Hi Mary,
We recently had a case similar- not the same- but similar to this come through
tumor board. Given this patient is removed from routine surveillance follow
up- when is the last time she had any imaging for cancer? Did she have
shoulder imaging as of yet?
Our situation resulted in a recurrence, which impacted the integrity of the
implant and ultimately forced the woman to present for treatment, but the full
imaging work up couldn’t be adequately completed until the implant was removed.
Given her unrelenting fatigue- has she had any other labs done?
Good luck!!!
Megan
From: aptaoncology-bounce@xxxxxxxxxxxxx <aptaoncology-bounce@xxxxxxxxxxxxx> On
Behalf Of Lesli R. Bell
Sent: Tuesday, October 27, 2020 5:17 PM
To: aptaoncology@xxxxxxxxxxxxx
Subject: [aptaoncology] Re: breast pain post implant [WARNING! - EXTERNAL]
Hi Mary,
I have read a few articles on breast implants. Unfortunately the implants that
pop can sometimes cause low grade infections. This happened to my sister in law
and she had tremendous pain and fatigue. It’s not that the silicone or saline
is causing the reaction, it’s the body’s foreign body reaction to it.
Interesting that they talk about contractures after implant but don’t address
pts other pain complaints in the articles I have read.
Agree with a surgical consult. And anything else that will normalize motion and
flexibility for the shoulder as many have commented on. Not sure I would do to
much to the breast and implant until after consult. But if all else is negative
then treatment of ms pain and scars might be appropriate. Dry needling could
work for that.
Keep us posted! Good case for us all to learn from!
Best, Lesli
Sent from my iPhone
On Oct 27, 2020, at 4:31 PM, Leanna Blanchard <blancharddpt@xxxxxxxxx> wrote:
Another thing to consider - if her breast implants were textured, certain
brands have been recalled due to associations with BIA-ALCL.
--
Leanna Blanchard, PT, DPT, CLT, OCS, FAAOMPT
Physical Therapist and Doctor of Physical Therapy
Board Certified Specialist in Orthopaedic Physical Therapy
Fellow of the American Academy of Orthopaedic Manual Physical Therapists
Certified Lymphedema Therapist
On Oct 27, 2020, at 3:55 PM, Nancy Roberge
<nancyroberge4@xxxxxxxxx<mailto:nancyroberge4@xxxxxxxxx>> wrote:
Mary,
Here is a link to an interesting article on breast implants which a patient of
mine shared. This particular patient has had pain and tightness from 2
different sets of implants and she was never as loose as she once was (and she
teaches YOGA!) and she always had mild to moderate discomfort. She opted to
have both taken out and is now recovering.
I also had a patient whose body kept trying to ‘reject’ her implants and she
too finally had them taken out.
There are just some women who do not tolerate implants very well for a
multitude of reasons.
Let us know how she makes out.
https://www.newyorker.com/magazine/2020/04/20/do-some-surgical-implants-do-more-harm-than-good
Dr. Nancy J. Roberge
Helping The Patient Diagnosed With Cancer To Live Their ‘Best Life’
Compassionate Oncology and Orthopedic Rehabilitation
On Oct 27, 2020, at 9:13 AM, Mary Fisher
<mary.fisher@xxxxxxxxxxx<mailto: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
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