Importance of Therapy After Mastectomies

Importance of Therapy After Mastectomies

by Shelia M. Tenny, OTR/L, CHTLeave a Comment

Did you know that one in eight women will develop invasive breast cancer in their lifetime1? Common surgeries and procedures to treat women diagnosed with invasive breast cancer include lumpectomies, mastectomies, sentinel lymph node biopsies, and axillary lymph node dissection2. Mastectomies are the most common surgery for breast cancer but are the most invasive type of treatment. Mastectomies are recommended to decrease the likelihood of recurrence and lower the risk of further surgical procedures in the future.

Of the women who undergo a mastectomy for breast cancer treatment, more than two-thirds will have arm pain and dysfunction following their surgery3. This dysfunction can present with a limited range of motion (unable to lift their arm above shoulder height) and decreased strength due to swelling and immobilization after surgery. Physicians recommend limited arm movement initially after surgery to preserve healing structures. Movement should be initiated as soon as medically appropriate, which will be determined by the surgeon. If active movement is delayed, it could lead to deficits that mimic or become a frozen shoulder. Frozen shoulders can be characterized by stiffness and pain in the shoulder joint and can develop from shoulder trauma or immobilization. A mastectomy causes scar tissue formation and can lead to protective posturing during the normal healing process4. Scar tissue from the mastectomy can become bound down to the ribs or other nearby connective tissue in the chest, which causes tightness and directly limits the shoulder’s range of motion. It is important to address this as soon as medically appropriate5.

The shoulder and arm dysfunction discussed above can alter several activities of daily living6. Common activities of daily living affected by mastectomies include bathing, dressing, and feeding. Several other activities can be impaired, including hobbies and recreational participation. Arm pain and dysfunction can impact these daily occupations and have been shown to affect overall quality of life7. Early initiation of therapy has been shown to improve arm function, decrease pain, and improve activities of daily living8. Addressing these deficits as soon as medically appropriate regarding wound healing is important. The timeline for these symptoms can vary for everyone. Some individuals have symptoms immediately following a procedure, and some do not see symptoms until months later. Receiving skilled therapy as soon as symptoms are reported will improve function and overall life satisfaction. Skilled intervention may be indicated prior to surgery to set realistic expectations, improve strength, instruct gentle AROM techniques to use post-operatively, and educate on methods to manage swelling. These techniques can decrease the severity of scarring post-operatively, allowing for improved functional outcomes.

At Athletico, our therapists will create a treatment plan specific to your needs based on your doctor’s preferences, precautions, and musculoskeletal deficits. The treatment plan may focus on physical and cosmetic concerns, including managing edema, gaining a wider range of motion, increasing strength, and addressing scarring and burns from radiation. Strengthening and stretching may be the primary focus for most treatment plans to restore functional use of the affected upper extremity. If you are experiencing these symptoms after a mastectomy or want to be prepared before your procedure, our Athletico therapists can address your concerns and needs.

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*Per federal guidelines, beneficiaries of plans such as Medicare, Medicaid, Tricare, VHA and other federally funded plans are not eligible for free assessments.

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References
1. Breastcancer.org. (2021, February 4). U.S. breast cancer statistics. https://www.breastcancer.org/symptoms/understand_bc/statistics
2. American Cancer Society. (2019, September 18). Surgery for breast cancer. https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer.html
3. Arsh, A. & Ulllah, I. (2019). Shoulder pain and disability among post mastectomy patients. Physical Medicine & Rehabilitation, 29(3), 151-155. https://doi.org/10.1055/a-0820-4976
4. Pedersen, A. B., Horváth-Puhó, E., Ehrenstein, V., Rørth, M., & Sørensen, H. T. (2017). Frozen shoulder and risk of cancer: a population-based cohort study. British journal of cancer, 117(1), 144–147. https://doi.org/10.1038/bjc.2017.146
5. Dominguez, S. (2016, November 9). Shoulder rehabilitation after mastectomy. Foundational Concepts. Retrieved September 6, 2022, from https://www.foundationalconcepts.com/the-pelvic-chronicles-blog/shoulder-rehabilitation-mastectomy/
6. Erdoğanoğlu, Y., Calik, M., & Vural, M. (2021). Functional evaluation of patients with mastectomy lymphedema. Turkish Journal of Physical Medicine & Rehabilitation, 67(1), 56–61. https://doi.org/10.5606/tftrd/2021/4616
7. Hidding, J. T., Beurskens, C. H., van der Wees, P. J., van Laarhoven, H. W., & Nijhuis-van der Sanden, M. W. (2014). Treatment related impairments in arm and shoulder in patients with breast cancer: A systematic review. PloS One, 9(5), https://doi.org/10.1371/journal.pone.0096748
8. Scaffidi M., Vulpiani, M. C., Vetrano, M., Conforti, F., Marchetti, M. R., Bonifacino, A., Marchetti, P., Saraceni, V. M., & Ferretti, A. (2012). Early rehabilitation reduces the onset of complications in the upper limb following breast cancer surgery. European Journal of Physical & Rehabilitation Medicine, 48(4), 601–612
9. Anna, G., Camilla, P., Ines, G., Veronica, B., Elisabetta, S., Giuseppina, M., Giardini, A., Pisoni, C., Giorgi, I., Borelli, V., Scoccia, E., & Majani, G. (2013). ICF, quality of life, and depression in breast cancer: perceived disability in disease-free women 6 months after mastectomy. Supportive Care in Cancer, 21(9), 2453–2460. https://doi.org10.1007/s00520-013-1794-7

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About the Author:
Shelia Tenny is an Occupational Therapist and Certified Hand Therapist. She is passionate about helping those with hand, wrist, elbow, and shoulder pain, including arthritis, sprains, strains, fractures, tendon, and nerve injuries. Sheila has certifications in ergonomic assessments in the workplace and ASTYM, which uses specialized handheld tools to manipulate soft tissue to facilitate healing and tissue regeneration.

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