The Benefits of Physical Therapy Before & After Mastectomy
For those of us who have faced a breast cancer diagnosis or watched a loved one navigate the journey, we understand the weight of the decisions that come along with it. When a mastectomy is recommended, whether as a life-saving measure or a preventive step, we are faced with a significant choice that has the potential to impact all aspects of our life — physically, emotionally and psychologically.
According to the American Cancer Society (ACS), approximately 33 percent of women with stage 1 or 2 breast cancer undergo a mastectomy, and 65 percent of women with stage 3 breast cancer undergo the procedure. Yet despite the frequency of this surgery, many people don't realize that afterwards, there can be a range of physical side effects that persist for months, years or even for the rest of our lives. Such symptoms include muscle and incision discomfort, swelling and more complex issues like cording, numbness, nerve pain and lymphedema. Additionally, up to 60 percent of people encounter a decreased range of motion following breast cancer surgery.
The good news is that physical therapy (PT), both before and after a mastectomy, can help reduce the frequency and severity of these complications. Prior to treatment, engaging in PT helps us better understand our body as we prepare for surgery, and after, PT can be instrumental in reducing complications and supporting a smoother, more holistic recovery.
Preparing Our Bodies: The Power of Prehabilitation
Research suggests that initiating PT prior to mastectomy is an important measure that can offer perspective around the changes our body may endure as a result of the procedure. Consider it a before and after picture — becoming familiar with our range of motion, strength and posture in advance provides a baseline by which to compare the various limitations we will experience post-op. Such awareness and information can lay the foundation for a recovery with fewer ongoing side effects and limitations.
In conjunction with PT, exercise can play a vital role in our recovery. Studies show that regular movement not only enhances our physical health but also improves survival rates and reduces the risk of cancer recurrence. A steady fitness routine pre-surgery can strengthen our body and make the healing process less challenging. Physical activity can also dramatically improve our mental and emotional health as we face fear, apprehension and anxiety surrounding the unknowns of how our cancer journey will unfold.
The Path of Healing: Physical Therapy After Mastectomy
After surgery, the healing process is gradual and often requires many months of rehabilitation. Physical therapy can play an important role in this process by helping offset and alleviate side effects and discomfort. Specifically, PT can ameliorate:
Pain: Both at the surgical site and as a result of scarring and cording, PT can help reduce pain, including the pain experienced when lifting arms overhead or around our back.
Swelling: Lymphatic massage can help treat and minimize swelling resulting from surgery and lymphedema.
Range of Motion: PT can help restore movement in the arms and chest, including lifting arms overhead and around our back, as well as maintain or increase shoulder flexibility.
Posture and Core Strength: A strong core can reduce the need to use our arms after surgery (a painful experience!). Getting in and out of bed or a chair is significantly easier when we engage our core and don't have to put pressure on our chest and arms.
Scar Tissue: PT can help soften scar tissue and increase flexibility across the chest, under the arms and back. It can also help prevent capsular contracture, which can form as our body's response to the presence of breast implants.
Sensation: Working with a physical therapist can help restore sensation at the surgical site and in the case of skin and nipple-sparing mastectomies, on remaining tissue.
In addition to helping to improve these symptoms, PT keeps us connected to our body, noticing small and large changes, as we heal. This mindfulness is a powerful tool for not only acute recovery, but also into the years beyond, when we need to stay vigilant around the possibility of recurrence.
Nonphysical Benefits of Physical Therapy
Ultimately, though, PT isn’t solely about addressing physical needs and changes; it also supports our emotional and psychological well-being. Knowing that we're "doing something" to help ourselves can feel productive and empowering. By proactively participating in our own healing, we can regain a sense of control, increase strength as well as build resilience.
The connection we share with our physical therapist can also be a safe space to voice concerns, ask questions and receive support from a professional during this unique period of time. Such communication may provide a sense of calm in being able to freely express our fears and issues — topics we may not feel comfortable sharing with our loved ones. It may also take some of the pressure off of our friends and family who may not know exactly what to do or say.
Embracing Our New Selves
Most cancer survivors will attest that our body is forever changed after undergoing a mastectomy. As a result of surgical changes, weight gain or loss due to chemotherapy and radiation treatment, hormonal therapies, menopause and lymphedema, we're forced to accept a new normal. Physical therapy is a profound modality that can help us adapt to these changes, offering practical ways to minimize these issues, mindfulness around body changes and nurture ourselves, both externally and internally.
"Your body, mind and spirit need to heal together. It's not just about surviving; it's about thriving and living your best life." – Joan Lunden
