I feel extremely fortunate my breast surgeon and plastic surgeon both recommended physical therapy for me after the breast surgeries they performed on me. My breast surgeon, Dr. Michele Ley, prescribed it for me about six weeks after she completed a double mastectomy due to my second occurrence of breast cancer. Dr. Chrysopoulo, my plastic surgeon, prescribed it for me after my DIEP flap breast reconstruction. I hear from many women who have not had the same physical therapy opportunity I did. So, I encourage them to ask their surgeons, “Why Should I Ask About Physical Therapy After Breast Surgery?”
Physical Therapy after Mastectomy Surgery
I began experiencing shoulder pain about three to four weeks after my double mastectomy. I went in for a follow up appointment to my breast surgeon around the same time. The shoulder pain occurred mainly when I was on my computer. This was during a time I was doing a lot of research to find a plastic surgeon to perform my breast reconstruction. She immediately wrote a prescription for me to begin physical therapy. It helped immensely.
My physical therapist and I would chat during my sessions. I told her I was going to have DIEP flap breast reconstruction. This discussion resulted in a double benefit for me. Not only did she work on my range of motion in the shoulder area, but she began preparing my chest wall area for DIEP flap surgery. She taught me how to pull the skin up and release it from my chest wall to keep it pliable and ready to receive the skin flap for breast reconstruction.
Dr. C saw me at my follow up about a week and a half after he performed my DIEP flap surgery. Since I traveled for my breast reconstruction, he asked if I had a trusted certified lymphedema therapist to perform physical therapy when I returned home. I knew immediately who I was going to call since Leslie had performed my post mastectomy physical therapy.
What Impact Can Breast Surgery Have?
Dr. C points out in the video he feels physical therapy is underutilized for breast reconstruction and breast cancer patients in general. Here are some of the things he points out that can occur and be affected by breast surgery, axillary surgery, lymph node surgery, and whether you have reconstruction or not:
- Shoulder movement
- Loss of range of motion
- Swelling caused by the aftereffects of any surgery
- Formation of scar tissue
- Fat necrosis after breast reconstruction
What Physical Therapy Techniques Can be Utilized after Breast Surgery?
We continue our conversation in the video with Dr. C pointing out the various techniques and purpose of each one.
- Deep tissue massage can help break up scar tissue.
- Myofascial release can help release and encourage the correct movement of certain tissues within certain plains.
- Ultrasound helps by decreasing fluid accumulation, encouraging drainage
Dr. C points out some physical therapist are concerned about using ultrasound in a cancer patient because there is a fear you are encouraging new blood vessel formation thereby encourage a recurrence. He reminds us there is no data to support this so he doesn’t personally buy into this thinking but points out some may get a bit of resistance from physical therapist because of this concern.
How Can Patients Continue the Benefits of Physical Therapy after Breast Surgery?
From my own personal experience and listening to Dr. C, there seems to be a window of opportunity to improve several of the side effects of breast surgery through early intervention with physical therapy. If a patient waits to long, you miss the opportunity to potentially soften things up.
The fat necrosis rates at his practice have come down in part because of prescribing early intervention with physical therapy. It softens the firmness of the flap, helps with decreasing the swelling quicker, and definitely improves the range of motion. As one of his patients, this was all the case for me after my physical therapy post breast reconstruction.
Dr. Garza points out any self-massage performed by patients should be physician directed as each case is unique. Scars can take a full year to mature. He tells us determining optimal timing of self-massage can improve the swelling, thickness, and inflammation of the scar. Dr. C says instruction and demonstration is important to truly help the patient understand what self-massage looks like whether it is from the physical therapist or the surgeon. This can then be utilized at home by the patient to continue and extend the benefits of physical therapy after breast surgery.
From the video: Please Note: Dr. Garza in no longer with PRMA.