Post-Cancer Treatment Care

Scar Tissue & Fibrosis After Cancer Treatment

Cancer treatment saves lives, but it can leave behind lasting effects on the body’s tissues. Many survivors notice stiffness, pulling, or tightness months to years later—sometimes called scar tissue or fibrosis. These changes happen because the healing process can “overshoot,” laying down too much collagen and reducing tissue flexibility. While this can sound discouraging, the good news is that fibrosis is treatable. With the right mix of self-care, physical therapy, and (in some cases) medical treatment, many people regain comfort, movement, and strength.

Quick note: This information is educational and not a substitute for care from your medical team.

What is “scar tissue” or fibrosis and why does it happen?

After surgery or radiation, the body repairs itself by laying down collagen. When this process is excessive or prolonged, tissues can become stiff, tight, and less elastic—what clinicians call fibrosis. Radiation can trigger long-lasting changes (via inflammation and growth factors such as TGF-β) that gradually thicken skin, subcutaneous tissue, fascia, muscle, and even nerves months to years after treatment (Yu et al., 2023; Stubblefield, 2011).

How it can feel: pulling, burning or aching pain; reduced range of motion (ROM); posture changes; difficulty lifting the arm or turning the head; sometimes numbness/tingling if nerves are involved (Stubblefield, 2017; DiFrancesco et al., 2020).

Common scenarios after cancer treatment:

A. Radiation-Induced Fibrosis (RIF)

What it is:
- a late effect of radiotherapy where tissues in the treated field slowly stiffen.
Most common sites (by cancer type):
- Breast/chest wall and shoulder/axilla after breast cancer treatment
- Neck and jaw (head-and-neck region) after head-and-neck cancer treatment
- Lung and chest wall after thoracic radiotherapy
- Pelvic tissues after gynecologic or prostate cancer treatment
  (Stubblefield, 2017; Yu et al., 2023).
How often it occurs:
- Studies suggest up to 50% of breast cancer survivors experience some degree of radiation-induced fibrosis in the chest wall, shoulder, or axilla. In head-and-neck cancer, fibrosis affecting the neck/jaw muscles is reported in about 25–40% of patients. Rates in pelvic or thoracic cancers vary more widely but remain clinically significant, especially with higher doses or combined treatments (Stubblefield, 2017; DiFrancesco et al., 2020).
When it shows up:
- often months to years after radiation, and it can progress without regular stretching and strengthening.
Why it happens:
- chronic inflammation, microvascular and lymphatic changes, and pro-fibrotic signaling (e.g., TGF-β).
Risk tends to rise with higher dose/volume, combined therapies, smoking, diabetes, and pre-existing limited ROM (Yu et al., 2023; Stubblefield, 2017).

B. Post-surgical scar tissue (surface scar + deeper adhesions)

Surface scars can be flat, raised (hypertrophic) or extend beyond the incision (keloid).
Deeper adhesions tether layers beneath the skin, limiting glide and motion.
How often it occurs:
- Raised scars (hypertrophic or keloid) develop in about 30–50% of surgical patients, with higher risk in younger individuals, those with darker skin types, or after tension-heavy incisions. Deep adhesions are common but under-reported, with studies showing 20–40% of breast surgery survivors reporting persistent tightness from deeper scar binding (Monstrey et al., 2014; Walsh et al., 2023).
What helps (evidence):
- once the incision is fully closed and your clinician says it’s safe, silicone gel or sheets are first-line for raised scars; gentle scar massage and progressive mobility improve pliability and comfort over time; stubborn keloids may need steroid or 5-FU injections and/or laser as specialist care (Monstrey et al., 2014; Walsh et al., 2023; Mony et al., 2023).

C. “Cording” (Axillary Web Syndrome; AWS)

What it is:
- painful, taut cord-like bands under the skin of the armpit/inner arm that limit shoulder elevation—most common after sentinel node biopsy or axillary dissection.
How often it occurs:
- Reported in 20–40% of breast cancer survivors after axillary surgery, though some studies show higher rates (up to 60%) when patients are carefully examined early after surgery (Lippi et al., 2022).
Who’s at risk:
- Younger age, more nodes removed, and axillary dissection increase likelihood; neoadjuvant chemotherapy may add risk (Chou et al., 2025; Lippi et al., 2022).
Does AWS mean I’ll get lymphedema?
- Evidence is mixed; recent systematic review suggests AWS is not reliably a long-term predictor of breast-cancer–related lymphedema—so AWS deserves treatment, but it doesn’t doom you to develop lymphedema (Brunelle et al., 2024).

What you can do now (self-care you can start—safely):

A. Gentle daily movement (as early as your surgeon allows)

A structured, early exercise program (stretching + progressive strengthening) begun right after surgery improves shoulder function and strength at 1 and 6 months compared with usual care (Min et al., 2024; Klein et al., 2021).

B. Scar care basics (after the incision is fully healed)

Moisturize daily; begin gentle scar massage (slow circles and along the line) 5–10 minutes/day.
Consider silicone gel/sheets for raised scars (often 12–24 hours/day for several weeks).
If the area was irradiated, wait until your team clears you; avoid friction while skin reactions are active (see precautions above). (Monstrey et al., 2014; Walsh et al., 2023; MSK, 2024).

C. For “cording” sensations

Gentle over-the-door flexion/abduction, wall walks, and slow end-range holds; do not forcefully “snap” cords yourself. Expect cords to soften with a few weeks to a few months of combined therapy and home work; manual therapy + stretching has emerging RCT support (González-Rubino et al., 2025).

How Physical Therapy (PT) treats fibrosis, scars, and cording:

Evaluation:

Your PT will check scar mobility, ROM, strength, posture, breathing mechanics, nerve mobility, swelling, and function (lifting, dressing, sport). Screening rules out red flags (e.g., infection, DVT). (DiFrancesco et al., 2020).

Hands-on care:

Scar mobilization & myofascial techniques to improve glide and reduce tenderness. RCTs and controlled trials in breast-cancer survivors show improvements in pain and function, with best results when combined with exercise (Lara-Palomo et al., 2021; González-Rubino et al., 2025; González-Rubino et al., 2023).
For AWS (cording): protocols using manual therapy + guided stretching 2–3×/week for several weeks shorten healing time and improve ROM vs usual care (González-Rubino et al., 2025).

Therapeutic exercise:

Progressive stretching of tight planes (chest/axilla/neck) and strengthening of scapular and rotator-cuff muscles to restore overhead motion and posture. Early, individualized programs help patients regain shoulder strength faster than usual care (Min et al., 2024).

Nerve/soft-tissue mobilization & posture/breathing retraining:

helpful in radiation fibrosis syndromes affecting the neck/shoulder or chest wall (Stubblefield, 2017).

When swelling co-exists:

PTs/CLTs integrate lymphedema care (education, exercise, self-massage/MLD when indicated, and compression) alongside scar and ROM work (González-Rubino et al., 2023).

Adjuncts your team may consider:

photobiomodulation/low-level laser (evidence mixed), taping, desensitization strategies—always individualized and coordinated with oncology/rehab.

Medical options your clinicians may discuss (adjuncts to PT):

Pentoxifylline + Vitamin E (sometimes with clodronate) for radiation fibrosis: small RCTs/series show mixed benefits; discuss risks/benefits with your oncologist (Nogueira et al., 2022; Patel et al., 2024).
Hyperbaric oxygen therapy (HBOT): for certain late radiation tissue injuries (e.g., osteoradionecrosis, soft-tissue necrosis), Cochrane reviews suggest HBOT can help selected cases; availability varies and referral is specialist-led (Bennett et al., Cochrane).
Raised/keloid scars not responding to silicone and massage: steroid injections, 5-FU or other agents, and lasers can be effective under dermatology/plastic surgery care (Walsh et al., 2023; Mony et al., 2023).

When to contact your care team promptly:

Sudden increase in redness, heat, swelling, or fever (possible infection).
Whole-arm swelling, calf swelling, or shortness of breath (rule out blood clot).
Open wounds or skin breakdown, especially in a previously irradiated area.
New or worsening numbness/weakness in the arm/hand or jaw-locking/trismus after head-and-neck RT. (General survivorship guidance: NCCN patient resources).

Key takeaways:

Scar tissue/fibrosis is common—and treatable. Consistent movement and strengthening plus targeted hands-on care are the backbone of recovery (Min 2024; Lara-Palomo 2021).
Cording (AWS) affects about 1 in 3 breast cancer survivors after axillary surgery; it usually improves with PT and home stretching and does not automatically mean lymphedema (González-Rubino 2025; Brunelle 2024).
Radiation fibrosis can affect up to half of survivors, especially after breast or head-and-neck treatment. Early exercise and PT are the best tools for prevention and recovery (Stubblefield 2017; Min 2024)

Scientific References:

ennett, M. H., et al. (2020/2023). Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database of Systematic Reviews.
Brunelle, C. L., et al. (2024). Is axillary web syndrome a risk factor for breast cancer-related lymphedema of the upper extremity? A systematic review and meta-analysis. Supportive Care in Cancer.
DiFrancesco, T. M., et al. (2020). Clinical evaluation and management of radiation fibrosis syndrome. Physical Medicine and Rehabilitation Clinics of North America, 31(1), 103–113.
González-Rubino, J. B., Martín-Valero, R., & Vinolo-Gil, M. J. (2025). Physiotherapy protocol to reduce the evolution time of axillary web syndrome after breast cancer surgery: A randomized clinical trial. Supportive Care in Cancer, 33, Article 326.
González-Rubino, J. B., Vinolo-Gil, M. J., & Martín-Valero, R. (2023). Effectiveness of physical therapy in axillary web syndrome after breast cancer: A systematic review and meta-analysis. Supportive Care in Cancer, 31, 257.
Klein, I., et al. (2021). A pilot randomized study of early physical therapy after breast cancer surgery. Breast, 59, 286–293.
Lara-Palomo, I. C., et al. (2021). Physiotherapy treatment of late complications (pain, scar adhesions, tightness) in breast-cancer survivors. International Journal of Environmental Research and Public Health, 18(9), 4832.
Lippi, L., et al. (2022). Axillary Web Syndrome in breast-cancer women: Optimal rehabilitation strategy after surgery. Journal of Clinical Medicine, 11, 3835.
Min, J., et al. (2024). Early implementation of exercise to facilitate recovery after breast cancer surgery: A randomized clinical trial. JAMA Surgery, 159(8), 874–883.
Monstrey, S., et al. (2014). Updated practical guidelines for scar management. Journal of Plastic, Reconstructive & Aesthetic Surgery, 67(8), 1017–1025.
Mony, M. P., et al. (2023). An updated review of hypertrophic scarring. Plastic and Reconstructive Surgery – Global Open, 11, e4888.
Murakami, T., et al. (2024). Pharmacotherapy for keloids and hypertrophic scars. International Journal of Molecular Sciences, 25(9), 4674.
Nogueira, T., et al. (2022). Interventions for radiation-induced fibrosis in breast cancer: A review. Advances in Radiation Oncology, 7(4), 100–110.
Patel, S., et al. (2024). Pharmacologic approaches to radiation-induced fibrosis: Current evidence and gaps. Current Oncology Reports.
Stubblefield, M. D. (2011). Radiation fibrosis syndrome: Neuromuscular and musculoskeletal complications in cancer survivors. PM&R, 3(11), 1041–1054.
Stubblefield, M. D. (2017). Clinical evaluation and management of radiation fibrosis syndrome. Physical Medicine and Rehabilitation Clinics of North America, 28(1), 89–100.
Yu, Z., Xu, C., & Song, B. (2023). Tissue fibrosis induced by radiotherapy: Molecular mechanisms, diagnosis, and therapeutic advances. Journal of Translational Medicine, 21, 708.
Skin care during radiation therapy (patient resources). Memorial Sloan Kettering Cancer Center (2024); MD Anderson (2024); eviQ (2024).