Challenging Cases

Post mastectomy pain—Less discussed but common problem

Mastectomy can be associated with some annoying symptoms like

  1. Tightness around the chest
  2. Chronic chest pain
  3. Stiffness and reduced shoulder movement
  4. Shoulder imbalance and associated upper back pain

Radiation therapy after mastectomy can aggravate all these symptoms. Some of these symptoms can have an impact on quality of life.

However, both these treatments are lifesaving essential treatments.

Why do these symptoms happen after mastectomy?

  1. During mastectomy along with breast, some chest muscles are removed because of which strength and flexibility of chest reduces.
  2. Arm pit fat pad is removed, and some nerves are cut during lymph node removal surgery which also leads to pain and reduced shoulder movement.
  3. Lymph is a white fluid which flows through out our body. After breast and arm pit surgery, its free flow/circulation gets impacted leading to collection of fluid around chest and arm called as lymphedema which can also causes pain and heaviness of chest and arm.
  4. After axillary/arm pit surgery, some women can develop, rope or cord like structure just under the skin in the area under your arm called as axillary web syndrome (AWS).
  5. Radiation therapy after mastectomy leads to fibrosis or in simpler terms shrinkage of fat and muscles left after mastectomy which makes symptoms of tightness, chest pain worse.

What can we do to reduce intensity of these symptoms and prevent them from getting bad to worse? Few suggestions are

  1. Regular and graded physical activity/exercise of affected shoulder, upper back, arm and neck to strengthen your remaining muscles and improve flexibilty. Regular physical therapy also helps prevent lymphedema/ swelling in arm. It should be learned with the help of a professional physiotherapist.
  2. Regular massage and light rubbing of chest and arm pit scar using some thick cream in upwards, circular and lateral scar movement.
  3. Use of adequate size and weight prosthesis to maintain balance and posture of shoulder and back.

What to do if symptoms do not get better after above remedies also?

  1. Consult your oncologist and discuss with him/her.
  2. Your oncologist might add some suitable pain killer medication for you.
  3. Sometimes even acupressure is known to help in reducing pain.
  4. If pain is due to lymphedema, then your oncologist might refer you to a physical therapist to learn manual drainage of accumulated lymph

Prevention of all these symptoms which occur due to “after effect” of cancer treatment is the key.


Dr Vineeta Goel

Director and Head

Department of Radiation Therapy

Fortis Hospital

Shalimar Bagh, Delhi


# Breast Cancer

# Mastectomy

# Pain and swelling after breast cancer surgery

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