Mastectomy from breast cancer can present multiple challenges in and of itself as the tissues heal and the shoulder is initially limited to lifting. If your mastectomy involved lymph node removal, there is a 20-30% chance that you may develop lymphedema. This is a fluid build up in the lymphatic system near the surgical site, into the arm of the affected side, often down to the wrist or fingers. The result winds up in a “heavy arm” with symptoms that can range from just pressure and/or fullness, to numbness, achiness, and pain that limit use of that arm. 

To move waste fluids away from the damaged area, lymphatic massage, which uses a gentle pressure, can help. It’s one technique used to reduce lymphedema. Immediately following lymphatic massage, it is crucial to apply gradient compression to the limb to maintain appropriate pressure on the lymphatic vessels. This will assist in decreasing  fluid retention and  stress on the skin to promote mobility. Gradient compression is NOT simply an ACE wrap! It is layers of different compression that apply even pressure to the limb without damaging the lymphatic vessels.  Here are the various supplies we use: 

Lymphatic massage is NOT something a masseuse does!! You need to see a licensed physical therapist or lymphedema specialist for treatment. They will perform the massage, which takes about 45minutes, followed by application of the layers of compression. After wrapping the arm, you would do very light exercises to further promote strength training while the muscles themselves pump fluid out of the limb and back into your circulation. Your arm will look like this!

In time, you will learn how to sequentially perform the massage on yourself and apply your own bandages so that you can bathe or remove it for a short break.

Lymphedema treatment can last from 4-8 weeks on average, depending on the grade of your lymphedema to begin as well as your compliance with the home program. The goal is to attain a limb girth equivalent to your non-operative side and “graduate” to a custom compression garment, which would fit like a pantyhose sleeve for your arm. 

I am excited to work with you! 

The post Lymphedema 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

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!  

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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.