First, do no harm

Managing your patients’ mammary structures in therapeutic environments.

Not all patients are the same. A skilled doctor knows how to modify clinical techniques to match the needs of special populations. Just as children and the elderly should be approached with greater care, another class of patients presents a clinical challenge.

Unfortunately, when you lay the majority of your female clients prone, you cause discomfort and pain to their breast structures. In some instances this positioning may potentially hurt them. For those patients with altered breast structures, you could actually be causing damage. And as a manual therapist, your primary objective is to do no harm.

Preventing pain is crucial to good case management and the care of your patients. During both short- and long- term duration techniques, therapeutic outcomes and results are best if the patient does not experience discomfort as a result.

Accident prone

Prone positioning and loading of a female patient’s thoracic cage causes compression and displacement of the breasts. Additional compression from therapy and loading the thorax may prompt breast displacement and often more pain.

Whether your patients’ breasts are natural, fibrocystic, in abnormal hormonal states (lactating, premenstrual), or surgically altered (via mastectomy, reconstruction, or cosmetic augmentation), treatment should be adapted to minimize their distress and improve their experience.

Breasts are composed of glandular and ductile structures that are susceptible to pain. Women with fibrocystic changes often report greater discomfort in prone positioning. Those with surgically altered breasts may have complex structures with scar tissue and implants, which are made of materials of differing mechanical properties.

Implants are highly elastic, while the adjacent scar tissue that surrounds every implant is not. Protecting all parts of the structure from potential trauma is crucial to providing a safe environment.

Widespread considerations

Trends are increasing toward breast augmentation, reconstruction following mastectomy, and prophylactic mastectomy following genetic screening programs. The American Society of Plastic Surgeons reported more than 440,000 breast structure procedures in 2014. Over 6 million women in the U.S. have surgically altered breasts, which means you will be treating these patients on a regular basis.¹

Your patients with breast complications need to be readily identified.

Many breast cancer patients who’ve undergone reconstruction find prone positioning uncomfortable.

Therefore, during intake, speak with patients about any abnormalities they might have. Manual therapists and clinicians of all disciplines should adhere to this responsibility. Identify those who need special care as part of your standard protocol for female prone-treatment techniques and exercise prescriptions.

Talk it through

Determining the need for treatment modifications is an important part of pretreatment. A thorough medical history should identify any previous surgery to the breasts, as well as the presence of abnormalities or disease.
Unaltered breast patients often report discomfort from lying prone, especially when hormonal influences associated with their menstrual cycle are in play. In addition to those women who undergo cosmetic procedures, this year in the

U.S. at least 230,000 patients will be diagnosed with breast cancer, more than half of whom will be younger than 65.

To ascertain whether patients experience any discomfort or pain during facedown activities, you should ask them some open-ended questions. Further detailed questioning upon confirmation of any preliminary queries will lead you to a greater understanding of the applicable modifications.

Reconstructed, augmented, and diseased or abnormal breasts do not move as natural ones do. Individuals with alterations need to be specifically considered during clinical and daily activities. Attention to the thoracic cage can also lead you to the most appropriate modified protocol.

Your awareness of these variations in therapeutic and clinical settings will improve the overall care, safety, and effectiveness of treatment, while ensuring that patients have a comfortable experience. It’s no longer acceptable to ignore preventable pain in today’s clinical environments. Look after your patients who need your help.

 

PAUL EVANS is an Australia-trained osteopath, prosthetist, and orthotist with over 20 years’ clinical and management experience in Australia and the U.S. He now calls the U.S. his second home. He currently is involved with the company MammaGard Operations, and is responsible for a new truncal orthosis that protects breast structures in prone positions. He can be contacted through mammagard.com.

 

Reference

¹ American Society of Plastic Surgeons. “2014 Plastic Surgery Statistics.” http://www.plasticsurgery.org/news/plastic-surgery-statistics/2014-statistics.html. Accessed June 2015.