Venus de Limbo

Ancient depiction of lymphedema and frozen shoulder

You might think that a mastectomy is all about the boobs, but you’re wrong. Sure, the surgery takes them away, but that’s not all it removes: what a lot of people don’t realize is how much this operation — and other treatments for breast cancer — changes a woman’s arms.

For a mastectomy to be successful, it must involve the removal of all breast tissue, which is extensive, and includes not just the breast mounds themselves, but a swath of surrounding tissue as well. With this flesh goes important nerves which allow you to communicate with your arms — both for sensation and for movement.

A double (or bilateral) mastectomy effects both arms too. I awoke from mine unable to move either arm; a consequence I was either not warned would happen or was too distraught by the knowledge that I was having both breasts amputated to register. In any case, it was a surprise. I knew my recovery time would take a while and involve discomfort, but I hadn’t considered the practical ways having no use of my arms would impact my healing. I suspect the doctors downplay this element because it might put women off from having a life-saving surgery whose prospect is already emotional enough.

The immediate impact is stunning: to re-enter the world both breast-less and arm-less is to have had the entire upper half of your torso nullified. You can’t take care of your wounds, and you can’t make yourself look pretty to make up for it, either.

Eventually, the nerves (mostly) grew back, like a pair of robots slowly coming back online after a power-outage, and after a few months I had control over them again. The hands took a little longer, and today — nearly a decade after that operation — I still drop things, and have trouble typing without making a million mistakes. The backs of my arms remain numb, however: sometimes I’ll get a tingly itch in my side that no matter how much I scratch or rub, doesn’t go away: the nerves don’t register any touch.

But surgery isn’t the only assault breast cancer treatment has on arms. For a start, the veins are perforated regularly with the IVs for blood draws, chemo, shots and the like. If the treatment makes you lose weight, you could be mistaken for a junkie.

Many women will also have had a bunch of lymph nodes removed from their armpits along with that breast tissue. This is where the cancer cells will migrate if they feel like taking up residency elsewhere in your body, so they must be checked too. The trouble is that lymph nodes are really important parts of your anatomy, and they don’t grow back. Silicone implants and numb arms you can get used to: a lack of lymph nodes, not so much.

Author’s arm, pre-lymphedema and frozen shoulder

Simply using your arm produces fluids. If you sustain an injury requiring white blood cells to repair (a bug bite; a burn; a cut or scrape, say), a fluid traffic jam ensues. This condition is called lymphedema, and it sucks.

Another thing that can adversely affect how your arms work is radiation treatment. The radiation is itself painless; but the accumulated radiation you’re given a tiny dose at a time is designed to change your cells. The outward side effects are temporary — the burns go away — but the internal havoc wrecked upon your flesh and joints is harder to come to grips with. The radiation exposure itself will aggravate an arm predisposed to lymphedema. The joint stiffness (particularly of the shoulder) caused by tightening, contracting muscles and sockets causes inflammation and swelling which blocks what little lymph flow you do have to drain the arm as it joins the torso.

The lymphatic system serves as the body’s wait staff: bringing essential fluids to cells and removing them. The nodes are hubs: without them, the lymph pathways cannot perform their task. As a result, fluids collect and the effected limb swells. If this swelling is not relieved, over time the flesh will harden permanently.

Another unfortunate possibility facing women recovering from the trauma of breast cancer is the chance that one or more of their shoulders will lose flexibility altogether, reducing their ability to move their arm in any direction: this is aptly called “frozen shoulder.” Curiously, the oncology docs say this complication is rare; the shoulder surgeon says he sees it “a lot.”

Perhaps people think that if you survive cancer you have no right to complain about other, less life-threatening ailments. You dodged a bullet after all. What’s a little swelling when you’ve already been cut up and sewn back together?

A lot, as it happens.

I once had a student who truly thought that the Greeks sculpted women without arms deliberately, as if arms were too utilitarian for beauty.

There is life after cancer. You need your arms to live it. Look at poor Venus de Milo: she’s probably cold. If she had arms, she could pull that cloth up to cover herself. She’s the Goddess of Love and Beauty and still can’t catch a break. Her flesh has hardened into cliché.

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