Cording, or axillary web syndrome (AWS), is a poorly understood condition. It’s often completely overlooked and simply seen as a breast surgery post-operation complication that has no solution. But, thankfully this is not the case.
What is cording?
AWS, also known as cording, is a common post-operation complication following sentinel lymph node or multiple lymph node surgery. It can be caused by scar tissue from breast cancer surgery without the removal of any lymph nodes.
While the exact cause isn’t understood, it’s thought that surgery in these areas damages the connective tissue surrounding the lymph vessels. This trauma leads to scarring and hardening of the tissue, which results in these cords.
Cording is not to be confused with lymphoedema (swelling of the arm). However, cording is associated with the risk of lymphoedema.
It usually occurs in the first eight weeks after surgery, but can show years later. It’s characterised by visible or palpable ‘cords’ in the axilla (armpit) of the operated side, frequently extending right down into the medial arm and forearm.
It’s accompanied by tightness; limitation of movement of the operated side, and a significant amount of pain.
Know the stats
Stats vary as to how many patients are affected. But, The American Journal of Medicine and the National Lymphedema Network reports the incidence being as high as 72% where there has been an axillary node clearance, and only a 20 to 41% where there has been only a sentinel node biopsy.
These figures are extremely high and more needs to be done to create awareness and, most importantly, treat this condition.
Treatment
Cording is easily treated and responds extremely well to the correct treatment. As soon as a patient develops signs, they should seek professional help.
It’s important to note that just as the medical profession has areas of speciality, so does the treatment of cording. A physiotherapist who specialises in post-operative breast cancer rehab should administer treatment.
Treatment involves scar tissue release, gentle mobilisation, and release of fibrosed lymphatic vessels. Too much pressure can cause damage and too little pressure will make no difference at all.
Bear in mind that the treatment is not the same as the treatment for lymphoedema patients.
Remember that the physiotherapy given to a breast cancer patient immediately post-op, in hospital, is very different to the treatment required for cording. It doesn’t develop while the patient is in hospital. It only develops weeks to months’ post-op and requires specialised treatment.
As a medical doctor having had a mastectomy, I can’t emphasise enough the importance of the post-operative physio. I was given physio while in hospital, but despite my medical background, I had no concept of what to anticipate in terms of recovery. How much mobilisation was enough or how much was too much? It was only when I developed cording that I was referred to Cheryl. This radically changed my post-mastectomy recovery. As a mastectomy patient, she had the empathy and understanding of my experience. The cording was treated with such expertise that I no longer have any symptoms. – Dr Jenni Noble
MEET OUR EXPERT – Cheryl Gaynor
Cheryl Gaynor is a physiotherapist and a breast cancer survivor. She has studied, researched and treated AWS for the past 10 years and assists patients to return to full pain free function again, both physically and mentally.
Please let m know where I can get physio for cording. I have had two mastectomies and have cording under both my arms with lymphedema on the right side.
I live in Bredell near Benoni.
Dear Maureen, please email info@cherylgaynorphysio.co.za for a recommendation of a physio in Johannesburg.
I had a mastectomy in January and developed quite severe cording by May. In spite of doing my daily post-surgery exercises, I couldn’t raise my arm properly or stretch it forward, which was very frustrating in terms of day-to-day mobility. I was referred to Cheryl and my arm is now back to normal – I am so thankful as the difference is dramatic.
My mastectomy was 2 years ago. I didn’t think that my ‘ropes’ were serious enough to look into treatment. Out of the blue in the same week, 2 good friends recommended I see Cheryl Gaynor. I thought I’d better do so… neither of them had had breast cancer, but they were sure seeing Cheryl would be a good idea. Well, I did, and physio began. After a few appointments, all the cording has gone and the static scar below my breast now feels normal.
I should also mention that an added bonus was that my shoulder that had been giving me trouble for over 15 years, was sorted out. Thank you, my 2 dear friends, for insisting and a huge thank you to Cheryl!