International Journal of Applied Research 2024; 10(7): 92-96

ISSN Print: 2394-7500

ISSN Online: 2394-5869
Impact Factor (RJIF): 8.4
Interventional modalities on early rehabilitation
IJAR 2024; 10(7): 92-96 among patients after breast surgery: A review
www.allresearchjournal.com
Received: 22-04-2024
Accepted: 25-05-2024
Angita, Dr. Jisa George T and Kumarasamy AP
Angita
MSc Oncology Nursing DOI: https://doi.org/10.22271/allresearch.2024.v10.i7b.11914
Student, All India Institute of
Medical Sciences, Bhopal, Abstract
Madhya Pradesh, India Breast cancer is the most frequently diagnosed cancer in women worldwide with more than 2 million
new cases in 2020. Breast cancer usually evolves silently. Most of the patients discover their disease
Dr. Jisa George T during their routine screening. Others may present with an accidentally discovered breast lump, change
Assistant Professor, of breast shape or size, or nipple discharge. According to the World Health Organization, improving
Department of Medical breast cancer outcome and survival by early detection remains the cornerstone of breast cancer control.
Surgical Nursing, All India With advances in screening, diagnosis, and treatment, the death rate for breast cancer has
Institute of medical sciences,
declined. Today there are various approaches, which can be made for the treatment of the cancer of
Bhopal, Madhya Pradesh,
breast such as surgery, radiation therapy chemotherapy, hormonal therapy and recently nanotechnology
India
and gene therapy. Mastectomy is a complete surgical removal of the breast glandular tissues with the
Kumarasamy AP aim to remove all in-breast neoplasia and/or glandular tissue. There are different types of mastectomy
Assistant Professor, procedures which differ in the extent of resection of additional tissues. Post-operative complications
Department of Medical after breast surgery include pain, restriction of shoulder range of motion (ROM), numbness and
Surgical Nursing, All India heaviness, loss of strength, sensory deficit, and poor quality of life. Post-surgery interventions are
Institute of Medical Sciences, needed to improve physical, psychological, social, emotional and functional wellbeing of the patient. A
Bhopal, Madhya Pradesh, search of articles was carried out with no time limit till April 2024 using various databases such as
India PubMed, Scopus, ProQuest, CINHAL, Semantic scholar and Google scholar. Search terms included-
breast cancer, breast surgery, pain, range of motion, muscle strength, quality of life, lymphedema. This
is review summarizes the interventional modalities that are being applied for early rehabilitation after
breast cancer surgery.

Keywords: Breast cancer, breast surgery, pain, range of motion, muscle strength, quality of life,
lymphedema

Introduction
Breast cancer was the most common cancer in women in 157 countries out of 185 in 2022. In
2022, there were 2.3 million women diagnosed with breast cancer and 670 000 deaths
globally. Breast cancer occurs in every country of the world in women at any age after
puberty but with increasing rates in later life (WHO March 2024) [1]. Surgery has been a
mainstay of breast cancer treatment for several decades. It is often the sole treatment in the
management of early-stage breast cancer. Multiple trials in the last several decades have led
to the evolution away from radical approaches towards less extreme, breast-conserving
procedures [2]. Postoperative complications related to breast surgery include seroma,
infection, hematoma, mastectomy flap necrosis, wound dehiscence, persistent postsurgical
pain, Mondor disease, fat necrosis, reduced tactile sensation after mastectomy, and venous
thromboembolism, seroma, infection, lymphedema, nerve injury, and reduced shoulder/arm
mobility [3]. Studies have been done to assess the quality of life among breast cancer patients
which showed that patients with breast cancer experiences negative quality of life during
their treatment phase [4]. From literature it has been found that prevalence of moderate to
severe pain after surgery was 27% [5]. An observational study was conducted which showed
that shoulder range of motion and strength of affected extremity reduced during the early
Corresponding Author:
recovery phase after breast cancer surgery [6]. Social support and exercise have positive effect
Angita
MSc Oncology Nursing on quality of life for a person with breast cancer and also spirituality or faith, or a more
Student, All India Institute of hopeful view that increases pleasure in your life [7]. This review has been developed after
Medical Sciences, Bhopal, comprehensive research by the team of investigators to sum up various interventional
Madhya Pradesh, India modalities for early rehabilitation among patients after breast surgery.
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Searched strategy using keyterms breast cancer, breast surgery, pain, range of
We searched English Literature from the inception of the motion, muscle strength, quality of life, lymphedema
database to April 2024. Pubmed, CINHAL, Scopus, Google showed in figure 1.
Scholar, Research gate, Semantic Scholar, were searched,

Fig 1: Flowchart of search strategy

Inclusion and Exclusion Criteria negatively impacting physical autonomy, psychological

Inclusion and Exclusion Criteria was formed using PICOS well-being, and social relationships [10]. A randomized
(population, intervention, comparison, outcome, study control trial was conducted to determine the effect of
design) format. Participants were patients after breast exercises program on pain, shoulder disability, and
surgery. Intervention used post mastectomy exercise, functional outcomes in women after breast cancer surgery
Aerobic exercises, Manual Lymphatic drainage, Massage and it showed a significant impact of exercise among
Therapy, Music Therapy, acupuncture, progressive muscle woman after breast surgery in reducing pain, improving
relaxation, baduanjin exercise in the experimental group. shoulder mobility and functional status [11].
Comparison involved no intervention or routine nursing care
to control group. Outcome involve assessment of one or Aerobic Exercises
more of the following quantitative outcome indicators- pain, Aerobic exercise refers to the type of repetitive, structured
arm strength, lymphedema, range of motion, muscle physical activity that requires the body’s metabolic system
strength, quality of life. Research studies with no clear to use oxygen to produce energy [12]. Studies reported that
intervention and result were excluded. aerobic exercise can significantly improve the quality of life
in breast cancer survivors and also alleviated the symptoms
Data extraction of depression and anxiety [13]. A randomized control trial
Data was extracted by one investigator and reviewed by all reported the effectiveness of water therapy program on
investigators. Information extracted from the studies improving shoulder or axillary pain among breast cancer
includes author, publication year, sample size, intervention survivors [14]. Change in the cognitive ability occurs among
technique, study design, participants and outcome breast cancer survivors, a study has reported the aerobic
indicators. exercises have potential to improve the cancer related
cognitive impairment [15].
Interventional Modalities
Physical therapy Manual lymphatic drainage
Exercise following breast surgery help to restore movement Lymphedema is a common complication after breast cancer
of affected extremity and helpful in preventing post-surgery surgery. It is characterized by persistent tissue swelling due
complications [8]. A systematic review was analyzed to to abnormal accumulation of lymph in tissues. Breast cancer
review randomized controlled trials (RCTs) evaluating the related post mastectomy lymphedema (BCRL) is the most
effectiveness of exercise interventions in improving common chronic condition following mastectomy, with an
upper‐limb dysfunction due to breast cancer treatment, incidence ranging from 8% to 52% in the first 2 post-
which concluded that Exercise can result in a significant and operative years. Manual lymphatic drainage is the specific
clinically meaningful improvement in shoulder ROM in massage technique instructions are summarized as follows:
women post-operative phase with breast cancer [9]. Post- Draw 5 diaphragmatic breaths and massage from under the
surgery pain after breast surgery reduces quality of life by ipsilateral ear auricle to the bottom of the neck, from
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inferior to the lateral aspect of the clavicle to its medial Baduanjin training
extent, from the operated side to the opposite arm’s armpit, Baduanjin exercise is a traditional exercise that combines
and the operated side armpit itself [16]. A pilot randomized breathing, body movement, meditation and awareness [31].
trial reported that manual lymphatic drainage is an effective From a review analysis it was noted that baduajin exercise is
way of reducing limb swelling following breast surgery [17]. effective in improving post-operative quality of life and
It has been suggested that manual lymphatic drainage along reducing depressive episodes among breast cancer patients
[32]
with standard treatment could enhance the effectiveness of . It was also found that baduanjin exercise have positive
treating volume reduction of lymphoedema [18]. Positive effect on improving cognitive functions among breast
impact of manual lymphatic drainage also noted in cancer patients receiving chemotherapy [33].
improving the quality of life among women underwent
breast cancer surgery [19]. Kinesio Taping
The Kinesio Taping Method is a therapeutic taping
Massage Therapy technique which alleviates pain and facilitates lymphatic
Massage as a complementary and alternative therapy has drainage by microscopically lifting the skin [34]. Studies have
been associated with enhancing health and coping with proved that Kinesiotapinf is an effective measure for
treatment-related side effects among breast cancer patients reducing lymphedema, decreasing level of pain, improving
and it has been suggested that massage may be a useful hand grip strength and overall quality of life among breast
intervention in alleviating negative emotions and fatigue cancer patients [35].
among breast cancer patients [20]. In the post-surgery phase It has also been noted in the studies that kinesiotaping in
massage therapy that consists of stroking, squeezing, and combination with decongestive therapy is more efficient in
stretching techniques to the head, arms, legs/feet, and back reducing lymphedema [36].
has been effective in reducing anxiety, depressed mood, and
anger also long term effect of massage therapy showed Conclusion
reduced depression and hostility and increased urinary Breast surgery results in the occurrence of various acute and
dopamine, serotonin values, NK cell number, and chronic complications that include pain, limited mobility of
lymphocytes [21]. Massage therapy also include classic affected extremity to long term complications like
massage, reflexology, myofascial release aid in reducing lymphedema. All these complications ultimately affect the
pain and anxiety among breast cancer survivors [22]. overall health related quality of life which can be manifested
by impaired physical functional status, poor social
Music therapy relationships, emotional disturbances and low mood. Early
Music Therapy is the clinical & evidence-based use of intervention following surgery could be beneficial for rapid
music interventions to promote wellness and physical recovery and also in the prevention of post-operative
rehabilitation [23]. Studies reported that music therapy is complications. This narrative review summarizes the
found to be effective in reducing stress, depression, anger, interventional modalities for early rehabilitation after breast
and anxiety among patients who were hospitalized for breast surgery with their positive effects in decreasing pain,
surgery [24]. Music therapy along with routine care has also improving range of motion and strength of affected
provided evidence on alleviating pain among patient extremity, decreasing anxiety and improving overall health
undergone breast surgery [25]. related quality of life. From literature review of previously
done studies it is evident that it could be more efficacious to
Acupuncture combine all these interventional modalities with routine
Acupuncture is a system of medical treatment and ideology nursing care and also the applications of more than one
based on the principle of applying small needles or pressure intervention have positive effects on the recovery in post-
to specific points in the body [26]. A study was conducted to operative phase.
evaluate the effect of acupuncture on motor function,
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