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Mastectomy, the surgical removal of the breast, is a procedure often undertaken to treat or prevent breast cancer. It can cause a variety of side effects, including tightness in the chest, which can be caused by the development of scar tissue, shortening of the muscle, or the effects of breast reconstruction. In some cases, part of the chest wall muscle is also removed. This can result in a limited range of motion in the arm and shoulder and an imbalance in upper-body strength.
| Characteristics | Values |
|---|---|
| Chest tightness | A common occurrence after mastectomy due to scar tissue formation, muscle shortening, and breast reconstruction. |
| Shoulder range of motion | Mastectomy can affect the shoulder's range of motion, causing tightness and pain. |
| Upper limb strength | Mastectomy can lead to an imbalance in upper limb strength, with greater strength loss on the affected side. |
| Chronic pain | Mastectomy can cause long-term pain in 40-60% of patients, impacting their physical and psychological well-being. |
| Nerve injury | Sensory nerve injuries during mastectomy can lead to chronic pain and altered sensations. |
| Muscle removal | In some cases, part of the chest wall muscle is removed during mastectomy, which can affect muscle strength and function. |
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What You'll Learn
Mastectomy and chest tightness
Mastectomy is a surgery to remove a breast, and sometimes other tissues near the breast, such as lymph nodes. It is most often used to treat breast cancer. In some cases, a mastectomy is done to help prevent breast cancer in women who are at high risk of developing it.
A person can experience chest tightness after a mastectomy. This is a normal and expected side effect of the surgery. The muscles in the front of the chest and those around the shoulder may tighten after a mastectomy. The largest of these muscles, the pectoralis major, performs two main actions: it pulls the arm inward and pushes it forward. A mastectomy can affect the pectoralis major and result in a limited range of motion of the arm. The shortening of the muscle can occur when the surgeon removes the covering of the pectoralis major, called the fascia, in a simple mastectomy, or the pectoral muscles under the breast in a radical mastectomy. They also remove surrounding tissue and skin. This may cause the muscle to shorten, leading to a feeling of tightness.
Inflammation and muscle spasms can also cause tightness and pain after a mastectomy. The development of scar tissue can contribute to this, as it can form around an implant and begin to tighten and squeeze it, causing a feeling of tightness and distortion. In some cases, surgery may be required to remove the scar tissue and replace the implant. The length of time a person experiences chest tightness after a mastectomy depends on the cause of the sensation. Recovery can take several months, especially if breast reconstruction is involved.
To alleviate chest tightness, a person’s healthcare team will usually recommend a series of exercises to be done with a physical or occupational therapist and at home. These exercises help to reduce pain and tightness in the chest, neck, and shoulders. They can also help restore a person’s range of motion in their arms and shoulders. However, if the exercises do not provide relief within the expected timeframe, or if the pain intensifies, it is important to contact the surgeon for further advice or medical assistance.
It is important to note that chronic pain after a mastectomy can significantly impact a person's quality of life, including their physical well-being, autonomy, relationships, and psychological well-being. This type of pain has been linked to sensory nerve injuries caused by the transection, stretching, or scarring of small sensory nerves during the surgery. Treatment options for managing this pain include opioid medications, NSAIDs such as ibuprofen, and neuropathic drugs. However, these treatments may not always be effective and can have adverse side effects.
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Breast reconstruction and chest tightness
Mastectomy is surgery to remove a breast, sometimes performed to treat breast cancer. In some cases, it is done as a preventive measure for women who have a high risk of developing breast cancer. During the procedure, other tissues near the breast, such as lymph nodes, may also be removed.
After a mastectomy, it is normal to experience chest tightness. This can occur due to various reasons, such as the development of scar tissue, shortening of the muscle, or the effects of breast reconstruction. The tightening of the muscles in the front of the chest and those around the shoulder can lead to a limited range of motion in the arm.
Breast reconstruction surgery can be performed during the same procedure as the mastectomy or as a staged process. The surgery can affect the muscles and cause a temporary feeling of tightness. This tightness occurs when scar tissue forms around the implant and begins to tighten and squeeze it. It can cause a feeling of tightness and may even appear hard and distorted. The swelling and bruising that cause chest tightness after reconstruction can last up to 8 weeks, and tight scar tissue can take up to 2 years to fully heal.
To alleviate chest tightness, a person’s healthcare team may recommend a series of exercises to be performed with a physical or occupational therapist and at home. These exercises help reduce pain and tightness in the chest, neck, and shoulders. Additionally, weight-bearing exercises, such as chest presses and tricep presses, can be introduced after getting clearance from a surgeon.
If the exercises do not provide relief within the expected timeframe, or if the pain intensifies, it is important to contact a surgeon. In some cases, surgery may be required to remove the scar tissue or replace the implant.
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Upper-limb dysfunction
A mastectomy is a surgical procedure to remove the breast, nipple, and areola, and it is often performed to treat or prevent breast cancer. In some cases, the entire breast, including the chest muscles under the breast, is removed. As a result, patients may experience chest tightness and upper-limb dysfunction.
Several studies have investigated the effects of mastectomy on upper-limb function. One study found that patients who underwent a mastectomy demonstrated more considerable changes in scapular kinematics during upper-limb movement compared to those who had breast-conserving surgery. The decrease in shoulder range of motion was more prominent in mastectomy patients, and this limitation was correlated with functional performance, as assessed by the K-DASH (Korean version of the Disability Arm and Shoulder Questionnaire) score.
Another study by Yang et al. (2012) assessed the impact of early free range-of-motion upper limb exercises after mastectomy and immediate implant-based reconstruction. They found that patients who started free upper limb exercises 15 days after surgery experienced less pain, greater shoulder amplitude, and better upper limb function compared to those who had restricted movement for 30 days. These findings highlight the importance of early postoperative exercise interventions in improving functional outcomes and reducing pain.
Furthermore, a double-blind, randomised controlled trial by Yuksel et al. (2021) investigated the effect of a mixed solution of sodium hyaluronate and carboxymethyl cellulose (HA-CMC) on upper limb dysfunction after total mastectomy. They hypothesised that applying HA-CMC to the pectoralis major muscle after surgery would reduce pain and improve the range of motion of the shoulder. The study included 99 women with breast cancer who were randomly assigned to either the HA-CMC group or the control group. The results of this trial could provide further insights into effective treatments for upper-limb dysfunction following mastectomy.
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Resistance training to improve strength
A mastectomy involves the removal of the breast, nipple, and areola, and is most often performed to treat or prevent breast cancer. In some cases, chest wall muscles may also be removed. As a result, patients often experience chest tightness, which can be temporary if breast reconstruction is done.
To alleviate chest tightness and improve arm strength, doctors recommend exercises that can be performed with the guidance of a physical or occupational therapist. These exercises are tailored to the patient's general health, medical condition, and fitness.
Resistance training is one such exercise that can improve upper extremity strength in breast cancer survivors. A study on 17 right-arm-dominant women with unilateral mastectomy found that resistance training improved strength in the dominant arm by 25% and in the non-dominant arm by 19%. Another study found that resistance training resulted in a 50% greater strength gain in the initially weaker upper extremity, effectively equalizing bilateral strength.
It is important to consult with a doctor or physical therapist before starting any exercises to ensure a suitable program is designed, taking into account the patient's specific needs and limitations. Strength-building exercises typically start with small hand weights and are gradually increased over time. Deep breathing exercises can also help relieve discomfort and tightness around the incision.
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Chronic pain after mastectomy
Mastectomy is a surgical procedure to remove the breast, nipple, and areola, and it is most often used to treat or prevent breast cancer. Sometimes, other tissues near the breast, such as lymph nodes, or chest muscles, are also removed.
Following a mastectomy, it is normal to experience chest tightness. This can be due to the development of scar tissue, shortening of the muscle, or the effects of breast reconstruction. The pectoralis major muscle in the front of the chest may be affected, resulting in a limited range of motion of the arm. The tightening of chest muscles can also be associated with reduced shoulder range of motion, which can lead to upper limb dysfunction.
Chronic pain, lasting longer than three months, after a mastectomy is a common complication, affecting 40 to 60 percent of patients. This pain can significantly impact various aspects of life, including physical well-being, autonomy, relationships, and psychological well-being. It can also lead to decreased work function, increased healthcare utilization, and an increased risk of depression. The severity of the pain is comparable to that experienced by patients who have undergone limb amputation, with average pain scores of 8 out of 10.
Post-mastectomy pain syndrome (PMPS) is a specific type of chronic pain that occurs after breast cancer surgery. It is characterised by nerve (neuropathic) pain in the chest wall, armpit, and/or arm that persists long-term. Younger women who have undergone a full axillary lymph node dissection are more likely to experience PMPS. The pain can manifest as numbness, shooting or pricking sensations, or unbearable itching.
The management of chronic pain after mastectomy can be challenging. Opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and neuropathic drugs like gabapentin or amitriptyline are often used, but they may not provide complete relief and can lead to adverse effects. Peripheral nerve surgery may be an option for some patients, as injured nerves are a common source of post-mastectomy pain. Nerve block during surgery and targeted muscle reinnervation have also been suggested as potential preventive measures for PMPS. Additionally, pharmacological agents like gabapentinoids, memantine, and nefopam have been found to be effective in reducing acute pain and the development of PMPS.
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Frequently asked questions
A mastectomy can weaken chest muscles, but this is not a given. A mastectomy is the removal of the breast, and sometimes other tissues like the nipple, areola, and lymph nodes. In some cases, part of the chest wall muscle is also removed. This can lead to a weakening of the chest muscles, but it is not guaranteed.
To prevent a weakening of the chest muscles after a mastectomy, patients can undergo breast reconstruction surgery during the same procedure. This can help to rebuild the chest muscles and improve the symmetry and aesthetics of the chest.
Yes, a person’s healthcare team will usually prescribe a series of exercises to be done with a physical or occupational therapist and at home. These exercises can help to alleviate pain and tightness in the chest and improve range of motion in the arms and shoulders. Resistance training has also been shown to improve upper-body strength after a mastectomy.
There is a high chance of experiencing chest muscle weakness after a mastectomy. Studies have shown that 40 to 60 percent of patients who undergo the procedure suffer from chronic pain lasting longer than three months. This pain can be similar in severity to that experienced by limb amputation patients.
