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Physiotherapy after breast cancer surgery

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Many women with breast cancer have had some kind of surgery, even though other kinds of treatment are also done, including also one or more of these procedures:

  • Breast biopsy
  • Lymph node biopsy or removal
  • Breast conservation surgery (lumpectomy)
  • Mastectomy
  • Breast reconstruction

Any of these surgeries can affect how well you can move your shoulder and arm, take a deep breath, or do your daily activities, like dressing, bathing, and combing your hair. Pain and stiffness can cause weakness and limit movement of the arm and shoulder. The surgery can also affect to the lymphatic system generating the accumulation of fluids in the body.

Lymphatic drainage
Lymphatic drainage or manual lymph drainage, is a technique for treatment of lymphedema, an accumulation of fluid that can occur after lymph nodes are removed during surgery, most often a mastectomy for breast cancer. Lymphedema can also be present at birth or develop at puberty or during adulthood. This type, known as primary lymphedema, can affect as many as four limbs and/or other parts of the body. The cause is unknown. Lymphatic massage for conditions other than lymphedema is not medically recommended, although it may be promoted by some therapists.

 Up to 25 percent of breast cancer patients whose surgery includes removal of lymph nodes in the area of the armpit eventually develop lymphedema. The condition can also occur in the legs or other parts of the body if lymph nodes are removed in the course of other types of surgery – for melanoma, colon, prostate or bladder cancer, for example – or are damaged by radiation treatment, infection or trauma. Symptoms include swelling and pain near the site of the removed or damaged lymph nodes. Lymphedema can occur immediately after radiation therapy or surgery, or weeks, months, and even years later.

A lymphatic massage session for women who develop lymphedema after surgery for breast cancer starts with light massage on the surface of the skin of the neck. The therapist gently rubs, strokes, taps or pushes the skin in directions that follow the structure of the lymphatic system so that accumulated lymph fluid can drain through proper channels. Lymphatic drainage is very gentle, is not painful and doesn’t have a stimulating effect. Each session lasts from 45 to 60 minutes, and therapy usually is performed once a day four or five times a week for two to four weeks. One study showed that the greatest reduction in swelling from lymphedema occurs in the first week of treatment and stabilizes during the second week.

Exercises can help restore movement
No matter what type of surgery you had, it is important to do exercises afterward to get the arm and shoulder moving again. Exercises help to decrease any side effects of your surgery and help you get back to your usual activities.

If you have radiation therapy after surgery, exercises are even more important to help keep your arm and shoulder flexible. Even if you don’t have surgery, radiation therapy may affect your arm and shoulder long after treatment is finished. Because of this, it is important to develop a regular habit of doing exercises to maintain arm and shoulder mobility after radiation treatments for breast cancer.