Post-Mastectomy Physiotherapy

The word cancer is a scary one. Even though we all hope that it never becomes part of our lifetime of trials, more often than not, we know someone that has had or is currently dealing with cancer. It is a testament to the medical community that so many women are able to wear the pink ribbon as a sign of triumph and pride, but we still mourn with those that wear it as a sign of remembrance and loss.

More than once, while talking with women that have begun treatment for breast cancer, the topic of whether or not to have a mastectomy has come up. It’s not a decision taken lightly, often one with multiple concerns about what happens after surgery. A post-mastectomy physiotherapy program can help address some of these issues.

Physiotherapy can’t answer all of those questions, but one thing a physio program can do is aid in the overall recovery process by focusing on regaining strength, increasing the range of motion, decreasing pain and other symptoms (ie. edema or nerve symptoms) in your shoulder and arm. Early intervention by a physiotherapist can help women regain full function following mastectomy surgery, regardless of whether or not a woman has had reconstruction.

Rehabilitation is always tailored to each patient’s specific needs. Not every patient experiences the same recovery, and as such, physiotherapists are prepared to help patients experiencing a multitude of symptoms.

Size, location and the type of mastectomy are important considerations when choosing a type of treatment. Exercises to maintain shoulder range of motion and arm mobility may be prescribed as early as 24 hours after surgery. These exercises are important in restoring strength and promoting good circulation. As rehabilitation progresses these exercises may be modified to meet new goals.

In previous years, a complete removal of the breast or radical mastectomy was the standard treatment for all stages of breast cancer. Nowadays, depending on the age, menopausal status, cancer stage, and other factors, different types of mastectomy are tactically performed on the patient.

These types of mastectomy are the following:

• Radical mastectomy or complete removal of the entire breast

• Simple or total mastectomy which is the removal of the entire breast but leaving the lymph nodes intact.

• Modified radical mastectomy which removes the entire breast and the lymph nodes, but not including the chest muscles

• Partial mastectomy wherein the cancerous cells and the tissue surrounding them are the only ones removed

• Preventive mastectomy sometimes called prophylactic mastectomy, which is usually done to women who had a breast cancer on one breast, and as a matter of preventive cure, the other breast is also removed.

It is a common occurrence for women who have undergone the procedure to lose their mobility right after the surgery. They usually feel tightness in the chest which gives them pain. This situation can influence the look and shape of the implants in the end.

After mastectomy surgery, patients may experience tightness around the surgical site. This is caused by scar tissue formation. The result can be very dense tissue under the incision, which is painful and can restrict the range of motion. The restricted range of motion puts a woman at risk for a painful condition known as frozen shoulder. Early treatment by a physiotherapist can help reduce the pain and help regain functional range of motion and strength.

Numbness and/or nerve sensitivity at the surgical site (or radiating down the arm) can develop post-mastectomy. Manual therapy can help restore sensation and relieve nerve pain. In severe cases, a chronic condition known as post-mastectomy pain syndrome may develop. This is caused by scar tissue impinging on nerves. Physiotherapy can be very effective at releasing scar tissue and reducing this nerve-related pain.

Axillary node dissection can lead to a condition known as cording or axillary web syndrome. Cording presents as a moderate to painful tightening, which appears as “cords” emanating from the armpit and extending down the arm. Cording significantly restricts the range of motion and arm function. Manual therapy and therapeutic stretching help to resolve this condition quickly.

Radiation treatment after mastectomy surgery can exacerbate posture and range of motion problems, causing fibrosis and skin tightness. Manual therapy can remediate these issues and may prevent them from ever becoming a problem.

The benefits of exercise and physiotherapy post-mastectomy treatment programs can differ greatly as seen above, but there are a few effects that all patients can benefit from:

• Improved shoulder range of motion
• Improved shoulder strength
• Improved functional mobility
• Improved posture
• Decreased pain at the surgical site
• Decreased edema on the affected side
• Improved sensation at the surgical site

Meeting with a physiotherapist before surgery can help you feel more at ease and more confident in your overall recovery goals. It’s never too early to ask questions!