A mastectomy itself is a treatment, not a condition with symptoms. However, after the surgery, patients may experience various post-operative symptoms and complications. These can be short-term or long-term:-

• Immediate Post-Operative Symptoms:
• Pain and discomfort: Around the incision site and potentially in the armpit.
• Swelling: Short-term breast swelling or a build-up of fluid (seroma) or blood (hematoma) at the surgical site.
• Numbness and tingling: Due to nerve damage during surgery, particularly in the chest wall and under the arm. This can be temporary or permanent.
• Phantom breast pain/sensations: Feeling pain or sensations in the breast that has been removed.
• Bruising: Common around the surgical area.
• Fatigue and weakness: Common after any major surgery.
• Nausea: From anesthesia.

Potential Long-Term Complications/Symptoms:

• Lymphedema: Swelling of the arm, hand, or chest on the affected side, especially if lymph nodes were removed (axillary lymph node dissection). This is due to impaired lymphatic fluid drainage.
• Shoulder pain and stiffness/reduced range of motion: Common due to scar tissue, nerve damage, or guarding.
• Scar tissue: Can be hard and painful.
•  Infection: At the incision site.
• Chronic pain: Persistent pain, sometimes described as shooting, prickling, burning, or stabbing, often due to nerve injury (neuropathic pain).
• Body image and psychological impact: Depression, anxiety, and feelings of loss of sexual identity can occur.
• Deep vein thrombosis (DVT): Blood clots in the legs, with a small risk of pulmonary embolism.

Advanced Physiotherapy for Mastectomy Recovery

Physiotherapy is crucial for optimizing recovery after a mastectomy, addressing both physical and emotional aspects. The goal is to restore strength, mobility, and function, and manage potential complications.

• Pain Management:
  • Modalities: Cryotherapy (ice) for swelling and inflammation, heat therapy (once cleared by surgeon) for muscle relaxation.
  • Manual therapy: Gentle massage around the incision (once healed) to reduce scar tissue tightness and improve circulation.
  • Myofascial release: Techniques to address tightness in the fascia (connective tissue) around the chest, shoulder, and back.
• Restoring Range of Motion (ROM) and Flexibility:
  • Early gentle exercises: Started often the day after surgery, focusing on finger, wrist, and elbow movements to promote circulation and prevent stiffness.
  • Progressive shoulder exercises:
    • Shoulder shrugs and circles: To relieve tension and improve general shoulder mobility.
    • Arm lifts (wand exercises): Using a stick or broom handle to gently assist the affected arm in overhead movements.
    • Wall climbing/slides: Gradually increasing arm elevation against a wall, ensuring proper body alignment.
    • Doorway stretches: To gently stretch the chest muscles.
    • Hands behind neck/back stretches: To improve internal and external rotation of the shoulder.
  • Mobilization techniques: Specific manual techniques to address joint restrictions in the shoulder and thoracic spine.
• Lymphedema Management: This is a critical component for patients who have had lymph node removal.
  • Manual Lymphatic Drainage (MLD): A specialized, gentle massage technique performed by a certified lymphedema therapist to encourage the flow of lymphatic fluid away from the swollen area.
  • Compression therapy: Custom-fitted compression garments (sleeves, gloves) to help reduce and prevent swelling.
  • Decongestive exercises: Specific movements designed to pump lymphatic fluid.
  • Skin care: Education on proper skin hygiene to prevent infection in the affected limb.
  • Education: Teaching patients about risk reduction strategies for lymphedema.
• Strengthening:
  • Gradual progression: Starting with isometric exercises and progressing to resistance exercises as healing permits.
  • Scapular stabilization exercises: Strengthening muscles around the shoulder blade to improve shoulder mechanics and posture.
  • Core strengthening: To support overall body mechanics and reduce strain on the upper body.
• Scar Mobility and Tissue Release:
  • Scar massage: Once the incision is healed, gentle massage helps to soften the scar tissue, reduce adhesions, and improve skin elasticity.
  • Instrument-assisted soft tissue mobilization (IASTM): Specialized tools to break down scar tissue and adhesions.
• Postural Correction:
  • Many patients adopt a protective posture (slumped shoulders, rounded back) after surgery. Physiotherapy addresses this through exercises and education to promote an upright, open posture.
• Functional Rehabilitation:
  • Gradual return to daily activities, including dressing, showering, cooking, and eventually recreational activities and work.
  • Ergonomic advice for home and work environments.
• Cardiovascular Fitness:
  • Encouraging light cardiovascular activity (walking) early on, gradually increasing intensity to improve overall stamina and well-being.