Under Your Skin Cartoon

Scar Tissue Formation and How Massage Can Help

I used to draw cartoons as a kid, through high school and college, and sometimes during my corporate career. I realized during massage therapy school that I retained information about the human body best when instructors characterized different parts and made it funny.

I talk about human physiology like this with my clients in my practice as a way to educate them about their bodies, and I started drawing “Under Your Skin” as a way to illustrate what I see in my head and to help answer some Frequently Asked Questions.

So, you’ve just had surgery. Here’s what’s going on under your skin…

When there’s trauma to the skin and underlying fascial layers, nerve cells located in that area go on high alert and stimulate nearby cells called fibroblasts.

These fibroblasts are like a construction crew, and they quickly start laying down collagen that forms a dense, fibrous matrix to close up the wound as fast as possible.

Collagen production usually shuts down once the brain senses that enough strength has been achieved. But, well, the fibroblasts’ work can sometimes be a little overzealous and sloppy, and when too much collagen gets laid down, and/or it’s deposited in a haphazard formation, it can form pathological scars. You might hear terms like “hypertrophic” or “keloid.” These scars can be raised, dense, puckered, dark in pigment, or some combination of these things.

Scar tissue, especially when it’s pathologically formed, can cause a “snag in the pantyhose” effect, creating tension on the surrounding tissue, pulling it inward, and impeding healthy lymphatic flow. It can also “bind down” to other structures and tissues below, like deeper connective tissue and bone. If you think about your layers of skin and fascia like layers of phyllo dough (yup, the flaky pastry stuff), imagine them all squished, dried out, and stuck together.

When tissue is dried out and bound down, it can affect your range of motion, cause sensations of tightness or tenderness, and can cause post-surgical swelling to hang around longer than it should.

Scar mobilization massage aims to create more tissue pliability, opening up those layers of phyllo dough so that the surrounding extracellular “goo” can get back in, and then the skin and fascial layers can slide against each other better, allowing for further, easier movement.

And this work is meant to be gentle and non-invasive, and works to keep your nervous system calm (because nobody wants your body thinking it’s going through more trauma – it could end up laying down more scar tissue, and those fibroblasts did enough, thankyouverymuch).

Not to mention, scar massage can also help scars look better – flatter, smoother, less puckering, less redness.

And with all that therapeutic effect on your scar tissue, maybe that could mean…

Wave on.

Post-Mastectomy Care and Massage

A client once told me that right after her double mastectomy, she felt like she was tossed into the ocean without a lifeboat or any direction. The surgery was a success, but no one warned her of the extent of pain and tightness she would feel as the scars began to form across her chest. About how she wouldn’t be able to lift her arm high enough to take a glass from the shelf, let alone brush her own hair.

This tightness and limited range of motion in the shoulder and trunk following mastectomy surgery is normal, but there’s also something that can be done to help aid the healing process during those early weeks after the procedure, and your surgeon may not tell you, not because they don’t want to help, but because maybe it’s out of their range of care or they aren’t sure where to refer out to.

When scars form, they can sometimes lay down collagen fibers in crazy, mish-mash directions. I like to personify the body, and I imagine a crew of construction workers with very good intentions, but their work isn’t always the neatest. Instead they’re shouting, “Fill the hole! As quickly as possible!” The body wants to heal quickly by nature. In fact, if you puncture the skin with a needle, it takes just one second after that puncture for fibrin (a wound-healing protein) to start forming, ready to fill the hole.

But those hastily-laid collagen fibers can cause lumpiness, pulling, and puckering in the superficial tissues. Adhesions can form, “webbing” in the armpit (called “axillary cording”) can occur, and scar tissue likes to attract more scar tissue, which only exacerbates the sensations of pain and tightness.

Massage can help encourage the construction crew to lay fibers down in a more organized manner, keeping the tissue pliable as it is forming, which can reduce pull on the incision and the surrounding tissues. Massage can also help create space and alignment in surrounding muscle tissue, such as in the upper chest and shoulders, which may be very tight after surgery. And lymphatic drainage massage can aid in keeping lymph circulation flowing, which can help reduce swelling.

I’ve been lucky to see some incredible results in my treatment room with a combination of very gentle scar work (which can be incorporated as soon as the incisions have closed up), lymphatic drainage massage, and non-aggressive myofascial techniques to help mobilize the shoulder joint and trunk. This can happen as soon as 2-3 weeks post-surgery. In fact, earlier on is great. As scar tissue forms, it’s a little like concrete setting. The longer you wait, the more difficult it can be to encourage the tissue toward greater pliability, so you can really benefit from the work in those critical first few weeks after surgery.

The work is painless and relaxing and is really just about kindly “nudging” the body toward smoother recovery. People are able to get back to their daily activities sooner. They can drive. They can blow-dry their own hair. Recently a client of mine walked into my office after we’d been working together for a few weeks, raised her hands above her head, and cried tears of joy at regaining her range of motion.

Though some post-mastectomy patients can feel lost, there is direction. There is massage, there is physical therapy, and there is a body that wants to heal. You don’t have to be lost at sea, and with your range of motion back, you can swim to shore.

“I found my way to Megan’s massage therapy practice two weeks after my surgery for cancer. Although the surgery was very successful, I was feeling tense and uncertain about what to expect as I healed, and how best to support the healing process of muscles and skin impacted by the surgery. From the moment I walked into Megan’s peaceful treatment room, I was put at ease—treatment was always gentle, attuned, and ultimately very effective in preventing scar tissue as well as increasing range of motion. I feel grateful to have had this skilled care and support during what otherwise would have been a much more stressful period of my recovery.”
~ J. L., Middlesex County