Ep. 17 -Enhancing Post-Breast Reconstruction Outcomes with Manual Lymphatic Drainage with Kathleen Lisson, LMT, CLT

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 Guest Welcome

Ericka Clinton: Good day, everyone, and welcome to another episode of [00:01:00] Collaborative Connections, a space for sharing and learning, sponsored by the Society for Oncology Massage and the Society for Oncology Aesthetics. My name is Ericka Clinton, and I will be your host. On today’s podcast, we have Kathleen Leeson, a massage therapist and educator.

Kathleen is a board certified massage therapist, a certified lymphedema therapist, health coach, and registered yoga instructor. So she checks all the boxes. She is an NCB TMB approved CE provider. Author and S4OM Preferred Practitioner. As well, this is her second appearance on Collaborative Connections, and I’m so excited that she could join us again to discuss breast reconstruction surgery.

Thank you, Kathleen, for taking the time to join us today. How have you been?

Kathleen Lisson: Yes. Thank you. I’ve been amazing and helping people after [00:02:00] breast cancer surgery and all different types of Breast surgery is an amazing part of my practice It’s rooted in my mother’s own practice fight from with breast cancer.

When I was a child, she was diagnosed with breast cancer. So to see the clients come into my office is very special for me. It’s one of my favorite clients to have.

Ericka Clinton: That’s wonderful. That’s wonderful to make that kind of personal connection. Yeah. So on our last podcast together, we discussed lymphatic massage and stress reduction and I still remember that Podcast and some of those breathing techniques.

I actually have been using with my students So they love to have that stress lecture where we just get to kind of turn down the volume on our nervous system And then they learn something that they can take home One of my students actually said I’m gonna do this with my kids and I thought that was fabulous and I know our community loved the talk and [00:03:00] the information and skills you provided.

Breast Reconstruction Surgery Overview

Ericka Clinton: so in terms of talking about breast reconstruction surgery, I think it’s good if we always start with some foundational information. So what are the breast reconstruction surgeries? I would say that are most commonly performed or that you see most commonly in your client population.

Kathleen Lisson: Yep. Yep. So you, people who have breast cancer and after they’re diagnosed, they have choices.

So the main choices and, prefaces with flat closure, aesthetic flat closure is always a choice. So, but if you wanted to try to reconstruct the breast, most surgeons will offer you the choice between some kind of implant based surgery and then flap based surgery where they take a piece of tissue from elsewhere in your body and then rotate it or move it up.

To the breast [00:04:00] area to like reconstruct extra tissue where they had removed the tissue in the cancer operation itself.

Deep Flap Surgery Details

Kathleen Lisson: what I see most often is what we call a deep flap or tran flap. And I see mostly deep flaps if it is a flap surgery. And that is the type of surgery that. A lot of people will say, Oh, it’s kind of like having a tummy tuck because they take the tissue from the abdomen and then they put it to reconstruct the breast.

They put it up into the upper chest area. So that is when the client comes to you. It will look like a mommy makeover. It is not a mommy makeover, but. You will see an incision that looks similar to an abdominoplasty incision. They’ll have drains and they’ll have their supportive bra on where they had the flap go up.

So we won’t see them in the immediate few days after surgery. They will usually have to [00:05:00] stay in the hospital because you have to make sure the staff has to make sure that the flap is surviving and perfused with blood and stuff. But once they’re cleared for, the massage they will really benefit from menial lymphatic drainage.

The, and it’s the same course that I would take if I had someone with a tummy tuck where we’re moving the fluid up to the axilla. And we have to, know how many lymph nodes, if they had an axillary dissection. So you need to know about their cancer operation to see where you want to start.

Specifically for that individual client to redirect the fluid, but generally I will redirect it up. And then you also open up the inguinal lymph nodes because the lymphatic system is a whole and I like to treat the person in the body as a whole. I don’t in the first weeks after it they will come in with their surgical bra.

So I won’t [00:06:00] really need to do any. MLD or anything right over where the flap is in less than until the surgeon states that’s okay. To understand it’s kind of the same with lymphedema surgery as it is with this breast reconstructive surgery is that You may have the same operation and five different clients, but if they have five different surgeons, you’re going to have five different post op protocols.

And so there is no one universal protocol, because honestly, the surgeons themselves, if you put them in the room, they’re not going to just, they’re not going to be able to agree on one protocol. So we have to individually reach out to each surgeon and ask them and verify with them. If you are touching breast tissue I’m in the state of California, so it’s different in every state, but we need a referral from a licensed medical provider, and we need them to sign a [00:07:00] consent form.

So I make sure that both of those are done, and then It’s much easier because in my practice, I just have everyone get referred from their plastic surgeon. So, I want the client to know that we’re doing breast massage, if we’re doing breast massage. I want their surgeon to definitely know, and then I want everybody to know that there’s still options.

You can still come in and get massage, on other areas of your body that aren’t the breast if we haven’t had the consent for those two. So, with the D Plap, I don’t have to. the breast tissue itself to get them relief because we’re addressing the donor area and it’s swelling in the donor area of the abdomen.

So for the deep flap, one clinical perform all that I’ll give is the last client that I had that had a deep flap. They had her put like an abdominal binder, which is kind of like a Velcro garment and she was having the umbilicus kind of going off [00:08:00] center and she was, yeah, she was like, this is very interesting.

What’s happening. And I said, are you pulling the binder really strongly over to one side? And then the umbilicus area is deviating a little bit and she’s like, oh, yeah. Like it is a coincidence that it’s the same side. So I said the binder works both ways. Just pull it over the other way and then we’ll put some foam underneath it.

And then later it evened out to where she was comfortable with that. So that’s if you see anything and this is even in Tommy talks, anything where you have the garment, even if it’s a garment that has the little hooks in the eyes, pulling that garment over to hook it, and then that can cause a little deviation, on the abdomen area.

So that’s a really great clinical pearl that. Now that you’ve heard it, if you ever see it in the future, that should be the first thing that comes to mind. Let’s look at the compression and what’s happening with the compression garment.

Implant-Based Reconstruction and Fat Grafting

Kathleen Lisson: So the other thing [00:09:00] that clients can have in reconstruction is an implant.

So the implants themselves, and I know we’ll get to this, but over the last 10 years where the surgeon puts the implant and how the implant is placed, and that operation has changed in advance. So if someone is a therapist, oncology massage therapist, and you took your oncology massage over 10 or 15 years ago even five or six years ago and, you haven’t like gone back to CE classes, this may be.

Something that you’re seeing now that maybe you weren’t seeing 10 years ago. It’s the changes in the implants and specifically What most of my clients coming in are? They had their reconstruction with the implant and they’re also having fat grafting So they’re having liposuction in different areas of their body and then the fat is placed underneath the skin to kind of help make the cosmosis of the [00:10:00] operation better.

So they’re getting a better cosmetic result. It’s important to know with that, and I kind of remind them, and I know their surgeon has said that, but that’s not a one and done operation specifically. You can go in, it can be a several step operation where they’ll do that, and then maybe six months later, you come in and if there’s any tweaks, they might put.

More take more liposuction and put more fat in the area, which when I talk to the clients about that, it’s like kind of a little sigh of relief. Nobody wants like 10 more operations. Like, I get it. Everyone wants to put the cancer and the whole thing in their rear view mirror. But at the same time if you are two months out and you’re looking at your breast and you’re like this isn’t the result that I wanted It’s kind of we’ll just wait until the six month mark and then we’ll go back to the surgeon and we’ll show him like There’s a little pit here.

There’s a little area here and then I can get more surgery I can get a better result eventually and we know that from [00:11:00] if you have breast cancer and you’re having Radiation, as a result of the radiation, the breast is going to change over the next few years anyways, and that is something that you can go back and go to your surgeon again and say, I’m looking for a better cosmetic result, and they will help you further.

Ericka Clinton: That’s wonderful. That’s wonderful. Because I know, again, people just assume that whatever the outcome is after that first major procedure is kind of what they have to live with. Yeah. So to speak. And and there can be a lot of dissatisfaction, particularly because the surgical process are intense.

And then to not have the result you want feels very kind of upsetting.

So that’s good to know.

Kathleen Lisson: Yeah, and for this particular client they sometimes feel like they’re caught in between a rock and a hard place

Ericka Clinton: because

Kathleen Lisson: what they really don’t want is like three more operations. What they really want is this to be [00:12:00] over and them to be happy.

And then also, In the back of the mind for so many of our clients is, well, I survived cancer and I’m doing pretty well. So like, shouldn’t I just be happy that I’m alive? You know, I’ve seen when you go into the waiting room at your doctor’s office, so many people look worse off than you. Like, why am I in here?

Advocating for Better Outcomes

Kathleen Lisson: Advocating for myself when I should, you know, you should just be glad that you’re alive. And that’s I really have to have the conversation with, like, we can get advances. We can get you as best. You know, the best results you can have. You don’t have to, you know, stop and just try to be satisfied with what you have now.

And I know later on, we’ll talk about some of the side effects and complaints that people have coming in. And one of them is, you know, like the shoulder mobility and we can always improve shoulder mobility, even like six months later, a year later, [00:13:00] like it doesn’t have to be something that the client has to live with because they have cancer and that they should just be satisfied with what they have now.

Ericka Clinton: Right.

Advances in Oncology and Fat Grafting

Ericka Clinton: So let’s talk about some of the advances and changes because my oncology training started over a decade ago. And so now as things kind of have evolved, you know, fat grafting for me is kind of new. Like I was like, what do you mean? And I thought, Oh, that’s so interesting because I had. So many clients who had an implant and they were so not happy with the like contour and the shape.

And so I’m like, Oh, this is great that they’ve kind of figured out there’s a way to modify things so that again, you get a better cosmetic appearance. But can you tell us a little bit about some of the changes that you have seen? And I, guess the benefits for people, of those advances.

Kathleen Lisson: Yeah.

Equity in Breast Reconstruction

Kathleen Lisson: So I want to [00:14:00] start out by taking us all the way back to 1998. That was the first big federal mandate. And there’s actually a really great piece, a journal article by the researchers at City of Hope that are talking about even since 1998 we still haven’t had full equity in breast reconstruction procedures.

So your client had breast Who are minorities who are in low income areas, rural areas, access to regional hospitals, access to the number of breast surgeons in their area. This may be where you’re seeing some of the divide where you’re seeing your wider, more affluent private insurance clients are having breast reconstruction.

And you’re more minority underrepresented clients are having less. So even though we have a federal mandate since 1998, we’re still not seeing the same amount of procedures [00:15:00] offered to different clients in different areas of AmEricka. So that’s first of all, we have to like, set the stage with that we’re not even we’re not to parody yet with that.

Innovations in Surgical Techniques

Kathleen Lisson: but there is also a really great article published recently by the researchers in mass general, which is like the Harvard teaching hospital, and they looked at over 3000 reconstruction procedures that they did over the last 10 years and really saw that. That over the last 10 years, they have seen a difference in the surgeries they were doing now versus 10 years ago, and they’re seeing more nipple sparing surgeries.

I earlier on in my career, I was not seeing as much surgeries where you would get your nipple and you’d still have the nipple. Their flat thickness has gotten thicker. And they are specifically the most surprising to me and the thing I think we’ll see most in our practice is 10 years ago it was under the [00:16:00] muscle where you put the implant.

So it’s the pectoralis muscle is here and either you put the implant under the muscle or you put it over the pectoralis muscle or you can put it like in between. There’s like a, hybrid approach but they’re seeing much more where they’re putting the. The implant over the pecs muscle. And they are using an, acellular dermal matrix or a DM to wrap or en mesh the implant in.

And then that is the new way that they’re doing the surgery. So. It’s super interesting. I, got, I went to the California Society of Plastic Surgeons conference earlier this year and I talked to the people at Galaflex, which is one of the companies that make the mesh. And they had to be very specific about how they were talking to me because even though, like in this study the surgeons were saying they’re using it on 55 percent of their cases, it’s not indicated for that use.[00:17:00]

Ericka Clinton: So it’s

Kathleen Lisson: indicated, mesh is indicated for other uses, but it’s not specifically indicated for the breast. So we’re still seeing it. We’re seeing a lot of it and we’re seeing it because they’re finding some advantages to doing it.

Capsular Contracture and Pain Management

Kathleen Lisson: And the number one advantage is where you will also be able to see an ADM on a cosmetic client who’s having an implant because they find it reduces the incidence of capsular contracture.

Is the number one, if not. In the top five reason why people will get another surgery and that’s cosmetic and for all breast implants. So capsule, every time you put a foreign body into the body the body is making a capsule, a thin capsule of scar tissue to enmesh it. And I kind of like to think of it as like, we’re an oyster.

And if you put a grain of sand in an oyster, it makes a covering on it because it doesn’t want that grain of sand be right next to its body. So the body is making that [00:18:00] capsule and in some people, for some reasons, The capsule gets harder, and it gets firmer, and it gets thicker, to the point where it causes pain to the person it changes the way that you see the breast implant, it’s not lying normally in the breast, so you can see where it’s at.

It’s very profound. You can see that there’s an implant in the skin. And then the, way that person touches themselves, if they touch the breath, it feels firmer. And the breath should feel like a pillowcase, and then it can feel more like the sofa pillow, and then it can feel more like, like a Nerf ball, and then at the very worst, it can feel like a lacrosse ball inside of you with the contracture of the capsule.

So the Doing it pre pectorally and having the acellular dermal matrix there is shown in this research study. It reduces pain in the client. It reduces the incidence of [00:19:00] capsular contracture. It, there is a really great screening tool called the Breast Q which has questions about how the person feels their breasts, how their breast surgery impacts their life.

If they get better scores on the Breast Q, so that’s, you’re asking the client to do Their subjective experience, and then they find an improvement in upper arm function, which is something that if you have the pectoralis muscle here, and then we’re putting something underneath it. You can have a limit in anytime you change something with the body, you’re going to something, you’re going to feel it somewhere else.

So they’re finding that the clients have an improvement in their upper arm function with that. So that’s the biggest thing. If you were if you did oncology massage 10 years ago, and then you’re coming into the field today, that is the biggest thing that you’d see as far as a change.

Ericka Clinton: It’s amazing.

And also so smart. I mean, at the end of the day, kind of focusing on. The top issues that I see, [00:20:00] which are loss of range of motion, pain, as well as contouring and comfort with the reconstruction. And it seems like The plastic surgery community is very interested in having their work produce better outcomes.

Kathleen Lisson: Yep. Absolutely.

Liposuction and Fat Transfer

Kathleen Lisson: And then if you add on top of it, like my surgeon that refers clients to me does the liposuction. So they’ll take the liposuction. I’ve seen research where there’s several different areas. Most of the areas that I see that my surgeon that refers the clients to me will be the abdomen in particular, the lower abdomen underneath the navel.

I to tell the clients, these are the areas of your body where that fat won’t, you can exercise and diet all you want. That’s not going to move. So that’s the good fat that we want to move up here because we know it’s like clinging at all. Cost to life and it will never die [00:21:00] and so it’s below the lower abdomen is really good The flanks those love handles that you can never get rid of and then if there’s a client that’s really low BMI We’ve all seen that could that Client who had breast cancer that she’s just skinny as a rail They will try to harvest from the upper inner thigh And sometimes that they can get fat from the upper inner thigh, especially if it’s just a client that doesn’t have enough fat on the torso or the love handles.

So those are the three big areas that I see and then they’ll, do just very thin, Transfer in very small amounts, so the fat can survive. You can’t just like transfer a big glob of fat. It has to be Thinly applied so that it can vascularize so that it can get enough nutrition and then survive on its own but they’ll do it to the upper pole and then if they have research has shown if you do it.

The fat transfer, even [00:22:00] like later on the fat transfer can improve the feeling of cold breast. Like you see the contours of the breast. And then if there’s a slight, a like a light capsular contracture, sometimes just having a little fat, a little more tissue in the area can help the client. If they really want to avoid having surgery, because if you have capsular contracture we can’t really do anything as a massage therapist to soften up a scar capsule.

It really is a surgical intervention. But luckily because of mandates if the, root cause is a breath cancer operation, they should, we should definitely be inviting them to go back to their surgeon because most often it will be covered by insurance.

Ericka Clinton: That’s good to know. That’s good to know.

Because that is a miserable negative side effect.

Kathleen Lisson: Yeah,

Ericka Clinton: miserable negative side effects. in terms of your clients, what are some of the complaints that they usually [00:23:00] come in and are looking for you to support or resolve post breast reconstruction surgery?

Kathleen Lisson: Yep, so we we foreshadowed it earlier on, and I’m sure everyone will shake their heads, but it’s the shoulder girdle.

It’s that they’re, not having full range of motion. And sometimes you really, I really have to have and ask a specific question with a specific conversation, because just someone who can do this doesn’t mean it’s comfortable, or they feel like they can do it all the time. And I was like, is.

Shoulders the same or the shoulders the same that they were before surgery to really get to the client who’s like, well, I can reach up, you know, and it doesn’t hurt so much. I’m going to the hospital. But that’s still, it doesn’t mean that we can just gloss it over and that you don’t need any help. And I always, so I will always automatically do.

Some nice shoulder girdle work on a client, you know with the [00:24:00] back of the neck and the upper back, especially if someone has not had implants before and now they have implants. Like heavy breasts hurt your upper back, like this period, having a weight here is going to have an effect on the structure of your body.

And then a lot with the pectoralis muscle and around here, wherever they were radiated the effects of radiation can last for years afterwards. And then, so improvements, we can try to make improvements in any kind of range of motion limitations, or the skin tissue texture after they have radiation, especially if they have, like, radiation fibrosis.

Another interesting thing that not a lot of people will talk to me about. But once, sometimes I have to touch their drain scar to have a conversation about how much that scar from their drain hurts and I try to tell them, like, your surgery lasted eight hours and then it was, you know, like the doctor sewed you up, [00:25:00] but that drain has been open for sometimes weeks.

Like that drain scar was open and something was inside your body and then removed. So I am honoring your drain scar and saying it can be angry. It doesn’t need to be angry. We can calm it down, but it’s a definitely okay. If you have pain in the drain scar area, you’re not the only one. And then, so I’ll use massage to just help that area.

And then a second, Sometimes they will see that it’s indented or there’s some unusual texture in the scar around there and I’ll just be like, ask your surgeon if the same kind of scar tape you’re using elsewhere, if you can just use a little square of that scar tape there, and that may help it and then just continued massage if you’re beyond the time the scar tape can help, and just daily massage and then, As we know with all of our breast cancer patients, there can be numbness and there can be chronic pain and that’s a sizable amount of [00:26:00] people after breast cancer surgery or having chronic pain in the area.

And that can be something that they can talk if it’s nerve pain. They can go ahead and talk to the surgeon about seeing if there’s any surgeries that can help with the nerve pain, if there’s nerve entrapment because it’s not them. They’re not alone. This isn’t a pain that they have to just deal with as a result of the surgery.

And I have never met a client and I’ve been practicing for eight years. I’ve never met a client who was fine with being on long term pain medication and didn’t want to try to do something to get off of that pain medication. So it’s. It’s kind of like having a conversation with us. If you, if they go into the doctor’s office, like, first of all, you can totally blank out.

Like, you have to, to the point where you, I tell people, you have to write the questions down that you want to ask, because when you’re in there, sometimes you totally blank out. But we’re, like you said, like the massage, they’re doing the breathing, they’re relaxing, their nervous [00:27:00] system is calm, they have an hour with us, and all these questions are, and we’re conversating, you know, we’re having a conversation, we, they see us as the expert, and all these questions are coming out.

So this is a really great opportunity for us to know who we can refer them back to and be confident in referring them back to them, because like I said, there’s a federal mandate, there should be some openness. With the health insurance to be able to get them the treatment that they need.

Ericka Clinton: That’s great.

Kathleen Lisson: Yep, and then the donor site. Sorry The donor site which we often forget and the surgeons often forget too that we’re focusing on the breast so much We need to focus on the abdomen if it’s a deep flap or a trans flap We need to focus on the liposuction area and some people have said like I thought That this would be an easier surgery and Don’t Well, I’ve not found it’s almost like the people with tattoos have a harder time with liposuction because I think if you go in and you [00:28:00] want to tattoo that, like, it should be fine.

But, Some people have an extremely hard time with liposuction and pain from after the liposuction operation. And I was just talking to a client yesterday who had some surgeries after she had breast cancer. And I said, you had surgery on over half of your body between all the liposuction areas and the breast areas.

And it is completely okay if you have pain in those donors sites. And I’m the person that can help you with that pain.

Ericka Clinton: Wow. Yeah.

Lymphatic Drainage and Healing

Ericka Clinton: so where does lymphatic drainage fit in most appropriately post surgery? Is it for support and healing at the donor sites reducing swelling in the breast area? Because sometimes people come in and they’re like I don’t know what’s going on.

And is this going to change? And they feel so kind of engorged in a way post surgery.

Kathleen Lisson: Yes. Yeah. So [00:29:00] if it was a multiple choice question, it would be E all of the above. I’m a huge fan of lymphatic drainage. The only, the clinical pearl I’ll give you on this ADM if so, I always have to ask the surgeon. To give the referral because some surgeons and I would agree with this for all of my clients is if you have a, that a sailor dermal matrix, how it works is that the body is going to form a scar tissue capsule around that ADM.

So I don’t want to get in the middle or move things around as they’ve been carefully sewn and carefully placed in a certain area. So I don’t touch ADMs until six, seven weeks out. So, and I am extremely cautious with. Where I’m even doing my manual lymphatic drainage over which breast tissue. So I really want the surgeon to understand and, sign off on what I’m doing.

And we can do manual lymphatic drainage [00:30:00] everywhere else. I’m comfortable with doing manual lymphatic drainage over the area that, that, If they’re wearing a bra that I still see the skin the sides to get to the axilla but I don’t want to if it’s, delicately or just sometimes some will use just like half cover it instead of cover it.

I don’t want to be the one that is the fingers pointed at if something moves around and something doesn’t work like it should. But all other times, like, I have a free continuing education class, Manual Lymphatic Drainage More Than Edema Reduction, where I talk about all the research that’s been done on manual lymphatic drainage and all its benefits in addition to edema reduction.

Like, it reduces the level of pain that they feel, it increases their pain threshold so they don’t feel pain until a higher level of sensation after the manual lymphatic drainage. And then just, Putting your hands on someone [00:31:00] just them seeing that someone is giving them a massage and that it doesn’t hurt.

And I’ll get this, is my favorite because I have a bachelor’s degree in massage therapy for Sienna Heights. And they’re like, oh my gosh, like I touch it and it hurts, but you touch it and it doesn’t hurt. And it really is because that the manual lymphatic drainage is that gentle rhythmic stimulation and that they’re at a they’re parasympathetic and they’re really relaxed and they’re lying down and they’re confident because their plastic surgeon has recommended me and they’ve seen

That I’m an expert and I’m not hurting them.

But I will be like, one of us has a bachelor’s degree.

But once they, once that happens, usually that. sticks around and then they are able to, when they self massage themselves, at least for a couple of days afterwards, they are feeling less pain as well. So then they get giving them the confidence to put their hands on the part of the body, especially like in the quadrant where they [00:32:00] had surgery.

surgery is helping them emotionally, physically, spiritually to reintegrate that part of their body with the rest of their body. And I think that’s really important to have someone be able and comfortable to put their hands On part of their body that had surgery because often I also love to talk to people about how now you discover after surgery how you have different mechanisms in your body to feel different sensations, like heat sensation is different from, you know, pushing sensation is different from pressure is different from this is different from that.

Because they get this feeling like alien skin after like, where they can feel something, they can feel the pressure, but maybe they can’t feel the fine sensation that they used to be. So they’re like, it doesn’t feel like me. It feels like an alien. I’m numb, but I’m not numb. I’m numb, but like, I can still hurt myself.

I don’t understand what’s going on. And I’m just like, here’s the beauty of our body with its redundant systems. [00:33:00] But the bottom line is they do feel like it’s an alien, and if I can get them back to feeling like it is their body, and they can more embody their whole body I think that is so beneficial in their healing.

Ericka Clinton: Yeah, no it’s, amazing, kind of the emotional space that they occupy as they’re going through the healing process. I had one client who comes to me every week and said, For whatever reason, the implant was like moving up her chest and she, you know, we, that would be the main focus of what we would do, but she just was like so disconnected from her body because the implant wasn’t sitting well and it didn’t feel like her and she hadn’t been able to really figure out how to kind of.

Integrate all of this new normal, in, in, in a more positive way for herself. But again, appreciated that I, you know, I could do something for her in those weekly [00:34:00] sessions.

Scar Management and Emotional Healing

Ericka Clinton: just as you were talking, I had this thought and I was like, scars. We haven’t talked about scars. And you mentioned scar tape as well as, you know, thinking about the reconstructive surgery sometimes.

has have a lot of components. And although people may get a really good cosmetic outcome, one of the things I finally really struggle with are the scars. And then, of course, we have the whole dance about let’s make you symmetrical. So now the other breast that didn’t have cancer Also now has scars.

And I just wondered you know, if you have any insight into bad things that we could be supportive with and help people as they manage scar tissue, but also, you know, surgical scars that are just very unsightly.

Kathleen Lisson: Yes, so I will start like at six to eight weeks after surgery and I, want them to feel, I want the scar to be mobile, so I’m kind of just cat’s pawing [00:35:00] around it to See what the mobility is.

And I think the verbally, a lot of clients really like when you talk about what you’re feeling, when you feel it. And it gives them a lot of confidence that I say, Oh, like this is a really mobile scar. And I actually have a client. She came to me because of, prophylactic mastectomy because she was BRCA positive and then she had the implants and she had the liposuction from the thighs because she was a lower BMI client.

So as I’m massaging her thigh, she has a scar from decades ago from like a knee surgery. And I always, I tell her, I love this scar. She was so, you know, like, oh, that scar. And I was like, this scar is so mobile. Like, you’re able to jump and run and squat and everything, right? And she’s like, I am. And it’s sometimes like me putting my hands, manipulating the scar.

This scar is so mobile. This is so great. Like, I love this scar. This scar is my [00:36:00] favorite scar. That gives them because they’re really scared. They don’t want to have a scar. The scar reminds them of, you know, like the worst time in their life and all this trauma and for us to be able to mobilize that scar to give them more of the range of motion in the shoulder.

Sometimes it’s impacted by the scar down here. Is beneficial. What’s beneficial is having an in person scar massage class. To get your butt in a seat and actually learn it on another human bodies about scars is that will give you as a therapist, the confidence that just taking online course and seeing pictures won’t.

And what I really like is, the close training, which I got my CLT from, they have a scar massage class. I think it even now it has part one and part two. So they’re showing you how to do like the C strokes and the S strokes and really feel it along the radiation and around the, [00:37:00] breast scars.

And then also Jen Hartley has a burn scar massage class where she, when I took it they had the second first. Part was the lecture and then the second part of the class people with different burn scars actually came in and talked and that was actually I love the class. I learned so much, but then I had to learn some stuff remedially because I was taking myself too seriously.

And sometimes I stare directly at the problem to find a solution when I need to focus on the entire body. And so learn from my remedial lesson, a gentleman came in, he had his he had his toes frozen off in an accident outdoors. And I came in and I really thought that I was going to massage like the bottom of the foot.

And I said, what can, but luckily I said, what can I Help you with today. And he said my hip because I have an orthotic [00:38:00] and you know, he has something and it’s, setting his hips off at the wrong. So what he really needs is hip. He doesn’t need anything on the foot. And I was just so humbled. So glad I asked it instead of just grabbing when the person needed the hip.

So I will ask someone, like, what is their experience of the scar? What do you What? How is this affecting you? And let’s do a little scar massage. And are you having a difference with how you’re affected? And that I think is so valuable to the client because it puts them in the driver’s seat of their own recovery.

Ericka Clinton: Wonderful. Wonderful. thank you so much, Kathleen. This has been amazing. And as always. So informative. I’m just like, we just talk all day. You’re like a wealth of information and I so appreciate how much you share with me and with our community and I would love to be able [00:39:00] to put some of the articles that you’ve written.

That you mentioned in our show notes as well as the class that you said that you offer for massage therapists. Yeah. Yeah. Yeah. That’s it. I was like, Oh, that sounds like something I want to do. So thank you. Thank you again. Really appreciate your time. Thank you. Have a good day, everybody.

You too. All right, collaborators. Have a great day. And thank you so much.

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