Index Title: RROQUE’s Medical anecdotal Report [04-7]

MAR Title: Contracture after Mastectomy

Date of Medical Observation: October 11, 2004

Narration:

MG 38-year-old female came back for a follow up check up 3 weeks after her mastectomy.  She complained of traction pain upon abduction of her upper extremity ipsilateral to her mastectomy operation.

Upon examination, I noticed that the part of the mastectomy mark near the anterior axillary fold was notably adhered to the underlying chest wall, rendering her upper limb functionally restricted to a degree that her hand barely contacts the contralateral temporal area.

I explained to her the characteristics of her difficulty, and the problem was a contracture– a shortening, as of muscle or scar tissue producing distortion and deformity producing abnormal limitation of movement of her shoulder joint.  And the contracture was an extrinsic (primary) type which involves the external or wound areas only.

My advice, was to try as much as possible to mobilize the upper limb, especially that part on the axillary area, and hopefully the contracture will improve as the scar would heal and will not develop to an extra incapacitating deformity.

I have encountered several patients with extrinsic axillary contracture after mastectomy.  The contracture occurred on incisions that intrude on the axillary folds.

The incidence of contracture with axillary intrusions considerably gains as attention for surgeons to rethink, re--evaluate and prevent such predicament.

Is this a matter of choice of incisions? Or is it an issue of post operative complications a surgeon fails to address?

As surgeons, we have a social responsibility to educate and improve the quality of life of our patients even after cancer surgery. Public education is a key strategy in achieving that goal.

Constant research and innovations will guide us to choose the most appropriate management process we could share with our patients.