Following breast cancer surgery, you may ask your breast surgeon "I am experiencing.....( pain, swelling, movement restrictions) " and the breast surgeon replies "that is normal".
During the recovery phase it is very difficult to know what normal is. Let's consider what has happened during surgery, healing timeframes and what rehab goals to expect.
Surgery at the breast to remove cancer requires the surgeon to open, go in and remove tissue and then come back and close up. This certainly is a simple view of the process, but we need to remind ourselves that the repair that follows is at many levels- from the skin to much deeper tissues.
This repair occurs in 2 -4 weeks if there are no complications. This is amazing! the body lays down new tissue to connect the cut tissues. The new tissue is initially not very stretchy and may not be laid down in the direction of the old tissue. This is scar tissue and scar tissue can modify over years- by getting a little more stretchy, and can even change in the lines and direction that it can stretch. Scar tissue that is not painful to pressure or stretch is called mature scar tissue. Scar tissue that is painful to pressure (touch) is active scar tissue. Scar maturity may take up to 2 years and this time gets extended with radiotherapy.
Complications that will slow down this repair process could be:
how much tissue needs to be removed
infection
the formation of a seroma (an internal space that fills with fluid)
overstretching to the point of micro tearing
understretching to the point of bracing or locking in the surrounding tissues.
chemotherapy
stress
poor nutrition or unmanaged food sensitivites
diabetes
persistent swelling at the breast
So recovery time following breast surgery will be variable between women depending on complications- so lets talk about rehab goals for your initial recovery from surgery which you can work towards:
Achieve reach of upper arm to ear with a slow down at the end range due to tightness.
Achieve full reach of the upper arm to ear with no slow down and no pain.
Achieve some reach of the arm out the back (behind the body) at shoulder height with a little slow down at the end range due to tightness.
Achieve full reach of the arm out the back (behind the body) at shoulder height with no slow down and no pain.
Achieve some reach of the arm out the back (behind the body) at a position higher than shoulder height with a slow down at the end rang.
Achieve full reach of the arm out the back (behind the body) at a position higher than shoulder height with no slow down and no pain.
Achieve some reach of arm out the back (behind the body) from the upper arm to ear position with a little slow down at the end range due to tightness.
Achieve full reach of arm out the back (behind the body) from the upper arm to ear position with no slow down and no pain.
You will be comparing your movement to what you had before surgery or to your other side.
At the breast/ chest (after mastectomy) expect the following during your recovery:
Swelling to go away
Pain to go away.
The scar tissue to go from ACTIVE to MATURE at all levels (depths of tissue).
The breast tissue be able to stretch in all directions.
The underlying rib cage to return to being flexible and no pain on pressure.
If these goals are hard to achieve during your recovery, then arrange to have a discussion with someone at your breast clinic who has both the time and the interest, to plan your physical recovery treatment program. As you can expect, this process make take some work on your part - depending on the skill level of staff available at your breast clinic.
The rehabilitation protocols for breast cancer are not the same as those for injured footballers or after back pain or even lymphoedema- so you may need to engage in a careful selection process to find the therapist to best assist you. This process will be required when you do not have a dedicated breast cancer rehabilitation therapist associated with your doctor or clinic. Don't let this barrier stop you from achieving your physical recovery goals.
The aim during recovery is to know what your body is doing, determine your recovery goal, decide if you need help and if so how to get help to achieve your goals.
Next blog: What is normal recovery after radiation.
