The goal of arm and shoulder exercises is to enable the patient to return to normal activity after breast surgery. At 3 or 15 months after surgery, approximately 80% of patients continue to report at least 1 problem. Problems may include swelling (25%), weakness (25%), limited Range of Motion (ROM) (30%), stiffness (40%), pain (50%), and/or numbness (55%).
To avoid these complications, physiotherapy treatment is must .Preoperatively the patient is evaluated for strength, ROM, sensation, posture, endurance, and general functional ability. The patient is instructed regarding ROM exercises, postoperative breathing, and initial mobility after surgery. The patient is encouraged to begin gradual stretching exercises for all degrees of motion within a few days of surgery.. Early mobilization of the glenohumeral joint improves shoulder ROM. Active and active-assistive exercises and exercises, such as wall climbing, and use of pulley or wand, are also added. With radiation treatment, ongoing ROM exercises are particularly important to prevent contracture formation. Lymphedema precautions are discussed with the patient before surgery, and her condition is reviewed within several days of surgery.
External breast prosthesis is an artificial breast form that can be worn after the breast has been surgically removed. There are several different types of prostheses including:
Any dissection of axillary lymphatics and nodes places a woman at risk for edema of the arm. Axillary surgery and irradiation can lead to lymphedema, which may be caused by direct damage to axillary lymphatics. Fibrosis of the axilla secondary to surgery and/or radiation causes venous and lymphatic obstruction by compressing major vascular trunks and blocking regeneration of lymphatic and venous collaterals. Additional radiation therapy, trauma, and infection are other causative factors.
Conservative management of lymphedema includes preventive and mechanical modalities as needed. Self-care instructions are also given to patient .
Complex lymphedema therapy is used to treat peripheral lymphedema. This therapy consists of manual compression, external compressive bandaging, and specific therapy exercises, including manual and massage techniques. Patients and family members should be taught these techniques. Intermittent pneumatic pressure devices are used in the management of lymphedema.