Atrophy of major and minor pec muscle post mastectomy

Thank you for a comment on the following:

I had a mastectomy and was told that both major and minor pec muscles
had been atrophied 10 years ago during a standard axillary dissection
[sampling of nodes - none were diseased]
I enjoyed 10 years of zero discomfort or defect before mastectomy

After the mastectomy it took quite a while, but
my chest has sunken and the ribs are clearly defined.

It appears that medical searches seem to contradict any connection with possible
nerve damage during  standard level I or II  dissection  
However, it is quite a surprise to now be told by another surgeon
that my axilla has been completely cleaned out
[axillary completion]
This seems to mean that even if levels I and II were gone- that level III
may have been performed during mastectomy and denervation occurred
at that time [not as surgeon said, 10 years ago].

My lower back has become weakened because I lack any
muscle strength in my left chest.

My question is -
1]how long does it take for the chest muscles to atrophy if they have
been denervated?  
2]...when does the atrophy  become noticeable
after  muscle denervation- can it be months to years??
Thank you for your help

[yizzit]

This is to edit my post
should have said
Total mastectomy was done
no plan for any nodal removal
But.....it appears MRM may have been done

[japdip]

Things were much different 10 years ago and I have no idea as to what might have been done at that time. I can tell you however that with either surgery nerve damage is always quite possible. In the past when a mastectomy was done the chest muscles were also resected in many cases; not so today though. If a complete axillary clearing was done 10 years ago I don't think it would have been repeated this time but I'm sure there would have been some sampling of a node somewhere for testing for the spread of cancer cells. There could have been some muscle atrophy that was not evident until the breast tissue was removed ... we are usually advised a number of exercises to prevent muscle atrophy and to regain normal range of motion after mastectomy. Atrophy or not we can now see our ribs quite clearly when the overlying breast tissue is removed and the chest does appear "sunken" on the operative side. You didn't mention how long ago the mastectomy was performed but unless you had been totally inactive (bedridden with no movement at all) your muscles would not atrophy in a short time, if at all.  Regards ....

[yizzit]

Thank you so much  for your reply
I am truly grateful to talk candidly with someone other than my own doctor

Sorry -- should have said the lumpectomy was 1994
and mastectomy 2004
I didn't notice that much discomfort for over a year or two
after the mastectomy - it has been much worse the last few years.

I am just trying to figure whether or not to try physical therapy as my new surgeon
is recommending. If the muscles are atrophied as he said.......I'm not sure therapy would do much good if I don't have chest muscles to use for exercise~

He showed me  the atrophied muscles on the MRI [but MRI does not show level III nodes unless there is disease - so he said his visual opinion is that a completion dissection was done during mastectomy]

I am  confused by your statement that "unless you had been totally inactive (bedridden with no movement at all) your muscles would not atrophy in a short time, if at all."]  
Do you mean this would apply to either surgery ONLY  IF NO nerve damage occurred?

I understand that to reach level III the muscle must be reflected-
- so couldn't the muscle [or nerve supply] have been damaged in a level III  dissection
causing the atrophy?

I am supposed to make up my mind about therapy by friday..........ugh it sounds
terribly painful~
  
I'll be back tomorrow to see if you replied
God bless~

[japdip]

You should have had some P.T. after the mastectomy ... did you do any exercise routine at all after the surgery in  2004 ? It's pretty much a routine post-op thing ... even Amer. Cancer Society sends video tapes to pt.s to use after surgery. I have considerable numbness from nerve damage but my muscles are fine. Makes me wonder since you mention a back problem if this is not related to either surgery but to something else entirely. You might think this a foolish question but do you wear a breast prosthesis and have you worn it as soon as approved since the mastectomy ?? I would advise you to at least go for evaluation and give P.T. a try; you might be surprised at the results.   Regards ....

[yizzit]

Thanks again
Well, no, dr. never recommended PT after mastectomy
I have read that it should always be recommended though

Yes, wore a "softie" for a while then the mast/bra
but now just wear the softie because the bra hangs too
heavily on my missing muscle and is very irritating.
I do realize the weight of the prosthetic may be important
for balancing purposes - so maybe I should try it again

Anyway - thanks for your generous time and so glad
that you are doing fine with your recovery.

[japdip]

Yes, the weight imbalance is very important and can cause back problems. If you have been this long without proper balance this should be considered as a possible cause of your back concerns. A proper size prosthesis and a well fitted mastectomy bra should not cause you any discomfort. There is also a "contact" prosthesis that does not cause the bra pressure you mention and can be worn with any bra. It gives you a more natural feel as opposed to the "hanging in the bra" feeling you mention. I'm sorry you didn't receive what I would call adequate post-op care but it's never too late to regain some strength thru Physical Therapy.  Take care now ....