What are the side effects of breast-sparing surgery? What about the side effects of radiation? I hear it makes the breast hard.

When considering what kind of surgery to have, it is important to know that there are potential side effects common to all surgical procedures. Any surgical procedure carries a risk of infection, poor wound healing, bleeding, or a reaction to the anesthesia. Also, pain and tenderness in the affected area is common, usually only in the short term. Because nerves may be injured or cut during surgery, most women will experience numbness and tingling in the chest, underarm, shoulder, and/or upper arm. Women who undergo breast-sparing surgery usually find these changes in sensation improve over 1 or 2 years, but they may never go away completely.
Radiation therapy can cause side effects, such as fatigue or skin irritation. These side effects tend to be mild. Radiation therapy can cause a skin condition that looks like sunburn. This usually fades, but in some women it never goes away completely. Some women do find that radiation makes their breast feel hard or firm. Again, this may last just a few months, or longer.
Removal of lymph nodes under the arms may be performed. This can lead to pain and arm swelling, called lymphedema, which can last a long time and be debilitating.
Keep in mind that the side effects of treatment vary for each person. Some women may have many side effects or complications, others may have very few. Pain medication, physical therapy, and other strategies can help women manage side effects and recovery.

I heard that radiation can cause cancer. Will it increase my risk for other cancers?

Radiation therapy has improved greatly through the years, and the doses are much lower than they used to be. The risk of another cancer due to radiation therapy to the breast is very small. The bottom line is that women who have radiation therapy after breast-sparing surgery are less likely to have cancer recur in the same breast, and they live just as long as women who undergo mastectomy without radiation.

If cancer recurs in the same breast after having breast-sparing surgery followed by radiation, will I need a mastectomy then? Will I be able to have breast reconstruction even though I have had radiation?

Cancer that recurs in the same breast usually is removed with surgery. Most often a mastectomy is performed at that time, because radiation is not recommended a second time. Breast reconstruction is possible after previous radiation therapy, but the surgery may be harder to perform. This issue should be discussed with a plastic surgeon.