Understanding the ‘Iron Bra’ and Other Challenges in Recovery
For many breast cancer survivors, the journey doesn’t end with surgery or oncology treatments. A significant number experience ongoing discomfort known as Post-Mastectomy Pain Syndrome (PMPS), a chronic neuropathic pain condition affecting some women after mastectomy or breast-conserving surgery.
What Is Post-Mastectomy Pain Syndrome?
PMPS is characterized by persistent pain in the chest wall, armpit, and/or arm that doesn’t go away after surgery. This pain can manifest as burning, electric shock sensations, stabbing pain, or numbness. The condition is thought to result from nerve trauma during surgery, particularly to a nerve called the intercostobrachial nerve. This injury can lead to chronic pain and sensory disturbances, but if treated early, the pain can be minimized.
Common Side Effects and Related Conditions
In addition to PMPS, patients may experience several other side effects from oncology treatments and surgery:
Peripheral Neuropathy: Chemotherapy can damage peripheral nerves, leading to tingling, numbness, and pain in the hands and feet. If you are having difficulty with tasks, such as twisting caps or opening jars, occupational therapy can give suggestions to make these tasks easier to manage. Your occupational therapist can provide pain management strategies to make your hands more comfortable.
Lymphedema: Removal of lymph nodes can disrupt normal lymphatic drainage, causing swelling/inflammation in the arm or chest wall. An occupational therapist with specialty training in lymphedema management can help you to identify your personal risk for developing lymphedema and can develop a program for minimizing stress and strain on the lymphatic system. With a therapist who has earned CLT-LANA credentials, you can learn ways to maximize lymphatic functioning and manage the lymphedema.
Axillary Web Syndrome (AWS): Also known as cording, AWS involves the development of tight, ropelike structures under the skin of the inner arm, limiting range of motion and causing discomfort. As an occupational therapist who frequently treats this condition, I can attest to the power of manual therapy interventions. I have had people start a therapy session barely able to raise their arm and leave the session with substantially greater movement, less pain and increased ability to perform simple tasks such as putting on a pullover top. With targeted OT intervention, lost motion can be restored.
Arthralgias: Joint pain, often a side effect of certain cancer treatments, can affect mobility and quality of life. Occupational therapists are well-equipped to help you manage joint pain. We may recommend supports or orthotics, and we develop exercise programs to reduce joint discomfort. You can receive instruction on what we call joint protection to reduce wear and tear on your joints to improve function in daily life.
Hypertrophic Scarring: Excessive scar tissue formation can lead to raised, thickened scars that may be painful or restrict movement. When scar tissue is managed actively with hands-on therapy using techniques such as myofascial release, elastic taping or cupping, we can help mobilize the tissue tightness and help scar tissue mature to allow improved ease of motion. And restoring motion puts good stress on the scar tissue for healing. Your occupational therapist will recommend flexibility exercises and may suggest compression on the tissue. Scar tissue is living body tissue and can undergo change for the better.
Hypersensitivity: Increased sensitivity to touch or temperature changes in the affected areas can be distressing and impact daily activities. Learning a self-management program using techniques called desensitization helps the brain to re-wire to better process incoming sensory information and lessen feelings of pain or discomfort. Your occupational therapist can tailor a program for your needs.
The ‘Iron Bra’ Sensation
Many women describe a sensation of wearing an “iron bra”—a feeling of extreme tightness and pressure across the chest and ribs. This discomfort can persist for weeks, months, or even years after surgery and is often associated with restricted mobility and muscle tension. The sensation may result from a combination of nerve damage, scar tissue formation, and muscle tightness in the chest area.
In addition to the skills your Occupational Therapist can offer, neuropathic pain may be managed with medications, so discuss this option with your medical provider.
Targeted manual therapy, exercises and stretches can help alleviate muscle tightness, improve range of motion and reduce pain. Together, we can restore your ability to engage in your daily activities. Symptoms can resolve over time and with the right combination of soft tissue mobilization and exercises. Your therapist can also assist you to adapting daily activities to accommodate limitations and reduce discomfort.
Mindfulness practices, work-rest balance and education on pain science can allow for self-management. Your occupational therapists can design a personalized pain management program to help quiet the nervous system and help you to engage in the activities that you want to do.
Lymphatic therapy can provide additional relief and improve overall well-being. An occupational therapist who has earned CLT-LANA credentials is well trained to help improve lymphatic functioning and teach you strategies to promote lymph flow as part of your daily routine.
Final Thoughts
Post-Mastectomy Pain Syndrome and its associated symptoms can significantly impact the quality of life for breast cancer survivors. Understanding these challenges and seeking appropriate interventions is crucial for effective management and recovery.
If you’re experiencing persistent pain or discomfort following breast surgery, consult your healthcare provider to refer you to Occupational Therapy tailored to your needs. If you live near Evanston, IL, click the link below to set up an appointment for an Occupational Therapy Evaluation.
Unshackling the ‘Iron Bra’: Your Journey to Healing Starts Here
Flourish Recovery & Wellness 