Physiotherapy can play an important role in the post-operative management of women whom have undergone a partial or total mastectomy. Pain in the neck, shoulder complex, and arm can occur for a variety of reasons and is often associated with adhesions and scarring that develops around the incision as a result of the surgery and/or radiation. It can also be a result of irritation of one or more of the nerves in the chest wall, which may be entrapped by scar tissue or which may have been cut during surgery. When this occurs, the arm is often held in a guarded position which may initially ease the pain, but ultimately causes tight musculature and fascia, particularly in the front of the chest and into the neck leading to restricted range of motion and poor postural habits.
If reconstruction surgery is performed, tension may be felt through the abdominals, low back as well as the hips. These areas of the body can also become weak post surgery. The pelvic floor muscles may also be involved resulting in discomfort with intercourse, incontinence, and weakness in this area of the body.
Lymphedema, or swelling in the arm, is a common concern. Swelling in the arm can range from mild to severe and can be temporary or permanent. It may occur with the removal of lymph nodes during the surgical procedure (lumpectomy, modified radical/radical mastectomy), and/or from radiation therapy, which can lead to the formation of scar tissue in the underarm. The lymphatic vessels can become blocked and the lymph fluid won’t drain as readily, resulting in arm swelling. Lymphedema may be present immediately after the procedure or may not occur until several years after.