Yikes,
This does sound like the implant is compromised.
Sometimes a slow leak like this can those constant fatigue and pain symptoms.
Is this a saline or silicone implant?
She need to get the surgery consult definitely. As far as PT, I’d work joint
ROM, posture, and scapula stability, as you’re doing, w/in a painfree range.
I’d be hesitant about manual therapy around that capsule until you can
determine if/where there is a leak. If she’s encapsulated, manual therapy may a
small leak worse.
I’d be worried about this protracted process causing fibromatosis, it’s quite
rare, but just b/c of such prolonged inflammation and likelihood of scarring
and scar overgrowth.
If this is a silicone implant, does she have any other autoimmune symptoms?
Lesli Bell lead a really nice clinical conversation article in Rehab Onc about
dry needling for chronic breast and chest wall pain in a patient with breast
implants.
(https://journals.lww.com/rehabonc/Citation/2019/07000/Dry_Needling_for_Chronic_Breast_Chest_Wall_Pain.10.aspx)
I think understanding the integrity of the device is foremost, keeping her
joint mobile in a pain-free range can accompany that until a course of action
is identified by the doc.
NS
Nicole Stout DPT, CLT-LANA, FAPTA
nlstout90@xxxxxxxxx
On Oct 27, 2020, at 9:12 AM, Mary Fisher <mary.fisher@xxxxxxxxxxx> wrote:
Hello All,
Looking for insights on this case:
Patient underwent mastectomy with implant in 2004 (in another city/docs we
don't know). We saw her for the first time 2 weeks ago. She is not being
followed by any onc docs/surgeons. She complains of significant fatigue and
pain which never goes away. Pain is generalized to the breast and axillary
area, although she is quite sensitive to the touch at the lateral aspect of
the breast. Additional significant findings include a feeling of a puckered
or crinkled implant (not firm/filled). She also reports that her implant is
smaller than it used to be; she wears a prosthetic in addition to the implant
to make breasts more symmetrical. Other not significant findings include
shoulder range limited by pain but lacks any joint mobility issues; some
minor tightness issues easily addressed through PT with subsequent increased
motion; postural changes easily addressed but not impacting pain; scapular
weaknesses also being addressed.
We are very concerned about a leaking implant and have recommended she see a
plastic surgeon.
What is the best course of physical therapy treatment? I cannot find
literature that supports best interventions for this type of situation.
Thanks in advance -
Mary
Mary I. Fisher, PT, PhD | Chair and Associate Professor
Board-Certified Clinical Specialist in Orthopedic Physical Therapy
Certified Lymphedema Therapist
300 College Park | Dayton, OH 45469-2925
mary.fisher@xxxxxxxxxxx <mailto:mary.fisher@xxxxxxxxxxx> | Telephone:
937.229.5617 | Facsimile: 937.229.5601
