From: Denise Stewart, founder of Breast and shoulder rehabilitation and breast cancer occupational therapist.
The soft tissues of the breast, chest, shoulder, neck, and arm are directly affected by breast cancer surgery, chemotherapy, and radiation therapy. Each of these treatments has different effects on each person. However, there are some common experiences that can be better understood and managed.
Let’s focus on the mastectomy, the resulting mastectomy scar, and some common experiences.
I have reported women dutifully putting oil or their best cream on their mastectomy scar line every day after the wound has healed so they can have a soft, “good” scar.
What’s wrong with this treatment option? There are two problems:
- The scar tissue extends much further than that Mastectomy (surgical) scar line where the skin was sewn together. Scar tissue forms as a normal healing response wherever tissue is cut or damaged. So, in a mastectomy, scar tissue must be effectively formed over the entire area where the breast tissue against the rib cage has been removed and where the breast tissue has been removed from the skin. Let’s call this area that Mastectomy chest scar . On the side of the body, the scar can form and connect to the soft tissues that enter the arm, pectoral muscle, lymphatic structures, serratus muscle, and other muscles connected to the shoulder blade. Therefore, the scar tissue that forms after a mastectomy can potentially be a very large area and potentially affect the stretching of other soft tissues in the nearby areas of the arm and shoulder blade, as well as the ribs (Mastectomy chest scar).
- Oil or cream applied to a mastectomy scar line will not cause any directional stretching of the deep scar tissue of the surgical scar line or the mastectomy breast scar.
Scar tissue that forms in the healing phase is often deposited in directions that are not in the same direction as the previous tissues. In other parts of the body, as the scar tissue matures (changes over time), our movement creates internal directional forces, which in turn help correct the direction, length, and softness of the scar tissue.
Properties of new scar tissue on the mastectomy (surgical) scar line and the mastectomy breast scar?
Some women may have a very bad feeling throughout this breast area of the mastectomy, it can feel dull.
The skin over the entire area may feel too attached to the rib cage and unable to stretch in the many directions in which the skin normally stretches.
Some women develop a significant one Tenderness / pain to light and deep touch.
In the weeks and months after surgery, the scar tissue has very limited stretch. When connections are formed with nearby tissue, movement in the arm is restricted. It can be difficult to get full reach behind the body.
The mastectomy (surgical) scar line will look red or darker than your skin color. This scar line can warp and stick to nearby structures (e.g. the pectoral muscle, the tissue that covers the ribs).
Fluid can collect below the horizontal scar line because the lymphatic vessels cannot pass through the scar tissue.
Does the scar tissue change over time?
Over time, the scar tissue can change, it can stretch, and connections to nearby tissue can even loosen or reshape.
Pain cannot occur if the tissue is touched and the scar line turns a lighter color. In order for the scar tissue to be changed and reshaped, a stretching or directional force must primarily be exerted on the scar tissue.water) and a good blood supply.
It is the first requirement – stretch, or directional force, that is a problem for the mastectomy scar tissue. In many cases, the scar tissue may not be stretched enough due to its position on the chest.
The typical time it takes for new scar tissue to turn into mature, stretchy scar tissue is approximately two years. This period is extended when radiation therapy is performed.
Can we help change and remodel the scar tissue from a tight mastectomy?
Because mastectomy scar tissue covers a large area and scar tissue changes take a long time, an assisted self-management approach may need to be adopted to achieve better results for women. Self-management requires:
- Learn and use Self-assessment Ability to evaluate stretch in tissue across the entire chest area;
- Learning and using a good strategy for assessing and restoring arm and shoulder blade movement;
- Frequently use treatments that produce a positive change in the tight scar tissue in the first 6 to 12 months after breast surgery.
- Use treatments regularly to make a positive change in scar tissue in the 12 to 24 months after breast surgery.
- Use treatments regularly to produce positive scar tissue change for 2-4 years if radiation therapy has been performed. and
- For some women, a management program may need to be carried out for decades.
Training, specialty treatments, monitoring and coaching are recognized support services for self-management programs for other chronic conditions. Women with problematic scar tissue with tight mastectomy also need support from breast cancer rehabilitation and exercise specialists.
The next blog will continue to discuss shared mastectomy scar tissue experiences and management options.
- Soft parts are muscles, skin, fat, fascia, blood vessels and nerves.
- Women with severe radiation therapy damage can be an exception to this type of self-management program.
Denise Stewart, founder of Breast and shoulder rehabilitation and an occupational therapist trained in Australia at the University of Queensland. Her career began in a large public hospital where people with very serious and chronic illnesses and injuries were rehabilitated.