Physical Therapy after Breast Reconstruction
I had the honor and pleasure of interviewing my physical therapist, Leslie Drawdy, to discuss the value of physical therapy after breast reconstruction. Before I share the information we discussed I want to share my personal story and how I came to meet Leslie.
My breast surgeon, Dr. Michele Boyce Ley, advised that I begin physical therapy soon after the mastectomy that she successfully performed. I went in for a follow up appointment after healing post-surgery and told her of onset and new shoulder discomfort, especially when I was on my computer. Knowing how much time I spend on my computer she gave me a sheet of well-qualified physical therapists. I chose Leslie because she is a lymphedema specialist. Although I did not have lymphedema my thought was, who would know better about the lymphatic system and post breast cancer mastectomy patients? I hit a home run.
Not only was I impressed with her professionalism, expertise and knowledge, but our personalities meshed quite nicely. Added to that, my experience with her after my DIEP flap breast reconstruction is an even more interesting story. My plastic micro-surgeon, Dr. Minas Chrysopoulo, advised that I begin physical therapy as soon as I flew back home after my DIEP flap surgery. He told me this at my post op appointment when I was still in San Antonio. I was returning home in four short days after seeing him and I had a moment of panic when he used the word immediately.
How was I going to find a physical therapist to see immediately? I think he recognized my glazed look of panic and kindly offered to find one in my home town that he could recommend. Being tired and exhausted from the surgery lends itself well to being easily rattled. Of course, I wanted to find a top notch physical therapist after lying on the operating table for 9 hours to rebuild my breasts! They better know what they are doing before they touch what I then and still do consider a work of art, my new breasts, even in their bruised and healing state just two weeks out of surgery.
Light Bulb Moment Remembering my Physical Therapist
I paused, worked hard to clear my post op and very foggy head, looked at him, and remembered Leslie who I had seen just a few months prior to my DIEP flap breast reconstruction. It was a light bulb moment! I called her place of work immediately after my appointment and told her office administrator the type of surgery I just had. I could feel the amazement over the phone as I told her my story. She asked me to hold on, relayed my message to Leslie, and as Leslie told me with a huge grin during this interview, “I told her to clear a space on the calendar and GET HER IN!”
I flew home Sunday from San Antonio and arrived home early evening tired and exhausted. Our oldest son had arrived to help me with recovery for the week since our youngest son and my husband had to be at work all week. Richard, our oldest son, and I were at her office Monday morning at 7:30 a.m. for my first appointment. Do you have any doubts now about my confidence in this woman? Leslie has seen me through the entire process from mastectomy to breast reconstruction. This is actually a benefit of her work for many of her patients, too, and it certainly was the case for me. There’s our personal story. Now, on with the interview and information…
How do patients find a physical therapist for post breast reconstruction?
- Usually physicians, in this case plastics surgeons, will make a referral.
- Leslie suggests starting with a lymphedema therapist. They have the necessary skills for post mastectomy therapy and encompass all soft tissue techniques and issues plus they have the unique ability to work with cancer patients.
- When a plastic surgeon does not have a specific referral Leslie provided this website that patients can reference:
- CLT-LANA.org
Breconstruction and benefits of PT
The protocol and order of procedures varies between plastic surgeons but soft tissue is often affected, especially if the treatment plan has been in this order; mastectomy, radiation then implants. Depending on how long or deep the area of radiated skin has been treated, not only are there changes in skin but so are there potential changes in the muscle. The soft tissue on the radiated side tightens up more and is less elastic. This results in the soft tissue on the radiated side drawing up more than on the non-radiated side thereby creating unevenness and the drawing up of one side over the other.
The benefits of physical therapy in this instance are two-fold:
- It breaks up the scar tissue helping the body reabsorb excessive scar tissue.
- It helps the body remodel when tissue is mechanically disturbed in a controlled way. This happens by stimulating fibroblasts production which is basically how your body remodels that tissue.
Autologous (as in DIEP flap, using your own tissue) Reconstruction and benefits of PT
One point that Leslie emphasized is when a patient calls for post DIEP flap physical therapy and it has been ordered by the plastic surgeon it should be prioritized. She certainly followed through on that for me! Here are the key reasons:
- Scar adhesions are less likely to form
- The ultrasound physical therapy minimizes fat necrosis by increasing blood flow to tissue.
- It minimizes swelling in the abdominal area due to the hip to hip incisions from DIEP flap. It is worth noting that Leslie gave me take home instruction to continue these lymphatic draining exercises that I still use today. I jokingly told her that “blogging is bad for my belly”. If I sit too long at my computer, even one year out, I still get a bit of swelling. Lying down in bed at the end of the day and doing these exercises feels so good and is very beneficial. I encourage patients to discuss this with your PT at the time of your visit.
I asked Leslie to review the process and procedure for the readers. Here are the steps:
- Areas of restriction are assessed, that is, areas that might be “stuck” after surgery.
- A gel can be applied to the area or as is the case in Leslie’s office they use a new product that is shown in the photo. The gel pad is placed on the wand rather than the gel used from the bottle. I thought this was totally cool as I got the gel squirted on me from the bottle. I was fascinated and I liked this new product/advancement in physical therapy!
- An ultrasound “wand” is used on those areas to work the very superficial layer.
- Manual massage is then used to help break down the tissue at a deeper level. Again, Leslie showed me techniques to do this at home in between our visits. She used to tell me, “We need to get that skin ready for phase two and keep it pliable.”
Is there pain involved in Physical Therapy after Breast Reconstruction?
I can tell you my personal experience and also give you insight from Leslie. I wouldn’t describe it as pain but rather discomfort. However, there were times when she worked on my abdominal adhesions that came close to pain. They were deep and she has what I call “magic hands”. It was not fun while I was on the table but I always, yes always, felt better when I left her office.
Leslie pointed out that pain is variable. Each patient has their own tolerance level. Consider these points:
- There is always some level of discomfort with scar tissue and mobilization of sensitive areas. It is simply inevitable with this surgery.
- Pain can be greater when the abdominal scar is particularly deep or the skin unusually tight.
- Physical therapists have methods and tools to minimize the pain.
- Numbness is inevitable with this surgery but over time sensations and feeling return. Sometimes those sensations are the in the form of what some patients have described as “zingers, burning, or shooting pains”. It is important to have a conversation with your physical therapist to communicate these sensations because it helps your PT to discern what kind of pain it is and how she can address it through self-massage and stretching.
Conclusion and with Gratitude ~
The number of treatments needed for physical therapy after breast reconstruction varies but a good number to keep in mind is an average of 4-6 weeks, three times a week. Of course, and as always, please be sure to consult with your plastic surgeon about this. Not all plastic surgeons follow up with physical therapy after breast reconstruction but it’s worth having the conversation. My hope and advice to women is to always check to see if it is covered by insurance. Many times it is the case, but of course, this depends on your insurance provider.
Physical therapy after breast reconstruction and mastectomy has so many benefits. I want to personally thank Leslie who took time out of her very busy practice to sit down with me to have this interview. I encourage each of you who are considering breast reconstruction to discuss this important part of the process with your plastic surgeon to optimize your outcomes and healing.