Post Mastectomy: Rehabilitating Range of Motion

Written by Anne C. Willis, L.E., C.M.E., founder and CEO of De La Terre Skincare®

Medical treatments for breast cancer have dramatically improved over the last decade. While these treatments have significantly increased survival rates, they are not without lasting, adverse effects. Cancer patients undergo many changes to their body and skin while receiving medical-oncology treatments. Side effects from chemotherapy, radiation, and surgery put great demand on the body. This demand reduces nutrient resources, lymphatic flow, range of motion, and increases the healthy cell’s exposure to oxidative stress. Though survivorship has increased, the lasting effects of medical-oncology treatments reduce patients’ quality of life and can leave them with debilitating impairments and changes to overall health.

After a mastectomy, the upper body will undergo physical injuries that can affect the range of flexion and extension in the arm, upper torso, and neck joint. The restrictiveness of regional, physical dysfunction not only triggers physical discomfort and pain, but also impairs head, neck, and shoulder mobility, contributing to lymphedema. Further damage to the lymphatic system can occur as a result of soft-tissue fibrosis. Fibrosis occurs when the tissue thickens during the reparative or reactive process of healing after surgery. This thick, stiff tissue obstructs the internal passageways of skin, inhibiting the movement necessary for proper detoxification and absorption of vital nutrients and limiting the ability of the skin to heal and recover.

The goal of skin therapies intended to meet the complex needs of individuals who have undergone mastectomies should include proper assessment of the clinical presentation of the skin. When skin demonstrates a light erythema and dry desquamation, skin care professionals may proceed with treatment. Treatment should only be avoided when the dermis is exposed or there is fluid weeping from the skin. Treatments should focus on reducing fibrotic tissue, supporting lymphatic flow, and restoring healthy skin function. Applying accepted, therapeutic compresses and redirecting lymph by activating lymph insertion points could accomplish this goal. Insertion points should not only be activated near the area of injury, but at insertion points throughout the body.

In addition, professionals will need to know the varying degree of medical-oncology treatment the patient has undergone, their current health status, and how they are managing the stress of their diagnosis and recovery. By accessing these stages of care, the professional will be able to determine the duration of time appropriate for administering treatment, how much therapy the body can manage, and how many sessions will be required in order to affect change to the condition.

Patients should not go into chemotherapy, radiation, or surgery in a compromised state or the outcome will increase delays in healing and impact overall recovery. Providing preemptive skin therapies to patients can improve the healing ratio, reduce the impact that detoxification has on skin health, and reduce the patient’s anxiety, allowing them to use these skin sessions as a tool to
manage stress.

It is vital to understand the patient’s limits and any contraindications associated with rehabilitating range of motion. There are areas of the body that practitioners should either avoid or handle with significant care when providing treatments. For instance, if a patient has undergone surgery, the next course of care may include chemotherapy. There are several ways that chemotherapy is administered, one of which is through a medical device called a port which is implanted under the skin on the chest. When administering skin therapies to the chest, practitioners should not apply pressure or techniques such as effleurage. Skin care products can be gently pressed into the skin, using little pressure, or applied over sterile gauze. Removal of products should be achieved through bathing the skin, using light activation.
If skin demonstrates extreme weakness, then great care needs to be demonstrated as to the choice of products and techniques applied. Anti-aging skin care products or products containing ingredients such as alpha hydroxyl acids, vitamin C, and retinol should be avoided, especially around the surgical site and the port implant. The goal should be to gently open internal passageways, increase nutritional resources, and gently prompt lymphatic movement.

Restoring mobility after a mastectomy and addressing changes to skin health requires therapies that are administered by professionals who have obtained specialized training and developed a standard for professional clinical practice. Protocols should not be oriented toward cosmetics, but rather a holistic, therapeutic, and healing approach. Patients have many needs! The opportunity for skin care professionals and massage therapists to help improve the quality of life for this fragile population will be at the forefront of the next chapter in cancer care.

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