Breast oedema and fibrosis are common side effects reported by patients who have undergone radiation to their conserved breast. Massage is used to treat breast oedema and fibrosis, with most symptomatic patients encouraged to perform self-massage at least once per day. Additionally, compression of the breast using bandages, dense foam inserts, and/or support bras are recommended. Despite good intentions to reduce oedema and fibrosis, incorrect use of massage and compression can lead to costo-chondritis and rib pain.
Aim and methods
Case studies and management plans of patients reporting rib pain without metastatic disease during treatment of breast oedema and fibrosis will be reported. All patients underwent lymphoedema assessments as well as palpation examination of their bilateral costo-chondral joints, inferior ribs and rib angles under the radiation fields. Pain and discomfort on palpation, as well as shoulder and thoracic movements were recorded.
Results and discussion
Treatment of breast oedema and fibrosis can be effective when a combination of massage and compression is used. Patients who are overly firm in their self- massage of their breast, and/or use very firm compression pads/bandages, underwire and support bras can aggravate underlying pain and inflammation of ribs and cartilage in the radiation fields, especially in the first 12 months after radiation. Irritability of the rib cage can easily be assessed by palpation.
Rib pain can result from firm compression and pressure used to treat breast oedema and fibrosis. Physiotherapists may need to check patients’ self-massage regularly to ensure that it is of the appropriate pressure and frequency. Wire-free and seam-free bras may reduce friction, pressure and inflammation at the inferior and lateral ribs.