By Kelly Reed, PT, DPT, OnCS, CLT-LANA
With the progression of treatment options and research, percentages of breast cancer survivorship are skyrocketing. Of course, this is amazing! However, what many find is that cancer and its treatment can leave behind frustrating side effects. During and after breast cancer treatment or prophylactic surgery, 90% of women are left with at least one side effect or impairment from cancer or surgery and treatment. The most common cancer treatment-related side effects are:
-Tightness (from axillary web syndrome, surgery, or radiation-fibrosis)
-Weakness or loss of muscle mass
-and so many more!
My name is Kelly Reed and I am a Doctor of Physical Therapy, Board Certified Oncologic Clinical Specialist, and Certified Lymphedema Therapist. If I were to send one message to the women’s cancer community it would be that these side effects are COMMON but NOT NORMAL, and you do NOT need to live with them forever! My passion for cancer rehab is to help women minimize and get rid of these side effects and symptoms so that they can get back to focusing on what’s most important in life. That’s why I started my Instagram page (@cancerrehabpt) and youtube channel (CancerRehabPT).
So let’s take a look at each of these:
Surgery and radiation can both cause scar tissue, or fibrosis, in the chest or breast area. It’s a thick tissue that can leave you feeling stiff and sore. Axillary web syndrome can also limit your motion. Although what these cords are is still controversial, it’s likely a lymphatic vessel that was affected in the surgery, but it can sometimes run from your armpit all the way down to your hand and cause pain if you try to raise your arm. It’s also common to see guarding. You just had treatment in an extremely vulnerable area! So keeping your arms in close and rounding your posture forward is a protective measure. However, when it’s safe to do so, it’s important to begin regaining your flexibility, range of motion, and strength. See below for more videos.
From Axillary Web Syndrome:
After Surgery or Radiation:
Like with the tightness, strength can be lost after surgery or with chemotherapy. Once it’s safe, it’s important to gently begin to activate and strengthen your muscles again. Working with your cancer rehab physical therapist can help guide and create a program specifically for you. I have created a couple of videos to help guide ideas for a general, 2-step, strength program I typically share with my patients.
Beginner Level Strength:
Intermediate Level Strength:
Lymphedema may occur primarily due to lymph node removal, but also in conjunction with radiation. The system gets backed up due to fewer lymph nodes moving and processing the lymph fluid. You may feel tightness, heaviness, or slight aching. This is different than post-surgical swelling, infection, or a seroma so you want to see a certified lymphedema therapist to help you assess and monitor your arm or breast.
There are ways to decrease your risk of getting lymphedema after breast cancer surgery. Be careful what you read online. This information, I find, can be very outdated! I have a video below on updated information as of early 2020, including the research studies for more information if you’re interested.
To manage lymphedema, a certified lymphedema therapist (CLT) will likely use Complete Decongestive Therapy (CDT) which includes compression, exercises, manual lymphatic drainage, and skincare. Many of these things you can do on your own after learning the correct technique. You can also follow along to step-by-step videos I created for manual lymphatic drainage and exercises for lymphedema or swelling after surgery, as well as compression.
How to Reduce Your Risk of Getting Lymphedema after Breast Cancer Surgery:
Lymphatic Massage for Breast Lymphedema or Swelling:
Lymphatic Massage for Right Arm Lymphedema or Swelling:
Lymphatic Massage for Left Arm Lymphedema or Swelling:
Exercises to Reduce Breast Lymphedema or Chest Swelling:
When to see a Cancer Rehab Specialist?
After the surgery is the most common time someone will seek treatment, but you’re never too early! If able, some patients who are at risk for lymphedema will go to a physical therapist prior to surgery to get baseline measurements and an assessment to be followed during and after treatment. Rehabilitation can also address neuropathy, fatigue, pain, and more. Rehab during treatment is shown to be highly beneficial, especially with chemotherapy, to safely exercise and minimize your side effects.
**Upcoming videos include topics on reducing cancer-related fatigue, chemotherapy-induced peripheral neuropathy in your hands or feet, and improving shoulder and neck pain after surgery. I will also address compression bra options and other important exercises. Feel free to Subscribe to follow along for weekly videos: https://www.youtube.com/c/cancerrehabpt