remain attached to the muscle. The main muscle and artery is called pedicle flap. This flap is released from the back, passed through a tunnel that is made underneath the axilla and into the anterior chest to fill the mastectomy defect site. The muscle is placed and sutured to the chest wall. An implant is then placed behind this flap and in front of the chest. One can also use a tissue expander and gradually increase to breast size. The advantage to this expander is it can completely replace the amount of breast tissue that has been removed and protect the latissimus flap. A completely inflated implant or a postoperative adjustable expander/implant can be immediately placed. It is not uncommon to require a secondary revision procedure to gain more accurate symmetry of both breasts. The latissimus flap is recommended for patients who have already had mastectomy and radiation. The use of radiation frequently limits the amount of implant surgery that can be performed. The secondary advantage of this flap is that it brings new blood flow and healthy skin to the radiated field. It is also recommended for patients who are very thin and have limited options for flap reconstruction. Complications, while rare, may include limited blood flow of the artery compromising the flap, skin loss, exposure of the expander, excess bleeding, infection, malposition of the implant so that asymmetry occurs, wrinkling or rippling of the implant, possible fluid collection underneath the implant, pain at the injection site, muscle spasms with expansion and/or unfavorable scarring. Breast reconstruction with abdominal-based flaps Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. In these cases, breast reconstruction usually requires a flap technique (also known as autologous reconstruction). This is the most common method of tissue reconstruction, using lower abdominal skin and fat to create a breast shape. A woman may also choose not to have an implant for personal reasons. The skin and fat used for this procedure is the tissue between your belly button and pubic bone that you can pinch. Once this tissue is taken to make a breast, you will typically have a scar from hip bone to hip bone and around your belly button. However, some women may not be candidates for abdominal-based flaps for various reasons: • Not enough donor tissue in the lower abdomen • Prior scars that may have damaged important blood vessels • Previous flaps that have failed and seeking an alternative Specific flap options Several different flaps use the tissue from the lower abdomen. The difference between each of them is related to blood vessels that supply these flaps. These flaps include the Pedicled TRAM (traverse rectus myocutaneous) flap, the free TRAM flap, the DIEP (deep inferior epigastric artery perforator) flap and the SIEA (superficial epigastric artery) flap. Pedicled TRAM flap A TRAM flap uses the muscle, fat and skin from your lower abdomen to reconstruct a breast. In order to survive on your chest in its new location, this tissue requires a blood supply. The blood supply to this tissue comes from the underlying rectus (six-pack) muscle. The flap remains attached to your rectus abdominis muscle and is tunneled up through the abdomen and chest to create the breast mound. Since your entire muscle is sacrificed, you may experience some abdominal weakness or have difficulty performing sit-ups. Free TRAM flap Like the TRAM flap, the free TRAM flap is also based on the blood vessels coming through the rectus abdominis muscle. However, in this flap the muscle above and below the blood vessels is divided, so that only a portion of muscle is removed. The entire flap is then transplanted to the chest. The blood vessels from the muscle are connected to blood vessels in the chest using a microscope. DIEP flap The DIEP flap utilizes the same lower abdominal skin and fat as the TRAM and free TRAM flap; however, it spares the rectus abdominis muscle and fascia. Rather than taking the entire muscle or a small portion of the muscle, the small blood vessels – an artery and a vein – that come through the muscle to the skin and fat are identified; these vessels are then dissected through the muscle prior to being divided. Once they are divided, the tissue is again transplanted to the chest and the vessels are connected to blood vessels in the chest. Since your muscle is preserved, there is a lower risk of abdominal weakness or hernias and less postoperative pain. SIEA flap The SIEA flap also uses the lower abdominal skin and tissue, but the blood vessels that supply this flap do not go through the abdominal muscle. Rather, they only go through the fat. Advantages of this flap include preservation of the abdominal muscles, resulting in less postoperative pain and a speedier recovery. However, these blood vessels may not be present in all women; and even when present, may be too small to provide a reliable blood supply for a flap. For these reasons, the SIEA flap is not performed as frequently as the DIEP or free TRAM flaps. Special notes regarding recovery Because the free TRAM, DIEP and SIEA flaps involve microsurgical tissue transfer, blood flow to the flap is closely monitored in a hospital setting after surgery. If there are concerns about the flap, a reoperation may be necessary to assess the blood flow. Breast reconstruction with thigh-based flaps Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. In these cases, breast reconstruction usually requires a flap technique (also known as autologous reconstruction). Thigh-based flaps may be a good option for women with small to medium volume breasts. To achieve a larger size, these flaps may be combined with an implant or another flap (called "stacked flaps," which are not widely available). All of these techniques require your plastic surgeon to have skill and training in microsurgery. However, some women may not be candidates for thigh-based flaps for various reasons: • Not enough donor tissue in the upper thighs • Prior scars that may have damaged important blood vessels • Previous flaps have failed and they are seeking an alternative Specific flap options Gracilis-based flaps are based on the gracilis muscle, located in the upper inner thigh. The gracilis muscle helps bring the leg toward the body, and its function will be lost after this type of surgery. During these procedures, a flap of skin, fat, muscle and blood vessels from the upper thigh is moved to the chest to rebuild the breast. Blood vessels are carefully reattached using microsurgery. Different names are used to describe the orientation of the resulting donor site incision on the upper inner thigh: • TUG flap: Transverse Upper Gracilis flap • VUG flap: Vertical Upper Gracilis flap • DUG flap: Diagonal Upper Gracilis flap The choice of incision depends on your unique thigh shape and your surgeon's experience. Most surgeons will try to conceal the scars in the crease at the top of the thigh, but the scar may end up a bit lower and be visible while wearing a bathing suit. These flaps result in a tighter inner thigh, similar to an inner thigh lift. Similar to the gracilis-based flaps, a PAP flap uses skin and fat from the back of the upper thigh to reconstruct the breast using microsurgery. PAP stands for Profunda Artery Perforator, which is a blood vessel that supplies this area of the thigh. No muscle is used, so a PAP flap is considered muscle-sparing. PAP flap scars are usually hidden in the crease between the lower buttock and upper thigh. Special notes regarding recovery Because these flaps involve microsurgical tissue transfer, blood flow to the flap is closely monitored in a hospital setting after surgery. If there are concerns about the flap, a reoperation may be necessary to assess the blood flow. Thigh-based flaps do tend to have more healing problems at the donor site than abdominal-based flaps due to the location of the incision. Lower leg swelling may occur but usually resolves with time. When one thigh-based flap is used to reconstruct one breast, asymmetry may result due to tightness and thinness of one thigh. Additional procedures may be recommended to improve symmetry between the thighs.

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