Resources
About Breast Health and MLD
Female breast tissue is composed of fatty, fibrous and glandular tissue. Glandular tissue includes breast lobes and breast ducts, which carry milk to the nipple. The lymphatic system supports breast health by regulating its fluid balance as well as filtering out harmful substances.
Mastitis is a common complication of breast feeding, and includes a spectrum of conditions resulting in ductal inflammation. Milk production is controlled by a feedback mechanism whereby increased milk removal causes increased production. Overfeeding from the affected breast or ‘‘pumping to empty’’ perpetuates a cycle of hyperlactation and is a major risk factor for worsening tissue edema and inflammation. If breast duct narrowing and tissue congestion are worsened by overstimulation of milk production, then inflammatory mastitis can develop, and acute bacterial mastitis could follow. Deep tissue massage can cause increased inflammation, tissue edema, and microvascular injury. This is why manual lymphatic drainage (MLD) is the preferred treatment to help manage and prevent the worsening of mastitis. By using a light skin sweeping technique, MLD helps clear mastitis associated inflammation and decongestion of the breast tissue. Below are some self- massage techniques you can use between sessions with your therapist to help optimize your MLD treatment. Be sure to review the technique with your therapist before proceeding.
Post-operative swelling and inflammation are common side effects after breast surgeries that can result in pain, discomfort, and associated muscle achiness from changes in posture and muscle load. These surgeries include breast augmentations, lifts, reductions, explantations, gender affirming top surgery, and cancer-related surgeries such as mastectomies, lumpectomies, and breast reconstruction. The gentle technique used in MLD does not disrupt the tissue around the surgical incisions. It can therefore be introduced earlier post-op than most other modalities since it does not impede healing. MLD can accelerate post–op recovery by creating an optimal healing environment for tissue. By facilitating the movement of lymph fluid to its proper drainage areas, MLD helps transport immune cells and ensures that waste from the surgical site is being removed. The sooner post-operative inflammation and swelling resolves, the sooner your physiotherapist can help with restoring functional range of motion, strength and posture (within your activity restrictions), so that you are able to return to your activities of daily living and regain functional independence.
You must receive clearance from your surgeon before proceeding with any post-op modalities or interventions, including MLD. At Lymphysio, we provide post-op MLD for all breast surgeries, as well as assess and provide personalized home exercise programs to help with functional recovery. Pre- and post-op MLD is indicated for the breast cancer population to help accelerate tissue healing in anticipation of further treatment, and can help prevent common complications such as axillary web syndrome (cording) and seromas. If you have had lymph nodes removed or radiated, this increases your risk of developing lymphedema. Early education and implementation of preventative care strategies can mitigate your chance of developing lymphedema and/or minimize your chance of it progressing further.
References
Härén, K., Backman, C., & Wiberg, M. (2000). Effect of manual lymph drainage as described by Vodder on oedema of the hand after fracture of the distal radius: A prospective clinical study. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 34(4), 367–372.
Ebert, R., Smith, A., Joss, B., & Janes, G. (2013). Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty. Archives of Physical Medicine and Rehabilitation, 94(11), 2103–2111.
Memorial Sloan Kettering Cancer Center. (n.d.). Anatomy of the breast.
Mitchell, K. B., Amir, L. H., Academy of Breastfeeding Medicine, Berens, P. D., Cadwell, K., & Spatz, D. L. (2022). Academy of Breastfeeding Medicine clinical protocol #36: The mastitis spectrum, revised 2022. Breastfeeding Medicine, 17(5), 360–376.
Vorvick, L. J. (2022, July 25). Lymphatics and the breast. MedlinePlus.
About Mepitel® Film
Support for the use of Mepitel® Film for the breast cancer population to prevent skin reactions and complications resulting from radiation treatment
Radiation therapy is a common part of the treatment protocol for the majority of breast cancer patients in the province. It involves using targeted high – energy radiation to destroy tumor cells. The number of treatments required is specific to each patient’s individual cancer. The goal of radiation treatment is to cure cancer, reduce the likelihood of reoccurrence or manage symptoms such as pain.
Radiation treatment, however, comes with its own unique complications. These include radiation dermatitis, which presents as blistering/peeling, erythema (redness), pigmentation (skin discolouration) and edema (swelling). Also, radiation-induced fibrosis, which is when soft elastic tissue in the radiation field, specifically skin, connective tissue, muscles, nerves, blood vessels and the lymphatic system, become stiff and tight. Both of these conditions have been shown to impact patients’ quality of life throughout and after radiation treatment, in that they can cause pain and discomfort as well as cosmetic and functional impairments. In severe cases, patients’ treatment may need to be temporarily delayed until these conditions resolve.
Recent research, both nationally and internationally, has been studying the outcomes of patients who use Mepitel® film (MF) throughout and after radiation treatment versus standard protocol. MF is a silicone based polyurethane film that is transparent and breathable, to provide optimal comfort and wound healing for patients. It is showerproof and uses Safetac technology, which does not adhere to the moist wound bed, reducing pain and trauma in the area.
Image Souce: Mölnlycke Health Care. (n.d.)
A recent study entitled, ‘Mepitel® Film for the prevention of acute radiation dermatitis in breast cancer: a randomized multi-centre open – label phase 3 trial’ (2023), concluded that MF significantly reduced the incidence of moderate to severe radiation dermatitis in patients with a mastectomy or large breasts from 45.6% to 15.5% when compared to current institutional standard care. Patients reported less tenderness, discomfort, pain and burning sensations. Patients and healthcare providers noted less blistering/peeling, redness, skin discolouration and edema. Another study entitled ‘Patient-reported experience with the use of Mepitel Film for prevention of acute radiation dermatitis in breast cancer’ (2024), concluded a positive patient –reported experience during radiation treatment and noted minimal impact on their activities of daily living. Amongst the participants, 92% agreed or strongly agreed that their experience was positive and 88% would recommend MF to a friend undergoing radiation therapy for breast cancer treatment.
Feedback from clients of Joanna Mascarenhas Physiotherapy support this research as well. One shared that “Mepitel® film was very comforting and soothing to the skin as I went through radiation treatment. It helped to prevent my clothes from rubbing on the sensitive areas. I heard about the protectiveness of Mepitel® from my plastic surgeon and after doing my own research. It was the best money I spent to protect my sensitive skin”. Another client reported “the film was incredibly comfortable and easy to care for, providing a protective barrier that saved my skin from major radiation dermatitis. While I did experience a few minor spots of irritation, they cleared up quickly. I can only imagine how much worse it could have been without the film's protection. The Mepitel® film played a crucial role in my treatment, and my hope is that others facing similar challenges can benefit from this knowledge. To anyone preparing for radiation therapy, I cannot recommend Mepitel film highly enough. It was a game-changer for me, and I believe it can make a significant difference for others as well”.
Image Souce: Mölnlycke Health Care. (n.d.)
You must receive clearance from your radiation oncologist before proceeding with MF use for radiation treatment. Contraindications for MF use include an active rash or preexisting dermatitis and silicone or adhesive sensitivity/allergy. It must be applied with the patient in the radiation treatment position (supine with hand behind your head on the treatment side), so it is best to have a trained healthcare provider apply it for you. It is best to have it applied as close as possible to the start day of your radiation treatment. You can shower as normal with the MF on, but try to avoid direct water spray to the film if possible. After showering, pat the film gently to dry and avoid scrubbing the area with your hands or a towel. Do not take baths, use hot tubs or swimming pools while the film is on, since this could cause it to come off. Heavy exercise and excessive perspiration may cause the film to come off as well, so during radiation you may need to make modifications to your exercise routine in order to preserve the integrity of the film.
Clients of Joanna Mascarenhas Physiotherapy can book ‘radiation prep appointments’ for access to this revolutionary intervention that is improving patient outcomes both nationally and internationally for this niche patient population. You can contact Joanna directly via the website to discuss further whether this service is appropriate for you.
References
Mölnlycke Health Care. (n.d.). Prevention and treatment of radiation skin reactions.
Mölnlycke Health Care. (n.d.). Mepitel® film.
BC Cancer Foundation. (n.d.). Radiation therapy.
Hayes, S. C., Spence, R. R., Galvão, D. A., Newton, R. U., & Schmitz, K. H. (2022). Mepitel Film for radiation-induced skin toxicity: A review of clinical evidence. Journal of Medical Radiation Sciences, 69(4), 381–388.
Royal Victoria Regional Health Centre. (2021). Mepitel film instructions.
Wengström, Y., Rustøen, T., & Bensadoun, R. J. (2024). Management of radiation-induced skin reactions: Clinical update and expert recommendations. Supportive Care in Cancer, 32(1), 64.
Publications
A Feasibility Randomized Controlled Trial of Prehabilitation During Neoadjuvant Chemotherapy for Women with Breast Cancer: A Mixed Methods Study
Brahmbhatt, P., Look Hong, N. J., Sriskandarajah, A., Alavi, N., Selvadurai, S., Berger-Richardson, D., Lemon-Wong, S., Mascarenhas, J., Gibson, L., Rapier, T., Isenberg-Grzeda, E., Bernstein, L. J., Santa Mina, D., & Wright, F. C. (2024)