Breast surgery can develop problems after any type of surgery, and may occur in at least one percent of women at any time according to the U.S Food and Drug Administration (FDA).The main complaint is chronic pain with an incidence from 20% at 60%.
Physical Therapy uses specialized manual therapy techniques such as myofascial release to treat and reverse breast surgery problems.
Is Physical Therapy Needed After Breast Surgery?
Some breast surgery complications related to fascia and scar issues can improve with physical therapy. The physical therapist uses a specialized manual technique called myofascial release to soften up the scar, by releasing scar tissue, and decreasing the pressure on the nerve. The irritated nerve sends a false signal of pain to the brain. Physical therapy reprograms the brain with a new message of moving easier, with less effort, and less pain.
Here is the list of complications related to fascia and scar issues according to U.S. FDA:
- Breast Asymmetry. The Breasts are Uneven After Breast Surgery.
- Breast Pain.
- Capsular Contractures.
- Malposition/Displacement Caused by Capsular Contracture.
- Palpability the Breast Implant Can Be Felt Through the Skin.
Some women experience breast size difference compared to the other after breast surgery.
Breast asymmetry tends to occur if the breast surgery was done only in one breast, or for having radiation therapy. The breast gets more uneven over time by the effect of gravity, healing process, and natural changes.
Breast pain it can happen after any type of surgery. Breast pain tends to go away within 6 months through a year after surgery. Unfortunately, some women can have pain for several months or years.
Capsular Contracture after Breast Surgery
A breast implant is recognized as a foreigner material. As a result, the body builds a shell or capsula of scar tissue around the breast implant to keep it isolated from other adjacent structures.
The capsula of scar tissue is a normal reaction from the healing process, that benefit the breast implant by helping it to stay in place. In some women, the capsula gets tight and hard, and become a complication.
Capsular contractures can cause pain from stretching adjacent tissue, pinching, or compressing on an adjacent nerve.
What are the Early Signs of Capsular Contracture?
- Breast Feels Tight and Firm.
- Change in the Appearance of the Breast.
- Breast Become hard and Painful to the Touch.
- The Breast Implants are Riding High.
- The Breast Implant Shift Out of Place
- The Breast Feels Hard When Lying on It.
How Long Does It Take for the Capsular Contracture to Occur?
Withing three months to two years after breast surgery.
Why are the Breast Implant Rippling?
- More common in women with a thin breast tissue because the breast implant is closer to the skin.
- Breast implants placed under the skin, instead of the pectoral muscle.
- Women with low body fat.
Post-Mastectomy Pain Syndrome or (PMPS)
Post-Mastectomy pain syndrome is a nerve pain in the armpit, chest, upper, and middle back following a mastectomy or other type of breast surgery. This pain persists for months or even years, impacting quality of life, and is not caused by infection.
Can Mastectomy Cause Nerve Damage?
Post-mastectomy pain syndrome occurs when a nerve is damaged during surgery. A damaged, scratched, or irritated nerve send false signals to the brain and the brain responds with a sign of pain. The pain may persist for many years if the brain is never reprogrammed to send the right signal.
In a mastectomy or breast reconstruction some nerves are injured. A damaged nerve shows signs of pain in the distribution of the nerve fibers. For example, the intercostal nerve supplies sensation to the skin of the armpit, lateral chest, and medial arm. In other words, the pain mostly will be felt in the armpit, lateral chest, and medial arm.
How Long Does the Pain Last After a Mastectomy?
Postmastectomy pain syndrome is a chronic condition that may last from three months, or several years after surgery without physical therapy.
What Does Nerve Pain Feel Like After Mastectomy?
Nerve pain is a persistent and uncomfortable feeling, characterized by burning sensation, and a sharp, throbbing, stabbing, or shooting pain in the distribution of the nerve fibers.
Who is Most Likely to Get Postmastectomy Pain Syndrome?
20 to 30% of women following breast surgery develop postmastectomy syndrome according to the American Cancer Society. And this condition continues growing as high as 50% of patients shown in recent medical studies.
Postmastectomy Pain Syndrome is more common in women who has:
Hematoma Formation After Surgery. A build-up of blood where the breast was removed during surgery.
Body Mass Index Higher than >26. (Normal BMI between 18.5-24.9)
Prior History of Headaches.
Pain before Surgery
According to the American Society of Regional Anesthesia and Pain Medicine, patients who are dealing with chronic breast pain before surgery, tend to use more amounts of pain medication in the 48 hours following surgery and develop Postmastectomy pain syndrome..
Younger patients (<40-50) tend to develop chronic pain, including postmastectomy pain syndrome. Younger people tend to have lower tolerance to pain, be more anxious, have higher nerve sensitivity, and surgical treatments tend to be more aggressive at younger age.
Arm pit lymph node surgery increases nerve damage to the intercostobrachial nerve, characterized by a dull, burning, or aching pain of the armpit, upper arm, axila, and sometimes the chest wall.
Radiation to the armpit increases nerve damaged with persistent pain that does not go away over time.
Patients who tend to be more depressed, sad, anxious, have more chance of having postmastectomy pain syndrome or pain for more than few months even for many years.
What Kind of Surgeries Increase the Risk of Developing Chronic Pain after Breast Surgery?
Cosmetic Surgeries such as:
- Breast Augmentation.
- Breast Lift.
- Fat Transfer Breast Augmentation.
Cosmetic breast surgeries can produce chronic pain, as a result of intercostal nerve injury, pinched nerve, and scar tissue from the incision area. In addition, the breast implants placed under the pectoral muscle, or above the muscle can produce tightness of the scar tissue that forms around the breast implants. This scar tissue will produce over time a capsular contracture, accompany with physical and emotional issues.
Mastectomy or Lumpectomy
A mastectomy is a surgery to remove one or both breasts, to treat or prevent breast cancer. As a result, the intercostal nerve can get injured during this procedure and produce pain.
Breast Reconstruction with Implants
It’s a procedure to restore the shape of the breast after removing the real breast. An artificial breast implant is placed either behind or in front of the pectoral muscle. Breast implants behind or under the pectoral muscle are more prone of injuring the pectoral nerve producing muscle spasms and pain in the same area.
Possible Problems after Breast Reconstruction
- Difficulty with Reaching Arms Over the Head due to Muscle Tightness.
- Numbness and Tingling Arm.
Breast Reconstruction Using Back Tissue
The muscle use to reconstruct the breast is the latissimus Dorsi, including, the skin, blood vessel, and fat from the upper back. The latissimus Dorsi is removed from the back and is transferred to the front of the chest, preserving the arteries, and veins. Most of the time, a tissue expander is used with the latissimus dorsi to recreate the breast shape.
Some women may have shoulder, arm, and back weakness after the surgery.
Breast Reconstruction Using Abdominal Tissue (TRAM Flap)
This procedure uses the patient’s own tissue to rebuild the breast shape. The tissue uses for the reconstruction can include skin, fat, fascia, blood vessels, and one abdominal muscle. The abdominal muscle uses in this case is the Transversus Abdominis. This muscle is moved from the abdomen to the chest. The abdominal muscle may get weaker after this surgery.
Breast reduction is a procedure where the excess of fat and skin from the breast are removed.
- Arm and Shoulder Weakness.
- Upper and Middle Back Pain.
- Painful Scars.
- Difficulty with Using Arms with Over Head Movements.
Possible Problems After Breast Surgery
- Weakness in the Shoulder and Arm
- Phantom Breast Pain.
- Pain is Aggravated with Shoulder Movement.
- Squeezing Feeling of the Chest Wall or Armpit
- Tingling, Numbness.
- Difficulty Sleeping.
- Affect Patient’s Mood.
- Difficulty Using the Affected Arm to do the Hair, or to Get Dress.
- Pain in the Surgical Scar.
- Nipple Pain.
- Annoying Pain.
- Shooting Pain.
- Gnawing Pain.
- Throbbing Pain.
- Pin and Needles
- Tingling Sensation.
- Pain in the Breast, Arm, and Shoulder.
- Muscle Spasms, Muscle Tightness that is Worsen with Movement.
How Can Physical Therapy Help?
Physical therapy is a very effective approach to reduce postoperative symptoms after breast surgery, such as pain, and difficulty moving with activities of daily living. In addition, physical therapy speeds up the recovery time, and improve quality of life.
Physical therapy can start as early as 2 days after surgery to quickly improve joint mobility, and quality of life, according to a study from the American Physical Therapy Association.
Early Physical Therapy improve arm and shoulder mobility and reduce postoperative problems of breast surgery overall.
What Exercises Can I Do After Surgery?
1. The most important exercise is Mindfulness Breathing
- Improve Blood Flow to the Postoperative Area.
- Reduce Pain
- Relax the Mind and Body
- Manage Stress.
Click here to learn more about Mindfulness breathing
2. Daily Walking
3. Daily gentle stretching exercises
If you are dealing with any physical problems related to the fascia and scar issues after breast surgery, give me a call Now. Let’s talk about your needs and get you ready for a fast recovery.
Note: Please consult with your Doctor before starting any exercise or physical activity.