All Parts are Equal or are They?

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When a person has back surgery or has had a limb amputated, it is standard for them to go through a rehabilitation process, including physical therapy or massage therapy to be prescribed. However, if a woman has breast surgery, rehabilitation (massage or physical therapy) is not automatically ordered and often not even suggested.
When a woman chooses to have her breasts removed, reconstructed, increased or reduced, it’s important that she understands not only the benefits of the procedures, but the risks as well. Chronic pain and postural problems can appear years later if rehabilitation is not completed following breast surgery.

Breasts are composed of mammary glands, connective tissue, blood vessels, nerves, and lymph vessels. Breast tissue can extend from the border of the breastbone near the center of the chest all the way to the armpit, and overlies the second to sixth ribs. The breast has an axillary tail, which is a tail of tissue that extends up into the armpit region. The breast lies on top of the pectoralis major muscle.
Breast tissue is part of the fascial web of connective tissue, which runs continuously throughout the body from head to foot and superficial to deep without interruption. Any alteration, even the slightest damage to the fascial network has major ramifications.
The body’s balance and symmetry can be significantly altered after a mastectomy, augmentation or reduction. This is something many women aren’t informed of or prepared for. Scar tissue is also a very important fact which women need to be aware of and prepared for. Unpredictable development of scar tissue is quite common after any surgery and can have long-term effects on the body.
Early intervention following breast surgery by a massage or physical therapist can play a pivotal roll in helping women heal and regain full function.
After mastectomy surgery a woman may experience tightness or pulling originating from her incision, which spreads across her body. This is caused by scar tissue, which is the body’s way of healing from surgery. The result can be very dense tissue under the incision, which is painful and which can restrict the arm’s range of motion (ROM). The restricted ROM puts women at risk for a painful condition known as frozen shoulder. Scars can range in size after a breast-conserving lumpectomy or a mastectomy procedure that removes the entire breast. Either way, most breast cancer patients are left with some sort of surgical scar as a by-product of their quest to heal.
In order to rebuild the breast, tissue is taken from another area of the body. It can be taken from several different locations. One host area is the Latissimus Dorsi. In the picture below you can see how much of the body is affected by this location.
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The TUG procedure uses skin and fat from the inner portion of the upper thigh; the incision scar will be hidden near the crease of the groin. The flap is named for the transverse upper gracilis muscle to which the skin and fat are connected. Muscle may be removed as part of the TUG flap.

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Radiation treatment for Breast Cancer has its own list of complications. This type of therapy not only changes tissue characteristics by making it more susceptible to breakdown, it continues to make tissues tighter for 2 to 5 years following treatment.

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It can also lead to:
Skin tightening;
Limited arm and shoulder mobility;
Chest expansion limitations;
Restrictions in and around the area of treatment.
Breast reduction surgery is still largely considered to be a cosmetic surgical procedure. However, it is most often performed to relieve significant physical and emotional problems resulting from overly large and/or heavy breasts. Surgeries are classified as “cosmetic” if it is an elective procedure that insurance does not cover. If it is a procedure that is restoring form or function, it’s referred to as “reconstructive”. Reconstructive procedures are often covered by insurance. The same procedure may be classified as cosmetic or reconstructive depending on how it impacts an individual. Public opinion still sees it as cosmetic but 9.5 times out of ten it is being performed to reduce pain or to alter the overall structure.

 

According to the American Society of Aesthetic Plastic Surgery, 112,964 breast reductions were performed in 2011. Breast reduction surgery leaves permanent scarring.

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The operation using the anchor technique leaves three scars:
One around the nipple (areola);
One from the nipple to the crease below the breast (this is the worst scar as it takes the most tension);
One from the breast bone to the armpit along the crease below the breast.

The severity of scarring largely depends on the individual. Most women are completely unaware of how the scar tissue is affecting them.

 

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Kelly Bowers, a massage therapist from Washington, DC states:
“I had breast reduction surgery in 1992. By 2012 I rarely thought of it and certainly didn’t think the scars were an issue any more. They were barely visible! Then I had scar release work. I was stunned at how far I felt the effects of the work. I felt it from my shoulder to my hip! I’m delighted I had a chance to experience this work and finally take care of these scars as they deserved to be taken care of.”
The American Society for Aesthetic Plastic Surgery also reported that breast augmentation is the most popular surgical cosmetic procedure for women, with more than 316,000 procedures performed in 2011. Yes, augmentation is an elective cosmetic surgery, but it is still a surgery that alters the body. Rehabilitative therapy is necessary after any surgery.

Women who have breast augmentation frequently experience:
Limited upper extremity mobility (range of motion);
Arm weakness and swelling;
Fatigue;
Shoulder dysfunction;
Back pain;
Chest pain.

 
Scar tissue can occur at any time after the augmentation has been performed, not just within the first few months. Capsular contracture is the term used to describe scar tissue that can form around breast implants which may cause the breasts to harden, look or feel different, and may cause some discomfort from the tightening of the capsule. Capsular contracture is an unpredictable complication, but it is also the most common complication following breast augmentation.

 
Scars left by breast augmentation surgery are usually hidden in the crease beneath the breast (inframammary fold incision), around the nipple (peri-areolar incision) or in the armpit (transaxillary incision). Rehabilitation/therapy and physical activity are integral to recovery and to reduce post-breast surgery side effects such as:
Scar tissue/soft tissue immobility;
Flexibility limitations;
Limited range of motion;
Decreased strength.

 
Even if a woman does not actually develop pain or limited function directly after the procedure, at some point pain and disability will become present if scar tissue is not addressed in a timely and proper fashion.

Do’s & Don’ts of Healing Scar Tissue-Tip #1

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Essential Oils or Vitamin E for Healing Scar Tissue

Whether it’s acne pockmarks, or the legacy of a burn, wound, or surgery, few of us like scars on our skin. And there’s no shortage of remedies that claim to make scars smaller, thinner, less noticeable, and heal faster. From natural at-home remedies to mass-produced and mass-marketed products, we are flooded with options that claim to help with scars. In this series of blogs, I will shed some light on natural and medical scar treatments.

What Should You Do to Heal Scar Tissue?

Do:

download (5)Use Lavender essential oil to treat scars especially burns. Lavender is one of the best all-round essential oil, according to Shirley Price in her book “Aromatherapy for Women.” Lavender oil is gentle, inexpensive and effective. Lavender essential oil can be used to treat acne, scars and most skin conditions; it can be applied direct to the skin, in small quantities.

Lavender essential oil is a very effective antiseptic, antibacterial, and antimicrobial that reduces pain, itching and promotes rapid healing. In addition, lavender reduces scarring. When lavender oil is applied to a burn from the onset, the burn may heal with no scarring at all. (For larger burns, put lavender oil onto a gauze or cloth and apply to the burn every few hours.)

How to use it?
• Apply several drops (2-4) on location several times a day
• Directly inhale, diffuse, or
• May be used as a dietary supplement

Safety Considerations With Lavender Essential Oil

Lavender essential oil can sting a little when a wound is still fresh, but once it’s scabbed over and has started healing, lavender essential oil, applied topically, can help minimize scarring while it heals.

Lavender has a relaxation property, often used to fragrance products for bedtime, like lotions and satchels for bedrooms. WebMD warns that lavender essential oil can depress the central nervous system and cause drowsiness and sleepiness (especially good when used properly to treat insomnia and induce relaxation but dangerous when used for other properties and healing in which sleepiness is not the desired effect). You shouldn’t drive or do other dangerous things until you know how lavender will work for you.

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History fact: A French scientist, René Gattefossé, was severely burned in a laboratory accident and immersed his hand in a vat of Lavender for two weeks. Gattefossé found that Lavender oil promoted tissue regeneration quickly and healed the wound with no scarring!

Don’t:

One of the most popular treatments for scarring is vitamin E.
But will vitamin E really help to improve your scar?

can_vitamin_e_h_photoVitamin E, or tocopherol, is a fat-soluble antioxidant. It’s found in capsule or liquid form at drugstores, grocery stores, health food stores, and online. The so called effective remedy consists of opening vitamin E capsules and applying the content on the scar. But this topical use of vitamin E does not result in scar healing.

Vitamin E has been shown to penetrate layers of the skin and reduce the formation of free radicals which can interfere with healing. Vitamin E also influences the production of collagen, a structural protein partially responsible for the strength and elasticity of the skin. Although many people apply vitamin E oil to their skin to minimize scars and it’s sometimes recommended by physicians after skin surgery, there’s very little evidence that shows it helps.

Vitamin E Research :
Current research does not support vitamin E oil to reduce scar formation.

A study on the effects of topical vitamin E on the cosmetic appearance of scars at the University of Miami that there is no benefit to the cosmetic outcome of scars by applying vitamin E after skin surgery and that the application of topical vitamin E may actually be detrimental to the cosmetic appearance of a scar. In 90% of the cases in this study, topical vitamin E either had no effect on or actually worsened, the cosmetic appearance of scars. Of the patients studied, 33% developed contact dermatitis to the vitamin E. Therefore it was concluded that the use of topical vitamin E on surgical wounds should be discouraged.

Research by K.C. Wan and J.H. Evans at the Hong Kong Polytechnic University, published in 1999 issue of “Free Radical Biology & Medicine,” found higher amounts of free radicals in hypertrophic scars, which become thicker, redder, and more elevated than regular scars. Another study by T.L. Khoo at the Hospital Universiti Sains Malaysia, published in a 2010 issue of the “Journal of Plastic, Reconstructive & Aesthetic Surgery,” concluded that tocotrienols, a vitamin E subfamily, made no significant improvement in scar parameters. Also, a study conducted by Morganroth, Wilmot, and Miller in Philadelphia for a 2009 issue of the “Journal of the American Academy of Dermatology” determined that scar products containing vitamin E oil did not support usage for the reduction of postoperative scar formation.

Be on the lookout:

For specific ingredients found in commercial wound ointments and dressings.

Listed below are just a few ingredients present in store-bought wound products. Most of these products produce skin irritation, sensitization, and are linked to allergies, cancer, and/or immune suppression.

Here they are:
• Petrolatum
• Mineral Oil
• Propylene Glycol
• Butylated Hydroxytoluene (BHT)images (19)
• Benzalkonium Chloride
• Yellow #5; FD&C Blue #1
• DMDM Hydantoin

Even many of the natural ointments contain some of these ingredients. Make sure to read the labels and please, test the area for allergic reactions before applying anything to your skin!

Hope this helps with your scar healing.

Check out the second post of the series: Do’s and Don’t’s of Healing Scar Tissue – Tip #2

》A B O U T   M A R J O R I E   B R O O K

marjorie brook lmt author headshotMarjorie Brook, LMT is a massage therapist, author and international educator. For over 21 years, she has specialized in scar tissue release and massage therapy. She works from the fundamental belief that your body is intuitively aligned with the thoughts you think, the emotions that you feel and the things that you do. She founded Brooks Seminars in 2007 after working as a decade as a nationally recognized massage therapist with a private practice on Long Island. She is the creator of the Scar Tissue Release and Integrated Therapies (S.T.R.A.I.T Method™) and offers continuing education courses on this method all over the world. Her articles have appeared in magazines such as Massage Today, American Fitness and Massage World. She’s approved by the National Certification Board for Therapeutic Massage and Bodywork, the Massage Therapy Association of Alberta and the College of Massage Therapists of British Columbia.