Billerica, Mass. —
Physical therapy for patients who have undergone mastectomies can make all the difference as they return to their old lives.
At New England Rehabilitation, which has outpatient offices in Billerica, therapists combines strengthening exercise with more advanced techniques to help patients who have had mastectomies regain their full range of motion following surgery. Joana Ingram, a physical therapist at New England Rehabilitation in Billerica, said therapy is something patients should be thinking about even before the surgery begins.
“Most people wait,” Ingram said. “Most people don’t wind up coming here. They think the cancer is gone and they end up developing scar tissue, or worse-case scenario, they get lymphodema.”
Ingram said the level of therapy, as well as how long it lasts, depends on the patient. Age, physical condition, and the complexity of the surgery all play a role in determining how long therapy lasts. Regardless, she said patients should get it done as soon as possible.
The physical therapy following mastectomies ranges from strength-training exercise to more complex procedures. Dr. Deniz Ozel, medical director for New England Rehabilitation, said a weakness or swelling in the arms is the main after-effect of mastectomies or lumpectomies.
“There are problems that occur can lead to functional problems, like not being able to do daily activities,” Ozel said. “They reduce quality of life.”
Range of motion and strengthening exercises are the first step of the post-surgery therapy, with gentle stretching and exercises to strengthen the muscles around the shoulder and elbow, as well as endurance exercises. Ozel said patients are shown how to compensate for limitations in motion in order to maintain their independence.
Lymphodema, a condition of fluid retention and tissue swelling caused by a compromised lymphatic system, is another potential effect caused by mastectomies. Should this occur, therapists use a four-step process called complex decongestive therapy. The first part is massaging the skin, followed by manual lymph drainage. Elastic bandages can be used to keep fluid from building up, and a variety of exercises comprise the final step.
“This could be done over a the course of a few weeks to four weeks,” Ozel said. “Usually if it’s caught early it doesn’t take very long.”
Ingram, who is certified in lymphodema treatment, said taking measurements of the patient’s arms prior to surgery can help determine if lymphodema occurs. Should it happen, patients need to take care to observe their skin condition, and try and avoid insect bites or injections on the affected area. If a patient with lymphodema develops folds in their skin, they need to examine the areas between the folds.
Effects on the patient
For patients who do not undergo post-operational therapy, the effects can be significant. Patients who undergo mastectomies or lumpectomies and don’t exercise following surgery can develop a condition called frozen shoulder, where they lose all motion in one or both arms.
Ozel said this therapy has come to the forefront in recent years, as more patients survive cancer.
“They want to return to their old lives,” said Ozel. “People are not satisfied with having limited movement.”
Ozel said this therapy is especially important if the patient leads a very inactive lifestyle. Though the therapy does eventually end, therapists always recommend their patients to maintain the exercise and continue to build strength.
Ingram said there is often a psychological side to this work. Some patients, in pain following the surgery, may be unwilling to attend therapy sessions. Others can become depressed by the scarring or other effects of the surgery.
“We’re supposed to just treat the body, but a lot of time we wind up treating the mind of the patient,” Ingram said. “Not everybody who’s here wants to be here.”
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