1. Mastectomy
2. 6 weeks of tissue healing
3. Rehab to normalize shoulder mobility and core strength –> Return to function
4. Reconstructive breast surgery
5. Rehab to continue shoulder strengthening and activity specific –> Return to activity/sport/work

After a long journey, your physical and emotional well-being may be drained. Changes to how your breasts and body look and feel may influence how you feel about intimacy as well.   

Find ways to relax. 

Your body has gone through many changes, and you may experience sensations differently than before. Finding ways to relax your body and decrease tension can help make intimacy more pleasant.    

Since you will be a pro belly breather after reading this blog, this method is one of the first relaxation techniques we teach. The slow controlled breathing actually helps to down train your nervous system. What does that mean? It allows more oxygen to circulate through your body, which helps decrease tension and stress in your muscles, and slows your heart rate and rate of breathing.  

Other methods that may help with relaxation are aromatherapy, changing the environment (lighting, bedding, music), and performing any activity you are comfortable with prior to getting more intimate.  

Communicate with your partner.  

What are you comfortable or not comfortable with? What will help you get aroused and more intimate? Let them know if you want to start slow and if you have any boundaries you would like to set.  

What positions feel good?   

This is part of communication with your partner.  Certain positions may cause discomfort, depending on your surgery and where the incision sites and scar tissues are located. Talk to your therapist if there are particular positions you are having difficulties with to see if anything can be addressed with physical therapy.  

Take your time.   

Healing times vary with each individual. Take your next step when you are ready.  

We often recommend you work with other healthcare providers since our specialty is in getting you moving. If intimacy is something you would like to get back to, ask your doctor if they have any recommendations, or search for practitioners near you at American Association of Sex Educators, Counselors, and Therapists.  

If you have more questions, please book an appointment with Dr. Ann DeGrey, PT, DPT, SCS or Dr. Lei Lee, PT, DPT for more information and to develop a plan! 

The post 10- Getting Sexy Back: Sex after mastectomy appeared first on MOTI Physiotherapy.

1. Mastectomy
2. 6 weeks of tissue healing
3. Rehab to normalize shoulder mobility and core strength –> Return to function
4. Reconstructive breast surgery
5. Rehab to continue shoulder strengthening and activity specific –> Return to activity/sport/work

This is up to you but we always recommend some sort of rehab after more surgery. This rehab duration maybe shorter than before because the reconstructive surgery is not as invasive as the initial mastectomy procedure. 

However, gaining and maintaining full shoulder ROM and core strength is very important to prevent future injuries. 

Without full range of motion, your body may start performing compensatory motions, which can later affect a different body part.  Your body is very good at finding ways to compensate without you realizing it! You may also feel weak from multiple surgeries and weeks of limited activity.  Carrying a load of laundry or picking up your child may be difficult if your core strength isn’t what it used to be. 

Also, if you want to return to a specific sport or manually intensive job, it is good to continue rehab and perform those movements with a trained specialist before hopping back into what you normally did before.

If you have more questions, please book an appointment with Dr. Ann DeGrey, PT, DPT, SCS or Dr. Lei Lee, PT, DPT for more information and to develop a plan!

The post 9- Keeping the Ball Rolling: More rehab after post-mastectomy reconstructive breast surgery? appeared first on MOTI Physiotherapy.

1. Mastectomy
2. 6 weeks of tissue healing
3. Rehab to normalize shoulder mobility and core strength –> Return to function
4. Reconstructive breast surgery
5. Rehab to continue shoulder strengthening and activity specific –> Return to activity/sport/work

Types of Common Reconstruction

• 1 – Expanders and Breast Implants
  • Expanders or pouches are placed inside your chest and inflated slowly over time with saline to expand the breast region. Once the pouch has enlarged to the size you wish your implant to be, a breast implant would replace the expander. 
• 2 – Liposuction injections or Fat Graft
  • Taking fat from your abdomen, glutes, or thighs to transfer to the breast and fill in any shape abnormalities. This is usually common after a lumpectomy where not a lot of breast tissue is removed.
• 3 – TRAM Flap (tummy)
  • Use of tissues and muscles from your lower belly, resulting in a tummy tuck.
  • This is a large incision across your abdomen and may decrease the strength of your abdominal region.
  • Some women who do not have enough fat or belly tissue will not be able to do this procedure.
  • This procedure can be done with or without implants following.

(https://www.cancer.org/content/dam/cancer-org/images/illustrations/medical-illustrations/en/breast-cancer-images/transverse-rectus-abdominis-tram-flap.jpg/jcr:content/renditions/cq5dam.web.1280.1280.jpeg)

• 4 – Lat Flap
  • Use of tissue and muscle from the lattisimus muscle to replace the breast tissue that was removed.
  • Commonly used when the pec muscle is damaged from Chemo or radiation.
  • This procedure is usually done with breast implants following.

(https://www.cancer.org/content/dam/cancer-org/images/illustrations/medical-illustrations/en/breast-cancer-images/latissimus-dorsi-muscle-lat-flap.jpg/jcr:content/renditions/cq5dam.web.1280.1280.jpeg)

Breast Implant Illness?

Breast Implant Illness (BII) is an illness doctors refer to large range of unusual symptoms following breast reconstruction that involves breast implants (of any type of implant material). Some patients feel symptoms immediately after surgery and some develop it months to years later.

Symptoms can include:

• Joint and Muscle Pain
• Chronic fatigue
• Memory and concentration problems
• Breathing problems
• Sleep disturbance
• Rashes and skin problems
• Dry mouth and dry eyes
• Anxiety
• Depression
• Headaches
• Hair loss
• Gastrointestinal problems

Who is more susceptible to BII?

• Autoimmune and connective tissue disorders (Lupus, rheumatoid arthritis) fatigue
• Family history of autoimmune and connective tissue disorders
• Severe allergies to many things
• Irritable bowel syndrome
• Migraines
• Chronic fatigue
• Fibromyalgia

Causes? Symptoms from BII derive from a constant high inflammatory response to the new breast implants. Researchers still don’t know why some women develop BII, but materials and exposure to things that may cause inflammation in the body may induce BII symptoms. 

Treatment? Usually removing the implant shows improvement in symptoms for most women within a few months, but not all. Some say a healthy diet, exercise, and decreased stress can help reduce the amount of inflammation in the body and also reduce symptoms of BII.

References

1. American Society for Aesthetic Plastic Surgery. Breast Implant Illness – Frequently Asked Questions/Talking Points. August 2019. Available at: https://www.surgery.org/sites/default/files/BreastImplantIllness_8-21-2019_FINAL.pdf
2. Maijers MC et al. Women with silicone breast implants and unexplained systemic symptoms: a descriptive cohort study. Neth J Med. Dec. 2013: 71(10). Available at: http://www.njmonline.nl/getpdf.php?id=1392

Nipple Reconstruction and Tattoos?

After your breast reconstruction fully heals, you may elect to also reconstruct your nipples. The coloration would be different because the surgeon will use a different tissue to graft so most people will choose to tattoo and define the dark area of the areola. 

A patient of mine went to this tattoo artist, Vinnie Myers, who is famous for creating 3D nipple tattoos for breast cancer survivors. Check out his website: www.vinniemyersteam.com

If you have more questions, please book an appointment with Dr. Ann DeGrey, PT, DPT, SCS or Dr. Lei Lee, PT, DPT for more information and to develop a plan!

The post 8- Hello New Boobs – Tummy Tucks and Expanders and Implants and Tattoos?! appeared first on MOTI Physiotherapy.

1. Mastectomy
2. 6 weeks of tissue healing
3. Rehab to normalize shoulder mobility and core strength –> Return to function
4. Reconstructive breast surgery
5. Rehab to continue shoulder strengthening and activity specific –> Return to activity/sport/work

Home Exercise Program (HEP)… What is that?

Physical therapists provide some “homework” for you to perform on days you don’t have a session to maintain the progress achieved with your therapist.  These usually include exercises to keep working on your range of motion (ROM), strength, and good posture.  

During your physical therapy sessions, your PT will assess your mobility, strength, endurance and more, and create a home program specific to your needs. It will also include scar tissue mobilization. 

Scar Tissue Mobilization

Scar tissue can be tender to touch, painful, stiff, and cause discomfort with everyday tasks like reaching for overhead cabinets, dressing, washing your hair, and even just trying to stretch from sitting. 

Start by pushing skin around your scar very gently. Sink your finger down until you feel resistance and then gently move your fingers up, down, left, and right. Go around your scar and hold for a few seconds at spots that you notice are more “stuck”.  Move in towards the scar and onto the scar. You may need to adjust the pressure depending on how sensitive you are.  If it is causing too much pain, back off and mobilize the surrounding tissues instead. 

Exercises to get you started

1. Dowel-Assisted Shoulder Mobility: 

Using the dowel, you’re going to have the unaffected arm help your arm move.  The arm you are trying to improve should be relaxed with no tension throughout the movement. See if you notice your shoulders shrugging up. Try to keep them down and relaxed. The video shows 3 motions: Flexion, Abduction, and External Rotation

2. Towel Slides: 

Grab a towel and place your hand on the wall.  You’ll move your hand in various positions in a pain free range at first. Make sure your shoulder stays down and back off if it is too painful.  with no tension throughout the movement. See if you notice your shoulders shrugging up. Try to keep them down and relaxed. The video shows 3 motions: Flexion, Diagonals (both ways!), and Rainbows

3. Shoulder Blade Squeezes: 

You want to strengthen the muscles between your shoulder blades as well.  While keeping your shoulders down, squeeze your shoulder blades together to the center towards your spine. Your chest shouldn’t pop out and make sure you’re breathing! 

4. Rows:

This one is the next step after you master the shoulder blade squeezes. If you have a elastic band, hold the ends while hooking the center to a sturdy surface. Keeping your shoulders from shrugging up, squeeze your shoulder blades back together while also pulling the band back. Your arms and shoulders should be working together.  Control the band from snapping your arms forwards and repeat. 

If you have more questions, please book an appointment with Dr. Ann DeGrey, PT, DPT, SCS or Dr. Lei Lee, PT, DPT for more information and to develop a plan!

The post 7- Keep it Moving – Home Exercise Program (HEP) and Scar Tissue Mobilization for Post-Mastectomy appeared first on MOTI Physiotherapy.

1. Mastectomy
2. 6 weeks of tissue healing
3. Rehab to normalize shoulder mobility and core strength –> Return to function
4. Reconstructive breast surgery
5. Rehab to continue shoulder strengthening and activity specific –> Return to activity/sport/work

I got a mastectomy… Can I get back to doing things I love? 

After a mastectomy and/or following cancer treatments, one can experience loss of both mobility in their upper body and core strength. Most patients also don’t realize how incisions can take a minimum of 6 weeks to heal, which can discourage movement and quality of life. 

Scar tissue formation from a mastectomy, lumpectomy, or lymph node removals can be painful and can restrict movement in the shoulder, even leading to serious orthopedic side effects like frozen shoulder.   

We’re here to help! 

With physical therapy, one can improve upper extremity mobility and strength baseline, so their future reconstructive surgeries have better recovery and faster outcomes. Exercises to maintain shoulder range of motion and arm mobility may be prescribed as early as 1 week after surgery. Patients may also experience nerve pain caused by scar tissue impinging on nerves. Manual therapy can help restore sensation and relieve nerve pain too!

What should I expect at physical therapy? 

As part of a post op mastectomy treatment plan, your physical therapist will utilize different manual techniques to improve the scar tissue from the incision and increase upper extremity range of motion, while also prescribing individualized exercises to help restore strength and promote good circulation. As rehabilitation progresses, these exercises may be modified to meet new goals such as returning to a sport!

Physical Therapy as part of a mastectomy treatment plan can have the following benefits:

• Improved upper extremity range of motion
• Improved upper extremity strength
• Improved functional mobility (dressing, driving, reaching, etc.) 
• Improved posture and core strength
• Decreased pain at the surgical site
• Decreased swelling on the affected side
• Improved sensation at the surgical site
• Improve scar tissue mobility
• Neuromuscular reeducate affected tissues
• Reduce fears of surgery
• Provide a therapeutic environment and psychosocial approach

What does a typical rehab session look like?

At MOTI, each patient will receive a 1 hour evaluation which will begin with getting a thorough medical history of current and past procedures, assessing your posture, measuring your upper body and spinal range of motion, and testing your core and arm strength. Next, your therapist will explain to you their findings and will provide some treatment to address any impairments found during the assessment. Your therapist will create and explain your plan of care, designed just for you and your needs. Additionally, your therapist will design and explain your customized home exercise program, which they will also email to you for independent maintenance of your rehab.

If you have more questions, please book an appointment with Dr. Ann DeGrey, PT, DPT, SCS or Dr. Lei Lee, PT, DPT for more information and to develop a plan!

The post 6- Giving you the tools: Physical Therapy After Mastectomy appeared first on MOTI Physiotherapy.

1. Mastectomy
2. 6 weeks of tissue healing
3. Rehab to normalize shoulder mobility and core strength –> Return to function
4. Reconstructive breast surgery
5. Rehab to continue shoulder strengthening and activity specific –> Return to activity/sport/work

Your surgery incision sites will make it difficult to expand your chest and ribs. The body will have a tendency to immediately recruit any muscle possible to help you breathe better, such as your neck and shoulders. In order to prevent excess pressure to the area and strain to your neck, diaphragmatic breathing or BELLY BREATHING is recommended.  

The diaphragm is a big muscle that sits below your lungs.  It is actually the main muscle to help breathe in air!  When you inhale, air fills up your lunges and pushes the diaphragm down, expanding your belly. You want to breathe deep to expand the diaphragm and belly which will help fill lungs with air without using your chest as much. As you exhale, the diaphragm contracts and pushes the air up and out of the lungs.

Breathe in through the nose, breathe out through the mouth.

Breathe to expand the belly, breathe out empty the belly.

(Image from https://sequencewiz.org/wp-content/uploads/2014/03/Breathing.png)

Take a look at the video below for some simple breathing exercises in different positions!

If you have more questions, please book an appointment with Dr. Ann DeGrey, PT, DPT, SCS or Dr. Lei Lee, PT, DPT for more information and to develop a plan!

The post 5- Mastectomy Recovery: Become a Pro at Belly Breathing appeared first on MOTI Physiotherapy.

1. Mastectomy
2. 6 weeks of tissue healing
3. Rehab to normalize shoulder mobility and core strength –> Return to function
4. Reconstructive breast surgery
5. Rehab to continue shoulder strengthening and activity specific –> Return to activity/sport/work

After surgery, you will want to make sure you have these types of clothing ready for comfort and convenience!

• Open front tops (flannels, zip ups, front button). Avoid anything where you have to pull over your head because your shoulders will not move in that motion for a bit.
• Loose fabrics such as cotton and satin is soft on the skin and easy to maneuver. 
• Do not wear anything fancy or expensive because you may bleed or leak into your clothes.
• Loose underwear. If you end up getting a reconstruction that takes tissues and fat from your abdomen, make sure your underwear elastic is not at the site of the incision. You can ask your doctor where the incision will be so you can plan accordingly.
• NO BRAS because the hospital will provide you with their special bras. Make sure you ask them if you can have or purchase a second bra so you can alternate them at home. 

How to put on your bra after mastectomy:

Don’t clasp your bra behind your back blindly, ESPECIALLY when your shoulders are sore, tender, and recently out of surgery. Try putting on a bra without cranking your shoulder this way!

1. Clasp the bra in FRONT of you instead of behind. Cups should be on your back.
2. Spin the bra so the cups are in the front.
3. Slip the straps up your shoulders.

If you have more questions, please book an appointment with Dr. Ann DeGrey, PT, DPT, SCS or Dr. Lei Lee, PT, DPT for more information and to develop a plan!

The post 4- Dress to Succeed during Post-Mastectomy Tissue Healing appeared first on MOTI Physiotherapy.

1. Mastectomy
2. 6 weeks of tissue healing
3. Rehab to normalize shoulder mobility and core strength –> Return to function
4. Reconstructive breast surgery
5. Rehab to continue shoulder strengthening and activity specific –> Return to activity/sport/work

You can start physical therapy as early as 1 weeks after your surgery! Discuss when you will be ready with your surgeon and call to make physical therapy appointments in advance to have a smooth transition to therapy. 

What can we do at this time? 

• Look at your incision sites and make sure it’s healing well
• If you are seeing us for Physical Therapy, we can help change your bandages if you bring your extra ones.
• Start gently moving your arms and strengthening exercises for surrounding muscles (not directly affected by the surgery).
• Gentle scar tissue mobilization once your incision site has scabbed over and fallen off.

What is scar tissue? 

After surgery, your body forms scar tissue over the incision site(s). The scar tissue is usually more fibrous and stiff, which can affect your mobility if it isn’t addressed. There are multiple layers of tissue in your body and scar tissue can cause these layers to get “stuck” and it can also be painful.  We will go over mobilization techniques later for you to get moving!  

(https://2rdnmg1qbg403gumla1v9i2h-wpengine.netdna-ssl.com/wp-content/uploads/sites/3/2017/03/Mastectomy-300×200.jpg)

I have lymphedema…  What should I do? 

The lymphatic system is part of your immune system that can be seen like a highway system throughout the body to help clear waste products and fight infections. Lymphedema usually occurs when lymph nodes are removed from the area, which can be paired with a mastectomy. Because the flow is disrupted with surgery, there is a chance of developing lymphedema where the affected limb becomes swollen. 

(https://blogs.bcm.edu/wp-content/uploads/2021/03/Lymphedema-image.jpg) 

If you are a post-mastectomy patient with lymphedema, you may benefit from seeing a Certified Lymphedema Specialist (CLT) instead. Talk to your doctor to see if they can recommend you a specialist near you. 

If you have more questions, please book an appointment with Dr. Ann DeGrey, PT, DPT, SCS or Dr. Lei Lee, PT, DPT for more information and to develop a plan!

The post 3- Chipping away at the wall: Tissue Healing after Mastectomy appeared first on MOTI Physiotherapy.

How do you navigate this journey?

Road Map to Recovery

1. Mastectomy
2. 6 weeks of tissue healing
3. Rehab to normalize shoulder mobility and core strength –> Return to function
4. Reconstructive breast surgery
5. Rehab to continue shoulder strengthening and activity specific –> Return to activity/sport/work

What is a mastectomy?

A mastectomy is a surgical procedure that removes a part of or the entire breast.

Types of mastectomy:

Total Mastectomy: The entire breast is removed.

(https://www.breastcancer.org/system/page_components/illustration_attribute_collections/pictures/000/000/150/large/total_simple_mastectomy_tcm8-326810.jpg?1355939182)

Radical Mastectomy: The entire breast is removed and the axillary lymph node is also dissected

(https://www.breastcancer.org/system/page_components/illustration_attribute_collections/pictures/000/000/152/large/radical_mastectomy_tcm8-326804.jpg?1355939374)

Partial Mastectomy or Lumpectomy: Only the cancerous portion of the breast tissue is removed

Nipple-sparing Mastectomy: All the breast tissue is removed except for the nipple

Some women decide to have their breast reconstruction during the same operation as the mastectomy. Others wait some time to get the breast rebuilt. Some don’t get it rebuilt at all because they don’t want to deal with things “weighing them down.”

Pros to Mastectomy Plus Reconstruction

• 2 in 1 procedure.
• Wake up and still have breasts.
• Help your breasts look natural under clothing.

Cons to Mastectomy Plus Reconstruction

• Needs to heal before chemotherapy so it delays treatment.
• Involves other surgical procedures such as liposuction or a tummy tuck which can be painful simultaneous to the chest incisions.

Please see our “New Boobs” blog post for more info on types of breast reconstruction!

If you have more questions, please book an appointment with Dr. Ann DeGrey, PT, DPT, SCS or Dr. Lei Lee, PT, DPT for more information and to develop a plan!

The post 2- Bye Boobs: Types of Mastectomy appeared first on MOTI Physiotherapy.

Dr. Ann DeGrey here, and I’m so glad you took the time to read our blog. We are really excited to touch on these topics because it has been an interest of mine since I’ve started working as a Physical Therapist back in 2014. After graduating from DPT school (University of Saint Augustine), I worked at an sports outpatient clinic in Pasadena. One of my first patients included a breast cancer survivor who had undergone a mastectomy on both sides. Being a new grad, I had no idea what I was getting myself into but I was motivated to help her and it paid off! I knew I wanted to use whatever school knowledge I had, I spent hours on research after work, and we were open to trying every type of possible treatment I could think of. Only 35 years old, that patient returned to work as a hair stylist, a full time mommy, and even returned to playing tennis!

Reflecting on that first experience has made me think about how I could help so many women, and some men, overcome the aftermath of breast cancer!

A little more about myself… I continue to treat patients as the Clinic Director at MOTI Physiotherapy Highland Park. I am a Sports Certified Specialist and have worked for Team USA Olympic Athletes and other sport teams. Even though I am a Sports Specialist, I have treated many different cases of mastectomies and have trained many of my fellow DPTs in post-mastectomy care. I thought it was a good time to finally put my experience down in a blog. 

If you’re worried about…

What is about to happen after a mastectomy?

What can I wear? How am I going to put on a bras?

How to manage working? 

How my body is going to feel and change after surgery?

What are my boobs going to look like? Is the scar bad? Can I minimize scarring?

What happens during surgery?

Is it necessary to get physical therapy? How is rehab going to be? 

Can a nipple be tattooed on? 

Will I ever do a clean and jerk again?!

What is my sex life going to look like?

…..you’ll feel right at home here.

Now over to my colleague, Dr. Lei Lee…

Hello everyone! My name is Dr. Lei Lee, and I am a physical therapist that just moved to the Los Angeles area around January of 2021! I treat orthopedic cases, pelvic floor (I love taking care of my mamas and mamas-to-be!), and post-mastectomy patients. I was one of the physical therapists that Ann trained.  It is most rewarding for me to work with women going through a body transformation and get back to doing what they love doing. Ann’s passion was highly contagious and now I also love working with those recovering from post-mastectomy. I believe MOTI provides a great environment to get moving with many encouraging staff members to support you on your journey. Get ready to move when you come here! 

On my time away from the clinic I enjoy moving as well. I like being active indoors and outdoors. I try to hike, run, and swim/snorkel every chance I get.  I have started training for a marathon (Big Sur International Marathon… I grew up in Monterey, CA so it has been on my bucket list). I’m looking forward to get you back to doing the things you love doing as well.

Together, LETS BREAK DOWN THE PINK WALL! 

The post 1- Breaking down the Pink Wall: Navigating Mastectomy Recovery appeared first on MOTI Physiotherapy.