Mondor Disease and Axillary Web Syndrome: What You Need to Know

Some patients who underwent breast augmentation through an armpit incision

have noticed, about 2 to 4 weeks later,

that when they raise their arm,

a cord-like line running from the armpit toward the inner arm

pulls taut like a guitar string,

and have been startled by it.

You may be worried that the surgery went wrong,

and that is completely understandable.

To get straight to the point,

in most cases this is what's called Mondor disease,

and it resolves within a few weeks to a few months.

Why does this cord form, and how does it go away?

Today, we'll go over what this armpit cord is

and how you can help it resolve faster.

Here's what you need to know.

1. What Is the Cord That Forms in the Armpit?

A thin vein or lymphatic vessel that runs just beneath the skin

hardens from post-surgical inflammation

and can be felt as a cord [1][5].

Lymphatic vessels are thin tubes

that collect and carry the body's fluids.

Usually they're not visible,

but when you raise your arm, the cord stands out,

and the skin along it puckers like a groove.

It may run from the armpit toward the elbow,

or down along the side of the chest.

When a vein hardens, it's called Mondor disease;

when a lymphatic vessel hardens, it's called axillary web syndrome (AWS).

The two are sometimes distinguished by name,

but they're hard to tell apart from the outside,

and their course and management are similar [5].

What matters most is

that this is a problem in the superficial layer just beneath the skin,

not a problem with the implant itself.

2. Why Does It Appear More Often After an Armpit Incision?

An armpit incision involves a small cut in the armpit fold,

creating a passage under the skin

to insert the implant up to the breast.

Along the path this passage takes,

many thin veins and lymphatic vessels converge,

so they're easily damaged.

Mondor disease has been reported in international papers

as a rare complication after breast augmentation,

occurring in roughly 1% of cases [2][3].

However, most of this data

comes from inframammary (breast-crease) incision surgeries.

In a study of 1,067 U.S. plastic surgeons,

only 3.3% said they primarily use an armpit incision [4].

In my personal view, part of the reason Mondor disease is rarely reported overseas

is that armpit incisions themselves are less common.

In Korea, by contrast, armpit-incision breast augmentation is common,

and quite a few patients come in with an armpit cord after surgery.

3. Will It Get Better on Its Own?

Yes, in most cases it improves on its own.

Usually the cord softens and disappears over about 4 to 8 weeks,

though in some cases it can take several months [1][5].

While the cord remains,

you may feel pulling or stiffness when raising your arm fully.

Once the cord resolves, arm movement

returns to how it was before surgery.

4. How Can You Help It Resolve Faster?

First, have the surgeon who performed your operation take a look.

Once an exam confirms it's the cord,

you can support recovery with the methods below.

Warm compresses

Apply warm compresses over the cord several times a day

to ease the pulling and stiffness [1].

If the pain is severe,

your doctor may prescribe anti-inflammatory pain relievers.

Gentle stretching

Stretching that gradually lengthens the cord

reduces pulling and pain

and helps you regain arm movement faster [5][6].

Among the exercises introduced by overseas rehabilitation physical therapists,

here are four simple ones [7][8].

① Arm Openers While Lying Down

Lie on your back and open both arms out to the sides,

palms facing up.

Exhale and relax your shoulders,

and once you're comfortable, slowly raise your arms to shoulder height

by sliding them along the floor.

② Chest Opener Lying on Your Side

Lie on your side with the cord side facing up,

and place that hand behind your neck.

Keeping your knees together, slowly open your elbow backward.

At the point of pulling, exhale,

hold for a few seconds, then return.

③ Big Arm Circles Lying on Your Side

Lie on your side and stack your legs,

then sweep your top arm across the floor

in a large circle, passing over your head and behind your back.

Repeat 2 to 3 times in each direction.

④ Arm Nerve Stretch

Sitting down, raise your arm out to the side to shoulder height,

then bend your wrist back and release,

slowly repeating about 10 times.

For all of these movements,

stay within a gentle pull,

and spread them out over several sessions a day.

If it hurts, reduce the range of motion.

While stretching, you may sometimes feel a "pop"

as the cord releases.

After that, the pulling often decreases noticeably.

However, don't try to deliberately break the cord

by pulling or pressing hard [5][8].

The timing for starting stretches

depends on how well the surgical site has healed,

so be sure to decide it with your surgeon.

For the cord after armpit-incision breast augmentation,

there are two things to remember.

First, a thin blood vessel or lymphatic vessel under the skin

has hardened,

and in most cases it resolves within a few weeks to a few months.

Second, once a doctor has confirmed it,

warm compresses and gentle stretching

can help you get through it more comfortably.

[Things to Check Before Surgery]

Whether you were told that a cord can develop in the armpit after an armpit incision

Whether there is a way to reach the clinic right away to be seen if you feel a cord

When you can start arm exercises and stretching

Which symptoms, such as swelling or warmth, require contacting your doctor immediately

This post is written for the purpose of providing accurate medical information

and in compliance with Article 56 of the Medical Service Act.

All procedures and surgeries can cause side effects, from minor to serious,

and these vary from person to person.

Please consult thoroughly with your medical team and make a careful decision.

Sources

Yamaguchi T. Mondor disease of the breast. Cleveland Clinic Journal of Medicine, 2022;89(7):371 — https://www.ccjm.org/content/89/7/371

Khan UD. Incidence of Mondor disease in breast augmentation: a retrospective study of 2052 breasts using inframammary incision. Plastic and Reconstructive Surgery, 2008. doi:10.1097/PRS.0b013e31817d6629

Gunnarsson GL. Mondor sykdom er ikke så sjelden som man skulle tro. Tidsskrift for Den norske legeforening, 2018 — https://tidsskriftet.no/2018/05/kommentar/mondor-sykdom-er-ikke-sa-sjelden-som-man-skulle-tro

Hidalgo DA, Sinno S. Current Trends and Controversies in Breast Augmentation. Plastic and Reconstructive Surgery, 2016;137(4) — https://www.drdavidhidalgo.com/wp-content/uploads/2020/09/34d9a108f03fbf3dd5084f9d248fa7a7.pdf

Koehler LA, Haddad TC, Hunter DW, Tuttle TM. Axillary web syndrome following breast cancer surgery: symptoms, complications, and management strategies. Breast Cancer: Targets and Therapy, 2019;11:13–19 — https://www.dovepress.com/axillary-web-syndrome-following-breast-cancer-surgery-symptoms-complic-peer-reviewed-fulltext-article-BCTT

Effectiveness of physical therapy in axillary web syndrome after breast cancer: a systematic review and meta-analysis. Supportive Care in Cancer, 2023;31(5):257. doi:10.1007/s00520-023-07666-x — https://pubmed.ncbi.nlm.nih.gov/37043039/

Yerbba – Breast Cancer (Dr. Jennifer Griggs). Axillary Web Syndrome: How to Manage and Treatment Options. YouTube, 2022-06-21 — https://youtu.be/yZekYNGMB3U

Cancer Rehab PT (Kelly Reid, PT). Getting Rid of Axillary Web Syndrome and Cording after Breast or Melanoma Cancer Surgery. YouTube — https://youtu.be/m14z2Xsilo8

Frequently Asked Questions

Does a cord under the arm mean the surgery went wrong?

In most cases, this is what's called Mondor disease, and it is not a problem with the implant itself. A thin vein or lymphatic vessel just under the skin hardens from post-surgical inflammation and can be felt as a cord.

How long does the armpit cord take to go away?

It usually softens and disappears over about 4 to 8 weeks, though in some cases it can take several months. While the cord remains, you may feel pulling or stiffness when raising your arm fully. Once it resolves, your arm movement returns to what it was before surgery.

Is it okay to apply warm compresses to the armpit cord?

Yes. Applying warm compresses to the cord several times a day may ease pulling and stiffness. However, it's best to have the surgeon who performed your operation examine you first to confirm it's the cord before you start.

When should I start stretching?

It depends on how well your surgical site has healed, so decide with your surgeon. Gentle stretching gradually lengthens the cord, reducing pulling and pain and helping you regain arm movement. Keep it to a light pull and spread sessions out over the day.

Is Mondor disease a common condition?

International reports describe it as rare, at around 1% after breast augmentation. However, that data mainly comes from inframammary (breast-crease) incision surgeries. In Korea, armpit-incision breast augmentation is common, so quite a few patients come in with an armpit cord.

What should I check before surgery?

Before surgery, confirm that you were told a cord can form after an armpit incision, and that you know how to reach the clinic right away if you feel one. Also ask when you can start arm exercises and stretching, and which symptoms, such as swelling or warmth, mean you should call immediately.