Breast Reconstruction
Some women decide to have breast reconstruction to rebuild a breast's shape after mastectomy. Many times, the client opts for reconstruction at the same time as the mastectomy surgery, in order to minimize the number of procedures and the accompanying pain or discomfort. Reconstruction has both pros and cons, and the decision that is right for one woman may not be right for another. 
 
Each of the following procedures, commonly referred to as "flap methods" are autogeneous tissue reconstruction, where the woman's own body tissue is transferred from one part of the body to the breast.
 
Transverse Rectus Abdominis Myocutaneous Flap (often referred to as a "TRAM Flap" or "tummy tuck"). TRAM involves the migration of tissue and its corresponding blood supply, from the rectus abdominis muscle to the breast. This technique is the most common one.
Latissimus Dorsi Muscle Flap (or LDM). The second-most-common procedure, the LDM flap is selected when there is a skin deficit that can be corrected with the transportation of large amounts of skin, fat, muscle, and blood supply, to the chest wall area. The LDM procedure transports a segment of skin from the upper back to the anterior chest.
 
Gluteal Free Flap. When other flap techniques are not appropriate, the breast can be reconstructed with fat and skin from the buttocks. This option is known as the gluteal free flap. The appropriate tissue needed for this breast reconstruction, along with a segment of the gluteus maximus muscle, transported to the chest and connected to the internal mammary artery.

Post-Traumatic Edema vs. Lymphedema
Edema, the presence of large amounts of fluid in the intercellular tissue spaces of the body, is not uncommon after the trauma of surgery. This collection of fluids normally dissipates slowly after surgery, without intervention. Light massage, however, is capable of reducing the edema more quickly and effectively than without touch.
 
Lymphedema, on the other hand, is the abnormal collection of protein-rich fluid, causing the swelling of a body part, usually an extremity. In the case of mastectomy, the operative arm is affected. As surgery, chemotherapy and/or radiation cause damage to the lymphatic nodes and vessels, a blockage of lymphatic fluid occurs. Subcutaneous tissue becomes hard and fibrotic and restricts the flow of oxygen and blood to the area. This becomes a good medium for the growth of bacterial and fungal infections. Decongestive therapy by a certified manual lymph drainage therapist is the only effective therapy, to date. Antibiotics are effective for an infection, but do not treat the lymphedema. 
 
The most important point is that regular massage therapy is a contraindication for lymphedema and may very well exacerbate the condition. This does not mean that massage can't be administered to the rest of the body, but the surgical arm is best approached with a light touch from proximal to the distal (axilla to fingertips) and at the same time keep the light touch always toward the axilla. When lymphedema is present, the lymphatic arm will be approached last. In this way, the lymph channels are open and receptive to lymph drainage. Once contracted, lymphedema is a lifelong condition. It is treatable but not curable. All that is needed is for one lymph node to be removed or destroyed and the client is at risk. Lymphedema may occur at anytime (e.g., weeks, months, years) after one or more nodes have been removed. No one knows the cause. There are women who have had radical surgery 30 years ago, with all the lymph nodes removed and have not signs of lymphedema. Then you may see a 30-year-old woman with only one node removed who develops lymphedema.
 
Treatment Precautions
 
Chemotherapy
The first record of chemotherapy being employed as a treatment for cancer dates back to 1600 B.C. in Egypt, and consisted of a mixture of fresh dates, limestone and water that was injected into the tumor mass, followed by surgical intervention.
 
Intravenous chemotherapy causes a decrease in platelets, red, and white blood cells. Therefore, deep massage may cause bruising. Chemotherapy also leaches calcium from the bones, leading to osteoporosis. Deep pressure may result in a bone fracture.
 
The optimal time for a massage is the day before chemotherapy treatment. Massage may be resumed only when the client is feeling ready for light touch. This time frame may vary for each client responds differently to the type of chemotherapy administered. 
 
Oral chemotherapy (e.g., Tamoxifen, Raloxifene) may be given in combination with other chemotherapeutic agents or alone. Tamoxifen is used to treat patients with advanced breast cancer and works against the effects of estrogen on breast cancer cells. 
 
As a treatment for breast cancer, the drug slows or stops the growth of cancer cells that are already present in the body. As adjuvant therapy, tamoxifen has been shown to keep the original breast cancer from returning and also prevent the development of new cancers in the opposite breast. Oral chemotherapy allows the client to resume normal or regular massage without the side effects of intravenous chemotherapy.