Have you noticed pain running down your arm or tightness in your underarm, making it hard to reach the top shelf of your kitchen cabinet since your breast cancer surgery? If so, you could be experiencing cording, also known as axillary web syndrome (AWS), which is a common side effect of breast cancer surgery.
With proper treatment, these symptoms that are limiting your daily activities will go away in most cases. Learn how you can relieve the pain and discomfort caused by cording and ways to speed up your recovery.
AWS often causes pain in the underarm area that can go down the arm, affecting your elbow in some cases. The pain can extend down to your hand, including your wrist and thumb, and even over the chest. It may make it hard for you to lift your arm above the shoulders or extend your elbow, limiting your range of motion. You may also feel heaviness, numbness, or tingling in your arm.
“The tightness in my arm starts at my wrist and goes right up under my arm to the armpit where it feels like a thick cord sticking out,” described one member of MyBCTeam. Another wrote, “Mine felt like a tight strap.”
Apart from sensations of tightness and pain, many people are also able to see AWS. It may appear like a net or web of tissue beneath the skin of your inner arm. “Yesterday, my armpit felt achy, and it looks like a swollen vein in my armpit,” shared one MyBCTeam member.
“Just finished therapy for cording from my armpit to almost my wrist,” said another. “It was tight, and you could see it through my pale skin.”
Lymphatic cording develops when connective tissue builds up in the area under your arm. This side effect usually appears several days to several weeks after breast cancer surgery, but in some cases, it can develop months later.
Cording usually happens after surgery to remove lymph nodes in the axilla (underarm) as a part of breast cancer treatment. There are two types of procedures used to remove the axillary lymph nodes — sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND). SLNB involves removing a few lymph nodes, and many lymph nodes are removed in an ALND. Generally, people who have had an ALND experience cording at a higher rate (36 percent to 72 percent) than those who have had an SLND (11 percent to 58 percent).
Although cording is most commonly seen after lymph node removal, it can also occur after other breast cancer surgeries, such as mastectomy, lumpectomy, and breast reconstruction. A MyBCTeam member shared, “I had cording on my left side that started about two months after my bilateral mastectomy.”
Another member shared, “With the mastectomy, there was cording of the tendons under my left armpit.”
It’s not clear what causes AWS, but researchers believe that the connective tissues in the axillary area surrounding the blood lymph vessels become inflamed and hardened because of trauma from the surgery. Scar tissue from the axillary surgery is also believed to contribute to the development of AWS.
AWS may increase the chances of later developing lymphedema. Lymphedema is another potential side effect of breast cancer surgery that develops when too much lymph fluid is produced. The main symptom is swelling and there may also be pain or discomfort.
Several risk factors have been associated with a higher likelihood of developing cording after breast cancer surgery. AWS is found to occur more frequently in people who:
Remember that these associations don’t necessarily prove any of these factors cause cording. They’re associations that researchers have noticed but can’t yet fully explain.
It’s important to seek treatment as soon as you notice the symptoms of cording to avoid long-term problems with being able to move around. Physical therapy (PT), which can improve your mobility and shorten your recovery time, is an important part of treatment.
Many members shared how physical therapy helped them treat AWS. One member said, “I went to PT every week for about six sessions where she worked to massage the cords and stretch them. The process was super painful, but always felt so much better after she had worked on it. Mine took about three months to fully go away. I would hear little pops periodically when the cords would start to loosen. Very bizarre sound and feeling.”
Another member encouraged other members experiencing AWS to keep on with physical therapy: “I too had cording. PT helped, and my friend also did the massaging and stretching the physical therapist recommended. I thought it was there for good, especially since radiation was making it worse. However, I stuck with the stretching and massage and it’s now gone. Took about two to three months, but you’d never know I had it unless you saw me during that time period. Hang in there.”
If you’re having trouble meeting with a physical therapist, there are several stretching and range-of-motion exercises you can do at home to improve your flexibility and mobility. You can find details and illustrations in this resource provided by the Ohio State University Comprehensive Cancer Center.
Apart from physical therapy, you can also consider trying these methods to relax the connective tissues and feel better.
Manual therapy, including massage, cord manipulation, myofascial release, soft tissue mobilization, lymphatic drainage, and compression bandaging can be used. Your physical therapist may massage and manipulate the cord and the surrounding area to release the adhesions. In some cases, you may hear a “pop” that is followed by relief of the tension and increased range of motion.
Your doctor may suggest taking nonsteroidal anti-inflammatory drugs (NSAIDs) to lessen pain, especially after doing exercises or manual therapy. These medicines can help control discomfort and swelling, making it easier for you to participate in therapy and exercises and help in your recovery.
Your therapist may use low-level laser therapy to treat cording after breast surgery. This therapy helps to break down the hardened scar tissue, reducing pain and improving flexibility in the affected area for a smoother recovery.
After breast surgery, applying a warm, moist pad to the cords can help ease pain and discomfort. Apply heat with caution. When you apply heat after breast cancer surgery, it can cause an increase in lymph fluid. This extra fluid can potentially make swelling and discomfort worse in that area.
Swimming is a great exercise option after breast cancer surgery that can help relieve pain and improve mobility. It’s easy on the body, letting you move gently to improve your range of motion and strength without stressing the healing surgical areas. Plus, the water’s buoyancy gives extra support, making swimming a therapeutic and enjoyable way to help you recover and stay physically well.
MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 64,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.
Have you experienced cording after breast cancer surgery? Has anything helped to resolve it? Share your experiences in the comments below, or start a conversation by posting on your Activities page.