Am I in pain? The Process of Healing from Breast Surgery
I am a physical therapist who primarily helps women rehab from breast cancer diagnosis. Last week, two separate women made a very similar comment that prompted this blog post. Both had recently undergone reconstructive breast surgery and now have their implants, and when they moved their arms, they were unsure what to make of the sensations they felt in their chest. “I feel it when I move my arms…is that okay???”
What struck me is that normally our brain is able to interpret the sensations we feel. It’s funny to imagine noticing a physical sensation, say the pressure from a hug, or a sharp pebble in our shoe, and having to ask someone, “Hey is this okay???” However after the emotional/physical roller coaster of breast cancer treatment, it’s fair to say your body/brain doesn’t know what is happening.
When deciding if a sensation is “okay” or not, the brain not only evaluates the sensation coming in from the body, but also considers things like past experiences and emotions. Regarding Past Experiences, in the recent past your body pulled a fast one on you. Here you were living your life, and BAM! Turns out, very silently, it was making cancer. I don’t mean to be dramatic but that’s a significant betrayal! How do you trust anything your body tells you after that? When you feel sensations around your implants after breast surgery, your brain is likely to respond “I don’t believe A THING you tell me anymore, so just to be on the safe side, I am going to assume this is a worst case scenario and OVER REACT!” You may feel A LOT of pain, especially when you try to move your arm.
Emotions are a biggie. Yes, we use the tidy word “mastectomy” but for a moment let’s call it what it is, a breast amputation. An amputation of any sort is brutal, but the breast also happens to represent femininity, motherhood, and sexuality- three very emotionally laden and personal topics. It doesn’t matter how you felt about your breasts pre-diagnosis, they were yours, and now someone has taken them away. Anecdotally, I can tell you from my time working as a physical therapist, the women who have made some sort of peace with diagnosis by the time they get implants seem to heal and recover much easier, with less pain, than those who haven’t. In my opinion, when there is still acute anger/resentment/disappointment around the diagnosis, it almost seems to become transferred to the mastectomy/reconstruction. In some ways it’s easier to have a physical manifestation of what hurts you. When you feel sensations around your chest, your brain may also consider the anger/resentment/disappointment and conclude “Yeah. We ARE in pain. Those chest muscle signals mean pain.”
There is research that shows sometimes just understanding what is happening between the nerves and brain can lessen a person’s pain. In addition, here are some of my tips:
- In the first few days/ week after surgery, take the pain medicine the doctor prescribed, as often as it was prescribed. This is not the time or place to “be a hero” and not take medication. Even if it feels like you might not need a second dose, take it anyway. It is much easier to stop pain than “chase” the pain that’s already left the station.
- But what about the opioid crisis? If you are extremely worried about becoming an opioid addict, and you have NO prior addiction history, you are probably NOT the person who is going to become addicted.
- It is appropriate to freak out if you notice an unusual red area somewhere in the surgical area that is accompanied with a fever and/or flu like symptoms, and/or it progresses (either spreads out or becomes a much brighter red color) in a matter of hours. In this case, you need to see a doctor IMMEDIATELY. Go to Urgent Care if you have to. This may be an infection and needs antibiotics ASAP.
- The only other time it’s appropriate to freak out is if something very dramatic happens, like you are in a car accident and hit in chest by an airbag, or you fall down the stairs. In that case, seek immediate medical attention.
- All other sensations you feel are NORMAL. It is normal to feel pulling, perhaps pain even into your arm, armpit, chest, shoulder, and back. When you feel it, try to remind yourself that this is part of the process and to be expected. Our inner dialogue is SO powerful! Use it for good, not evil. Try to resist the temptation to dwell on “this will never get better,“ and replace it with “this is a normal part of healing and every day I am getting stronger.”
*Despite my tips, if you are really concerned about your healing after surgery, ALWAYS CALL YOUR DOCTOR’S OFFICE!
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