PHYSIOTHERAPY AFTER MASTECTOMY

Anna Wdowiak

BREAST CANCER

SYMPTOMS OF BREAST CANCER

• Lump (navikas)• Different shapes and size of breast and nipple• Nipple can be inverted• Pain of breast• Tissue inflamation• Redness• Orange-pell texture of the skin• Enlarge lymp nodes

RISK FACTORS

• Female sex and older age• Lack of childbearing or breastfeeding• Smoking tabacco• Genetic (BRCA1 BRCA2 gen mutation)

DIAGNOSIS

• Mammography is the process of using low-energy-X-rays to examine the human breast and is used as a diagnostic and a screening tool. The goal of mammography is the early detection of breast cancer.

• Most types of breast cancer are easy to diagnose by microscopic analysis of the biopsy.

PREVENTION• breast exams• mammography• genetic screening,• ultrasound • magnetic resonance

imaging

BREAST EXAMS

• Breast self-examination (BSE) is a screening method used in an attempt to detect early breast cancer. The method involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling.

Methods of breast examination

Breast cancer treatment

• Breast cancer is usually treated with surgery and then possibly with chemotherapy or radiation, or both.

SURGERY

• Mastectomy: Removal of the whole breast.

• Quadrantectomy: Removal of one quarter of the breast.

• Lumpectomy: Removal of a small part of the breast.

TYPES OF MASTECTOMY

• Simple mastectomy - breast tissue is removed, but axillary contents are undisturbed. Sometimes the "sentinel lymph node"--that is, the first axillary lymph node that the metastasizing cancer cells would be expected to drain into—is removed.

• Modified radical mastectomy - breast tissue is removed along with the axillary contents (fatty tissue and lymph nodes). In contrast to a radical mastectomy, the pectoral muscles are spared.

TYPES OF MASTECTOMY

• Radical mastectomy - removing the entire breast, the axillary lymph nodes, and the pectoralis major and minor muscles behind the breast.

• This operation is now reserved for tumors involving the pectoralis major muscle or recurrent breast cancer involving the chest wall.

Physical Consequences of mastectomy

• Effects of lie down• Scar tissue and adhesions after surgery• Pectoral muscle damage• Limitation of motion in the joints of the shoulder• Reduction of the shoulder girdle muscle strength

and the operated limb• Loss of lymph node-lymphedema• Disorders of body symmetry and posture

PhychologicalConsequences of mastectomy

• Fear of dying• Fear of child bereavement• Fear of disability• Fear of loss physical attractiveness• Fear of losing a partner• half of women's syndrome

REHABILITATION AFTER MASTECTOMY

THE AIM OF PHYSIOTHERAPY• Prevention of pulmonary complications• Prevention of deep vein thrombosis• Edema prevention or minimization of it• Prevention of joint mobility limitations• Prevention of faulty posture or reeducation• Prevention of deterioration total exercise

capacity of the body• Physiotherapy education

Physiotherapy before surgery• Talking about the state of the body after

surgery: sickness, vomiting, weakness, aversion to moving.

• Talking about pain, which may occur in the wound area, shoulders and upper limbs.

• Talking about the need for education and training weight used and explain their aim and carry out instruction.

• Teaching to adopting appropriate andrequired position with the use a wedge.

Physiotherapy before surgery II

• Necessary indications: such as not to inhibit the breath in fear of pain, breathe "full breast", try to move.

• Necessary contraindications: such as not to leave the arm on the operated side of bed, the hand can not hang, do not wear watch or jewelry on hand.

Physiotherapy after surgary (0-3 day)

AIMS of physiotherapy:• Prevention of complications of circulatory• Prevention of respiratory complications• Prevention of of deep vein thrombosis• Adapting to a sitting or standing position

Prevention of complications of circulatory

• Active cardiovascular exercises - exercises are easy to do, very time-consuming. In the first three days of each exercise should be repeated every half hour or every hour, 20 times.

• Active exercises of large joints of the lower limbs and upper side of the operated with - 3 times a day 20 times from 2 day after surgery,

Prevention of respiratory complications

• Diaphragmatic breathing exercises.

• Breathing exercises with resistance (with the bottle) - the first day we start from the low water content in the bottle-gives the minimum resistance.

• Exercises effective cough

Prevention of deep vein thrombosis

• Bandage legs by elastic band.• Elastic stockings on the lower limbs.• Intermittent pneumatic compression of the

lower limbs.• Legs elevation.

Physiotherapy after hospital (4-5 day)AIMS of physiotherapy:

• Further prevention of thrombosis of the legs.• Prevention of edema lymphatic.• Flexibility postoperative tissue.• Work on maintaining or increasing range of

movements.• General exercises with elements of self-service.

Prevention of edema lymphatic.

• Position of the upper limb on the operates side with wedge.

• Lymphatic drainage or self dreinage of the upper limb on the operated side.

• Complementary techniques such as kinesiology taping

Physiotherapy in the late outpatient - sanatorium

The aims of physiotherapy• Improving general condition.• Improving lymph drainage.• Scar greater flexibility and range of motion to

restore the operated limb.• Re-education of the body posture.• Improving the appearance.• Improving mental state and relax.

Improving lymph drainage.

Complete Treatment of edema:• Manual lymphatic drainage• Compression• Kinesio taping – lymphatic aplication• Self-dreinage• Elevation position of the upper limb on the

operated side.

Scar greater flexibility and range of motion to restore the operated limb.

• Mobilization of scars• Kinesiotapig – aplication on the scars• Postisomeric muscle relaxation• Stretching

Improving mental state and relax.

• Relaxation training for example by Schultz.• Simonton’s programme• Musicotherapy• Aromatherapy• Activities at the pool• Relaxation gymnastics• Psychological care

Re-education of the body posture.

• Exercises to strengthen the back muscles such as PNF.

• Exercises in front of a mirror.• Supply of prosthesis!

Improving the appearance.

• Implants• Prothesis• prosthetic underwear• Wigs

PHYSIOTHERAPY TREATMENT OF LYMPHEDEMA

Lymphedema is most frequently seen after lymph node dissection, surgery and/or radiation therapy, in which damage to the lymphatic system is caused during the treatment of cancer, most notably breast cancer. In many patients with cancer, this condition does not develop until months or even years.

TREATMENTS:

Manual lymph drainage - consists of gentle, rhythmic massaging of the skin to stimulate the flow of lymph and its return to the blood circulation system. In the blood’s passage through the kidneys, the excess fluid is filtered out and eliminated from the body through urination.

Bandaging or wrapping

Compression bandaging, also called wrapping, is the application of several layers of padding and short-stretch bandages to the involved areas. Short-stretch bandages are preferred over long-stretch bandages as the long-stretch bandages cannot produce the proper therapeutic tension necessary to safely reduce lymphedema and may in fact end up producing a tourniquet effect. During activity, whether exercise or daily activities, the short-stretch bandages enhance the pumping action of the lymph vessels by providing increased resistance for them to push against. This encourages lymphatic flow and helps to soften fluid-swollen areas.

Kinesio TapingKinesio Taping is the method using natural body healing ability. Kinesio Tex applications cause delicate lifting of the skin, increasing the space between the crium and fascia, what result in reduction of congestion and lymphoedema (improvement pf lymph microcirculation).

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