After breast cancer treatment, many women feel like they need to take some time for themselves to recover. This is completely understandable! However, it's important to make sure that you're taking the necessary steps to fully recover. In this blog post, we will discuss breast cancer rehabilitation and how to make the most of your recovery process.
1. Treat and reduce risk of Lymphedema
How do I know if I have Lymphedema?
Lymphedema after breast cancer is often swelling that is present in the affected side arm, breast, chest, or neck area. When lymph nodes are removed or vessels are damaged in the arm pit region of the body, lymphedema can develop. An axillary lymph node dissection has an increased risk because these nodes might be drainage pathways for the arm and breast tissue. When axillary lymph nodes are excised, this raises the risk of lymphedema developing in the arm by up to 30%. It's important to take steps to reduce your risk of developing lymphedemas. Some ways to do this include wearing compression sleeves or wraps, receiving Manual Lymphatic Drainage, exercise, and taking precautions to limit risk of exacerbating Lymphedema or swelling. A Certified Lymphedema Therapist (CLT) will be able to provide appropriate Lymphedema treatments and recovery using compression, MLD, bandaging, exercise and education on self-care.
2. If necessary, receive treatment for Axillary Web Syndrome.
What is Axillary Web Syndrome?
Consistent to current research, it is believed that Axillary Web Syndrome or "cording" is a natural but excessive lymphatic process linked to the body's natural healing mechanism. Lymphocele formation is associated with high protein content lymphatic fluid leaking from areas of vessel disruptions. It is proposed that this protein-rich liquid can lead to the formation of fibrotic tethering between the vessel and the subcutaneous tissue.
Our body drains lymphatic fluid through healthy vessels that move fluid along to collectors in regional lymph nodes. These arm collectors are within the surgical field for sentinel lymph node biopsy 40% of the time and up to 81% of the time for axillary lymph node dissection. Typically AWS is diagnosis within 2-8 weeks of Breast Cancer surgery.
If you have cording problems, it is advised that you see a trained Physical or Occupational Therapist. A warm compress, NSAIDs, controlled stretching, and soft tissue mobilization are some treatment choices. Normally AWS will clear in a few weeks with appropriate therapy.
3. Reduce risk of seroma
What is a seroma, and how does it arise?
A seroma is a pocket of lymph and inflammatory exudate that may develop following surgery. This pocket of liquid trapped under the skin is usually aspirated by a needle for quicker dissolution. The best method to reduce the chance of future lymphedema is to prevent seroma formation following surgery. For 2-3 weeks after surgery, delaying aggressive shoulder motion can help to avoid seroma development, as well as keeping shoulders at less than 90 degrees of flexion. Also, not enough compression may cause surgical site seromas and breast edema.
4. After surgery, address complex shoulder, thoracic, and rib mobility.
If your arm does not move adequately following mastectomy, or other breast cancer surgeries, tissue adhesions, shoulder stiffness, rib and clavicle rigidity, and lymphatic obstruction may occur.
Excessive motion after surgery might result in mastectomy skin flaps that don't adhere and seromas. Too much activity too soon can hinder lymphatic regeneration and increase the chance of lymphedema. After surgery, limit shoulder movement to around 90 degrees for approximately 2-3 weeks. To modify your environment, you may use a reacher for picking items off the floor, and rearrange your space such as placing dishes on counter to allow easier reaching and light lifting. Keep active by going for walks and carrying out activities within your limits during this time.
Then after the 2-3 weeks, you may begin the treatments and stretches that are designed to help you attain complete range of motion under supervision of a therapist. Begin recommended exercises and stretches for shoulders, thoracic area, and rib cage allowing full range of motion.
Symptoms of decreased mobility may include: stiffness in shoulders, upper trap spasms, and tightness in pectorals muscles. Weak areas can include mid, and lower traps and serratus anterior muscles. These dysfunctions can also result in poor postural control with forward shoulders, reduced scapular rotation and pain. Fascial adhesions in diaphragm area and in between ribs can also cause difficulty taking deeper breaths.
Ideas For Treatments:
Stretches: pectoralis minor/major, other shortened muscle groups
Strengthen: mid traps and lower traps, serratus anterior, etc (shoulder and scapula stabilizers)
Massage: soft tissue mobilization using compressive, bending and sweeping techniques for tightness and scarring
Heat: May help improve tissue elasticity and ease some pain
5. Decrease risk of breast cancer reoccurrence
A cancer diagnosis can be a wake up call to changing your health behaviors, now it's more important that ever to improve your chances or survival, decrease complications of treatments and recurrence.
Why is exercise and health behavior so important after a breast cancer diagnosis?
Patients with a high BMI (< 26) are more likely to have worse prognosis and overall survival after treatments than patients in a health BMI range in many studies. Modifying diet and exercise can improve overall health and well being throughout treatments. BMI of <30 in obese and morbidly obese result in a two to threefold increase in odds of developing breast lymphedema. Even if you were a couch potato before, studies show adding exercise after treatments can improve risk for mortality and recurrence.
Exercise!
Can help reduce risk of bone density decline
Decrease weight gain
Improve range of motion in shoulder
Prevent breast cancer recurrence
Reduce risk for onset of Lymphedema, seroma and axillary web syndrome
Improve risk of mortality
Reduce calorie intake and increase activity to reduce weight. Cardio exercise and weight training are very beneficial for the heart and bone health. To reach approximately 180 minutes of activity each week, try to walk 30 minutes every day 6 days a week. Smoking and drinking alcohol must be stopped. Focus on nutrition by eating more fruits and vegetables while eliminating processed and sugary foods.
6. Manage Stress
Many breast cancer patients experience anxiety and stress as a result of their disease and treatments. Especially in the case of people with fast-spreading cancer, finding some activities to unwind is critical. When our bodies are at rest, it is possible for it to heal. You may try: deep diaphragmatic breathing, relaxing activities, meditation, proper sleep, mindfulness, walking and exercise help to reduce anxiety and promote calm nervous system function.
Hope this helps in your recovery! Feel free to reach out to a skilled professional in your area with a background in Breast Cancer Rehabilitation. Unfortuneately, Breast Cancer patients can be very underserved without realzing that they are deserving of caring professionals to improve their quality of life long after their cancer treatments and surgeries. Feel free to contact Wisconsin Lymphatic Therapy located in Madison, WI, for any questions.