J Breast Cancer.  2019 Sep;22(3):472-483. 10.4048/jbc.2019.22.e40.

Early Rehabilitation after Total Mastectomy and Immediate Reconstruction with Tissue Expander Insertion in Breast Cancer Patients: A Retrospective Case-control Study

• Kim KH
• Yeo SM
• Cheong IY
• Kim Y
• Jeon BJ
• Hwang JH

• KMID: 2458867
• DOI: http://doi.org/10.4048/jbc.2019.22.e40

Abstract

PURPOSE
To prevent surgical site complications, many plastic surgeons use the so-called "conventional protocol," which immobilizes the shoulder and upper arm for 1 month after reconstruction. In an effort to improve the shoulder mobility of patients who received immediate breast reconstruction with tissue expander insertion (TEI), we introduced an early rehabilitation protocol with a short-term immobilization period of 2 weeks. This study aims to compare this early rehabilitation exercise program with the conventional protocol and to determine factors affecting shoulder mobility and quality of life of patients after immediate breast reconstruction.
METHODS
A total of 115 patients with breast cancer who underwent reconstructive surgery were retrospectively reviewed. For patients who underwent reconstruction before January 2017, the conventional protocol was followed with immobilization of their shoulder for over 4 weeks. Patients who underwent reconstruction after January 2017 were educated to undergo a self-exercise program after a short-term immobilization period of 2 weeks. We compared shoulder mobility, pain, quality of life, and complications at postoperative 1 and 2 months between the groups.
RESULTS
Patients who received early rehabilitation showed greater shoulder flexion and abduction range at postoperative 1 month than those who received the conventional protocol. This increased shoulder abduction range continued until postoperative 2 months. There were no significant surgical site problems in both groups during the 2 months of follow-up.
CONCLUSION
To enhance the recovery of shoulder mobility, early rehabilitation with a shorter immobilization period should be recommended to patients with breast cancer undergoing reconstruction surgery with TEI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03541161

Keyword

Breast neoplasms; Range of motion, articular; Reconstructive surgical procedures; Shoulder; Tissue expansion devices

MeSH Terms

Arm
Breast Neoplasms*
Breast*
Case-Control Studies*
Female
Follow-Up Studies
Humans
Immobilization
Mammaplasty
Mastectomy, Simple*
Plastics
Quality of Life
Range of Motion, Articular
Reconstructive Surgical Procedures
Rehabilitation*
Retrospective Studies*
Shoulder
Surgeons
Tissue Expansion Devices*
Plastics

Figure

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  Figure 1 Flow diagram of the study. PT = physical therapy; op = operative.

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  Figure 2 Self-exercise program to improve shoulder range of motion and overcome disuse muscle atrophy.

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  Figure 3 Shoulder range of motion: early rehabilitation versus conventional protocol (A) Early rehabilitation and shoulder flexion ROM. Early rehabilitation group had greater shoulder flexion at postoperative 1 month than conventional protocol group. (B) Early rehabilitation and shoulder abduction ROM. Early rehabilitation group had greater shoulder abduction at postoperative 1 and 2 months than conventional protocol group. (C) Early rehabilitation and shoulder external rotation ROM. The ranges of shoulder external rotation showed no significant difference between conventional protocol and early rehabilitation during 2 months of follow-up. (D) Early rehabilitation and shoulder internal rotation ROM. The ranges of shoulder internal rotation showed no significant difference between conventional protocol and early rehabilitation during 2 months of follow-up. ROM = range of motion. *p < 0.05.

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  Figure 4 Shoulder range of motion: sentinel lymph node biopsy versus axillary lymph node dissection (A) Extent of lymph node dissection and shoulder flexion ROM. The SLNB group showed better ROM in shoulder flexion than ALND group throughout 2 months of follow-up. (B) Extent of lymph node dissection and shoulder abduction ROM. The SLNB group showed better ROM in shoulder abduction than ALND group throughout 2 months of follow-up. ROM = range of motion; SLNB = sentinel lymph node biopsy; ALND = axillary lymph node dissection. *p < 0.05.

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