PURPOSE: To determine whether and, to what extent, breast and arm symptoms are associated with sick leave (SL) shortly after breast cancer (BC) surgery, and to investigate the associations of these symptoms and different surgical procedures with SL, adjusting for age and work posture. Women (n = 511), aged 26-63 years, who worked ≥75% before a BC diagnosis, were included within 12 weeks of surgery. RESULTS: 31% reported breast symptoms and 22% arm symptoms; and, of these, 47% reported both. Having strenuous work postures increased the OR for being on SL most (OR 2.60), followed by breast symptoms (OR 2.40), more extensive axillary (OR 2.24) or breast surgery (OR 2.13), and arm symptoms (OR 2.06). CONCLUSIONS: Breast and arm symptoms are as strongly associated with being on SL as types of breast and/or axillary surgery. Early self-reported symptoms are important to consider in guidelines for SL and rehabilitation after BC surgery.