Many patients do not realize that physical therapy can play a beneficial role in their breast reconstruction preparation and recovery. We sat down with post-mastectomy physical therapy expert, Diana Tjaden, and her patient, Erica Misorek, for a Q&A on what makes this kind of care unique and what it can help patients accomplish.
Diana is a physical therapist and developer of the Full Circle Breast Cancer Recovery Program, which is specifically designed for breast surgery and cancer recovery. She and Erica both sit on BreastReconstruction.org’s advisory committee.
Q: Why should patients consider physical therapy after breast reconstruction?
Diana: First of all, I think it should be part of the plan of care in just a continuum. The surgeons have done the job, removed the cancer, done the reconstruction, and now we’re going to improve your quality of life. It’s the next step.
Q: What do patients work on? How is it different from standard physical therapy?
Diana: We work on range of motion, tissue work, very specific muscle work, but it’s different from ordinary physical therapy because there are very specific guidelines that include understanding the reconstruction and the lymphedema situation. Treatment, lymph node situation, reconstruction—you really have to have an understanding of all of these elements and how they relate to the patient. If someone had a lumpectomy with no reconstruction that can be as challenging as a mastectomy with reconstruction.
Q: Erica, can you provide a patient perspective on what physical therapy might target after mastectomy?
Erica: It was so helpful for me. It released a lot of scar tissue, improved motivation, and offered relief. And I knew that Diana knew exactly what happened, and she was able to break it down for me in a way that I could understand. Then, she was able to help me physically just to gain the strength back. I had my implants converted from under the muscle to over the muscle, which meant that I had the use of my pecks again for the first time in years, and I couldn’t lift. Now, I have almost full strength. I’m swimming full speed, and I’m getting stronger.
Q: When was your original breast reconstruction?
Erica: My original reconstruction was in 2013, and I had my revision procedure in the end of 2023, so there were ten years in between. Before the surgery, I was very strong, I could do push ups.
Q: It sounds like having implants repositioned impacted your strength more than you anticipated, Erica.
Diana: People are putting the pectoralis muscle back on the chest wall and that’s a full surgery, which people do necessarily realize. Erica is starting to feel like she can engage the pec again. That’s an important part of physical therapy, giving people back a quality of life they didn’t know they could have. I’ve been seeing a lot of patients after more extensive diastasis repair during DIEP flap breast reconstruction. Some of those patients didn’t realize what a deficit they had and now we’re restoring strength.
Q: Erica, did you do physical therapy before your initial mastectomy and reconstruction?
Erica: I did physical therapy the first time around. I was so terrified before my surgery, I was just so focused on the fact that an anesthesiologist could control my breathing for 8 hours without getting tired. I was shell shocked when I went to physical therapy for the first time and learned that I need to walk my hand up a wall so slowly. I didn’t know what prehab was.
Q: Diana, could you explain prehab to folks who are unfamiliar?
Diana: Prehab is an assessment before surgery. If we’re able to see someone and get their baselines before surgery, we can identify issues ahead of time. For example, if say, a patient had shoulder issues you can work on them before surgery. People often come for just one session, we get baselines, we talk about how to take care of yourself after surgery, how to get out of bed.
Q: Is there anything specific you often see in prehab, particularly for natural tissue reconstruction patients?
Diana: We see a lot of weakness in the core in general, which is important for DIEP flap patients. There’s very specific muscle groups to work. There’s the transverse and the obliques that we tend to want to strengthen ahead of time. If we’re talking about the TUG flap, we’re talking about all the hip muscles that we tend to be weak in anyway as women. We’d have the opportunity to stretch that muscle if it’s tight and strengthen the area, we do a lot of stretching if we know these people are going to have these surgeries. LD flaps are a tricky surgery when it comes to the mechanics of the shoulder afterwards. There’s some very specific things to work on for all of those that would be nice to get a little baseline and then get started.
Q: What about people who think they are in good shape?
Diana: If you come in for one visit after, then we’re at least a resource for you if you have any problems. If you’re tight in an area after surgery, then you can come back in and we’ll work on it. People think they have a good range of motion, but they’re actually tight. If you’re going to have radiation, you should be having physical therapy, because of the impact that radiation has on the tissue. It physiologically changes the tissue makeup, over time, there will most likely be some type of deficit here. Everyone should have a consultation just to understand their situation.
