Recently, a charming young woman named Sally came in to my office after having a mastectomy. She was sporting a cute hat and said that she had just finished chemo and was on her way to radiation oncology. She said she had surgery over eight months ago, and she wondered if she should be coming to physical therapy. She said she was stiff in the morning in her shoulders, and that one of her scar lines was thicker than the other, with a little fluid along the scar, too. Otherwise she was doing well, she thought.

Over 18 years ago, I started treating clients after breast cancer surgery and our goal is still the same. Early rehabilitation in physical therapy after surgery yields the best results for our ladies in every physical way. Just as early detection is key, so is early treatment in therapy for the best quality of life after surgery. In fact, our best results are with ladies who come in after their drains are removed, which is usually about two weeks or so after surgery. We can then start gentle active and assisted range of motion, and begin the re-direction of lymphatic flow patterns due to lymph nodes being removed. It doesn’t matter if only the sentinel node is removed or a dozen nodes are removed, the re-direction of the lymph system is needed and the body needs help in knowing where to go with that fluid, because it is no longer being picked up by the nodes that are gone.

The scar also needs to be mobilized; this starts in the next two weeks. The scar line should be able to move in every direction with no areas of “pulling or tagging.” Something called “axillary cording” can also begin in the armpit after surgery. It usually starts very slow and almost has the feel of guitar strings, then it becomes thicker, like a strand of rope. It especially needs to be released, otherwise it will slowly begin to limit your mobility, and you will not even notice it. To check yourself for it, lie on your back and put your arm on the pillow over your head. Then rub your fingers across your armpit. If you feel any rough or thick areas when you compare it to the other side where no nodes were removed, then you know that axillary cording is beginning to occur. This cording should not be there and can be reduced with the right stretching, massage and exercise.

The key before you have radiation is to make sure you have full shoulder flexibility, mobile scar lines without axillary cording, and to have no swelling in the chest wall or under the arm pit. Radiation is often the hardest on the system. It is because a lot of fibrosis can occur when you are having radiation. Fibrosis is when the tissue layers become thick and tough. There, natural elasticity decreases, and then swelling and fluid backs up in certain areas. The tissues that were flexible before will become stiff and hard to move again. If there was any axillary cording starting, it will often become worse after radiation also.

Physical therapy rehabilitation after breast cancer surgery is a four-step process. If you are doing the four steps you will have done everything you can to take the best care of you. Come to physical therapy and learn the four steps, Sally did, and so can you.

Sheree DiBiase, PT, and her staff can be reached at (208) 667-1988 for the full four-step rehabilitation plan for breast cancer. Lake City Physical Therapy.