Breast reduction may be necessary for men or women. In women, enlarged breasts
are called breast hypertrophy, and in men, enlarged breasts are called gynecomastia.
Typically, breast hypertrophy in women occurs in both breasts at puberty or
soon afterward, although pregnancy related breast enlargement can persist indefinitely.
There is also a rare possibility of women experiencing sudden onset breast enlargement.
About half of all men today have excess localized fat and/or excess glandular
tissue in one or both breasts. Gynecomastia accounts for more than 65 percent
of all male breast disorders, according to the American Society of Plastic Surgeons
(ASPS). In most cases, the cause is unknown. Gynecomastia can be caused by an
imbalance of the sex hormones estrogen and testosterone, certain endocrine disorders,
tumors, chronic diseases, anti-depressant medication, blood-pressure medication,
marijuana, steroids, lavender oil, or tea tree oil. True gynecomastia will not
improve with diet and exercise because the fat pockets that form will be resistant
to these health changes. Rehabilitation from breast surgery, including liposuction,
can and should begin even 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 physical therapy treatment that begins immediately
after surgery - the most critical period of time for rehabilitation.
Why physical therapy before and after reduction? The most common physical problems,
pain, and dysfunction that come with large breasts can be improved by physical
therapy to encourage better surgery outcomes, faster recovery time, and improved
pain management. Many plastic surgeons recommend that activity should be kept
to a minimum for 1-2 weeks and that heavy lifting or pushing should not be allowed
for 3-4 weeks. We will provide education, guidance, and support so that you
can get back into physical activity and your daily activities with less fear
and anxiety.
COMMON PROBLEMS
Patients that have breast reduction frequently experience:
Limited upper extremity mobility (range of motion)
Arm weakness and swelling
Fatigue
Shoulder dysfunction
Back pain
Chest pain
Uncomfortable or painful scars
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 they realize their arm does not move as it 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. Once the stitches are removed and the incisions are closed
we will provide and instruct you how to perform gentle scar massage to help
improve the shape, movement, and pliability of your scars.
OTHER DIFFICULTIES
Additional difficulties may result from breast reduction surgery 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). This may be first noticed when the patient tries to reach for something, or when headaches, low-back pain or interscapular pain occur.
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.
Over-compensating for the loss of breast weight may cause prolonged spasms of the rhomboids or trapezius muscles.
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)
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.