About that scar tissue nobody warned you about…
From the Sunday Self-Care Chronicles | 8/2/26
Hey there, friend.
Two weeks ago we talked about Time and Space, and how healing needs room to actually happen.
Last week was Context and Education - the foundation that keeps every strange sensation from spiraling into fear.
Today we're on the third Fundamental of Active Healing: Professional Care.
And I want to start with what I see on my table, because it isn't what most people expect.
I see women who are two, three, sometimes five years out from treatment, and they're still struggling to reach the top cabinet in their kitchen.
Because here's the thing about scar tissue that nobody warns you about.
After surgery, your body lays down collagen to close the wound. But it often lays it down fast and a little bit messy - like a child scribbling with a crayon.
Without skilled hands to help organize those fibers, they keep building, layer on layer, binding the skin to the tissue underneath. Pulling on the fascia. Restricting the muscle.
And the wild part? The scar can look completely fine on the surface. Faded, flat, maybe even almost invisible. While underneath, it's slowly turning into a straitjacket.
I watch this happen when women come in and tell me they can't sleep on their side anymore. Or they can't wear a certain bra because it adds pressure and makes their ribs feel too tender. Or that something is constantly pulling weird across their chest. Or they used to love yoga and now child's pose feels like their torso is being held together with duct tape.
They don't connect it to the scar because the scar looks healed. But much like an iceberg, what you see on the surface is only a tiny part of the full scar tissue story.
Radiation fibrosis is has a similar trajectory, just deeper and slower.
Radiation doesn't just affect skin. It damages the microvasculature - the tiny blood vessels that keep tissue soft and supple. It creates inflammation in the fascia, the connective tissue that wraps every muscle and organ like spider webbing. It decreases elasticity from the muscles that still connect and overlap in and around the chest wall and shoulder.
Over time, that tissue changes texture. It goes from soft and pliable to something that feels like leather, or cardboard, or chewing gum that's drying out. And it keeps changing. Months after treatment ends. Sometimes years.
I have women come in who finished radiation eighteen months ago, and they're just now developing restriction in their chest wall. They thought they were in the clear. The medical system had moved on. But their tissue is still responding to what happened, quietly stiffening, and now they're bracing against their own body when they try to take a deep breath.
This is why I get so specific about who you let touch that tissue.
Because the wrong hands can set you back. Or hurt you. Or - and this is maybe the most common - leave the most delicate work completely untouched because the therapist was trained to avoid anything cancer-related, and didn't know what to do with a post-mastectomy body that needed gentle, specific work.
Last year I wrote about exactly this - what happens when a surgeon's well-meaning referral sends you to someone who isn't actually trained for your body. If you missed it, or want the full story of the "medical massage" that went sideways, you can read it here. The point isn't that the surgeon meant harm. The point is that no one in that room understood what her body actually needed in recovery.
And that's the gap Professional Care is meant to fill.
Professional Care isn't just "having a team."
It's having the right people in your corner for the body you have now. Not the body you had before. Not the body the medical system treated and discharged. The body that's living with scar tissue, possible radiation changes, possible lymphatic disruption, and a whole new set of needs.
So what does the right kind actually look like?
For massage it's finding someone who has training specific to oncology massage, not just someone who's licensed by the state for general massage therapy, or claims to do “medical massage” because that can mean something different in every state or even every practice.
Oncology massage training teaches therapists what to do with surgical sites, with compromised lymphatic systems, with tissue that's been radiated. It also teaches them what NOT to do - because sometimes the most skilled thing a therapist can offer is to work around a site, not directly on it.
Credentials like CLT or CMLD when lymphatic work is part of the picture aren't just bonus letters for a PT. They mean someone has spent hundreds of hours studying a system that most providers barely acknowledge.
And it means finding someone who has real experience with your particular history. Mastectomy, reconstruction, flat closure, radiation, node removal - these are different bodies with different rules.
You're allowed to ask a provider about every bit of that before you ever get on the table. A good one will be glad you did.
But here's the thing that gets skipped in all the advice about "finding the right provider."
Knowing what to look for is only half the battle. The other half is knowing what to say when you get there.
Because "this is bothering me" gets dismissed in a five-minute appointment. "I can't sleep on my side anymore" gets a sympathetic nod and a pamphlet. But when you can describe the pulling, the restriction, the way your body compensates and braces - when you know the vocabulary and the questions that actually move things forward - that's when you stop being a patient and start being a participant in your own care.
That's a huge part of what you learn in my new program, As You Are Now. Not just the knowledge of what your body needs, but the map to who can actually help, and the words to get their attention. How to ask the questions that don't get brushed off. How to become your own advocate in a system that rarely gives you enough time to finish a sentence.
Let me be clear: I don't know more than the surgeons and oncologists who treat cancer. Their job is to remove it, reduce it, contain it. Thank goodness they're brilliant at it.
My job is to support the person who lived through all of that, and help her recover, reconnect with her body, and feel whole again.
That's a different scope, a different training, and a whole lot of nuance that rarely makes it into the medical conversation. And that's why professional care matters on a broad scale whether it's massage therapy, lymphatic support, acupuncture, exercise, you name it.
Which brings me back to last week.
Context and Education is how you know what your body needs. Professional Care is how you find the people who can actually give it to you.
The knowledge you build inside As You Are Now is exactly what lets you look at a referral, or a new provider, and ask the questions that keep you safe.
A white coat, or the word "medical" in front of "massage," doesn't automatically mean someone understands what your body needs in recovery.
You're allowed to ask. You're allowed to say no. You're allowed to get a second opinion, even on a referral.
Tell me: have you ever known exactly what your body needed, but couldn't find the right person to help? Or found someone, but couldn't get them to hear what you were actually asking for?
Hit reply and tell me. I read every one.
And if you're sitting on an "is this provider even right for me?" question right now, the AMA call below is exactly what it's for.
I'll see you next Sunday, with the fourth Fundamental: Self-Care. And we'll talk about what happens when the only guidance you can find is a random YouTube video - and why learning from someone who actually knows your body changes everything.
P.S. If you want the full map - the discernment, the vocabulary, and the actual guidance on who to reach out to for what - As You Are Now is where you'll find it. Founding member spots are open through August 31st at $495, and every founding member gets a 45-minute 1:1 with me this summer. Here's the full breakdown and how to apply.
P.P.S. Free AMA call: Thursday, August 20th at 12:30pm ET. Save your seat here.