Family Physical Therapy Services

BREAST AUGMENTATION

Women may choose to have breast enlargement surgery for various reasons. These reasons may include feelings that their breasts are under developed, differences in the size of the breasts, changes to the breast from pregnancy or breast feeding, weight loss, or aging. No matter the reason for breast augmentation, rehabilitation from breast surgery can and should begin before the surgery itself.

Patients who are to undergo breast surgery, no matter the extent of the procedure, will benefit from a physical therapy program that includes a baseline evaluation before the surgery, followed by exercise that begins immediately after surgery - the most critical period of time for rehabilitation.

Why begin physical therapy so soon? The most common physical problems resulting from breast augmentation are in a large part, preventable. We want you to enjoy your new features, not be limited by them.

COMMON PROBLEMS

Patients that have breast augmentation frequently experience:

Limited upper extremity mobility (range of motion)
Arm weakness and swelling
Fatigue
Shoulder dysfunction
Back pain
Chest pain

Patients may not immediately notice these difficulties, as they may have intentionally kept their arms immobile for fear of hurting the incision. It may be only when a patient tries to lift something, perform household chores, drive - or even zip up a zipper - that she realizes she cannot move her arm as she once could.

Several of the post-surgical problems are interrelated. The surgery itself and scarring from it can, for example, tighten the skin on the chest wall and form fibrous adhesions, which can cause shoulder joint dysfunction. This dysfunction can lead to improper joint use, in turn causing the joint to contract, or tendonitis to develop. The results are pain, muscle spasms, immobility and the loss of range of motion.

OTHER DIFFICULTIES

Additional difficulties may result from breast augmentation may include:

One of the most significant complications of breast surgery is lymphedema, or swelling of the arm. In addition to causing discomfort, such swelling can produce other complications, including infection as well as changes in posture and musculoskeletal problems related to the increase in the arm's weight.
The scapula, or shoulder blade, is susceptible to problems after surgery. Trauma to the long thoracic nerve during surgery can cause temporary or permanent paralysis of the muscle that helps stabilize the scapula (the serratus anterior muscle). A scapula that wings or sticks out may be first noticed by family or friends. The patient may notice problems while trying to reach for something, or when headaches, low-back pain, or interscapular pain occur.
Sometimes through the body's natural healing process, the implant (seen as a foreign object by the body) can become encapsulated. This can occur anytime after surgery but typically within a few months post augmentation. This encapsulation can cause the implant to look distorted and to feel hard or misshapen and potentially painful. Through soft tissue work and manual physical therapy we will work with you to treat this conservatively instead of, or in adjunct to, surgical correction. Please note that if surgical correction is performed, it is possible for adhesions to form or for encapsulation to occur again.
If infection occurs, it is usually within days or weeks of the surgery. Though rare, infection can occur long after breast surgery when the incisions are completely healed. In rare cases, the implant is removed until the infection subsides, and replaced at a later date. In the case the implant is removed and then replaced, physical therapy should be sought for this challenging time to ensure range of motion is maintained, pain is minimized, and adhesions or scar tissue is reduced.
Bottoming out occurs when the implant is too low in the breast tissue; this may cause the nipple to point upwards. Through soft tissue work and manual physical therapy we will work with you to treat this conservatively instead of, or in adjunct to, surgical correction.
Symmastia is when the breast implants cross the breast bone, this produces the appearance of breasts being too close to each other. This can occur when the plastic surgeon attempts to increase cleavage by releasing the soft tissues or origins of the pectoralis muscles. Surgical correction may be necessary. This can involve removing the implants, closing the space in the middle of the chest with internal sutures, and then reinserting the implants after at least 12 weeks. During implant reinsertion larger implants may be exchanged for smaller implants. A special support bra and supportive bandages may be required for improved tissue healing. Through soft tissue work and manual physical therapy we will work with you to treat this conservatively instead of, or in adjunct to, surgical correction.
Nerve entrapment by adhesions or cutaneous nerve regeneration may cause chest wall pain and numbness. These conditions are often worse for patients who have undergone reconstructive surgery.
Abdominal pain often occurs after reconstructive surgery.

FAMILY PHYSICAL THERAPY TREATMENT

The degree of difficulty patients encounter with any of these complications varies with the extent of the disease and the procedure, as well as age and prior orthopedic problems.

Recovery from breast surgery - which may take several years - is however, even more directly linked to the timing, intensity and quality of a rehabilitative physical therapy program.

With a preventative goal, a physical therapist will begin treatment before surgery to:

Establish a baseline functional ability and arm circumference.
Instruct patient on how to prevent shoulder limitations.

Immediately following surgery - ideally while the patient is still hospitalized - a physical therapist will re-evaluate the patient to determine the extent of dysfunction, set rehabilitation goals and begin assisted and self-managed exercise.

A good physical therapy program, such as the individualized programs available through Family Physical Therapy Services, may include:

Instruction in proper posture and relaxation techniques
Gentle stretching
Active assisted motion
Range of motion exercises
Strengthening exercises
Massage
Design of a home exercise program
Wound and skin management
Transcutaneous electrical nerve stimulation (TENS)
Desensitization techniques
Abdominal exercise for reconstructive surgery patients
Education about and treatment for lymphedema and its prevention (including skin care, the avoidance of strain, the reduction of fluids, improving the skin's elasticity, reducing the risk of inflammation)

ERCHONIA LASER

To provide the best treatment possible to our patients, we have the Erchonia PL Series Laser. Low-level laser therapy is simply the use of low intensity photonic energy as a treatment modality. The photonic stimuli excite the body's cells infusing them with energy; this allows for inflammation reduction, cell regeneration, and increased blood flow. This laser allows us to treat a number of issues such as pain, tissue injury, and wound care. Below is researched information regarding the use of low-level laser therapy to treat issues such as neck and shoulder pain, surgeries, wound & burn care, bone healing, and breast augmentation.

Jackson, Roche, and Mangione's study, Low-Level Laser Therapy Effectiveness for Reducing Pain After Breast Augmentation, provided evidence that low-level laser therapy is effective at significantly decreasing postoperative pain and the amount of pain medication needed after breast augmentation at 1 day and 1 week. The laser therapy was found to be easily and safely administered with no adverse reactions noted.

Because prevention in the key to recovery, Family Physical Therapy Services encourages patients who have experienced breast surgery to begin treatment as soon as possible. All programs are customized to the specific needs of each patient and are administered with continuing communication with and support from the patient's physician throughout the duration of treatment.

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