Early Free Range-of-Motion Upper Limb Exercises After Mastectomy and Immediate Implant-Based Reconstruction Are Safe and
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ORIGINAL ARTICLE – BREAST ONCOLOGY
Early Free Range-of-Motion Upper Limb Exercises After Mastectomy and Immediate Implant-Based Reconstruction Are Safe and Beneficial: A Randomized Trial Samantha Karlla Lopes de Almeida Rizzi, PT, PhD1 , Cinira Assad Sima˜o Haddad, PT, PhD2, Patrı´cia Santolia Giron, PT, MSc1, Patrı´cia Vieira Guedes Figueira, PT, MSc1, Amanda Esteva˜o, PT, MSc1, Simone Elias, MD, PhD1, Afonso Celso Pinto Naza´rio, MD, PhD1, and Gil Facina, MD, PhD1 1
Department of Gynecology, Federal University of Sa˜o Paulo (UNIFESP), Sa˜o Paulo, SP, Brazil; 2Lusı´ada University Center (UNILUS), Santos, SP, Brazil
ABSTRACT Background. This study assessed the impact that free range-of-motion (ROM) upper limb exercises 15 or 30 days after mastectomy and immediate implant-based reconstruction has on surgical complications and kineticfunctional recovery. Methods. This randomized clinical trial included 60 women who had breast cancer treated with mastectomy and immediate implant or tissue expander reconstruction. The patients initiated the exercises with shoulder ROM limited to 90° the day after surgery. After 2 weeks, the patients were randomized into two groups of 30 patients each: the ‘‘free-range group,’’ which permitted shoulder range exercises until limited by pain or wound dehiscence, and the ‘‘limited-range group,’’ which maintained shoulder movement restriction at 90° until 30 days after surgery, at which time they also were allowed to perform free-range exercises. The patients underwent evaluations preoperatively, then 7, 15, 30, 60, and 90 days after surgery. The primary outcomes were incidence and prevalence of dehiscence and seroma and incidence of infection and necrosis. The secondary outcomes were shoulder ROM, pain, and upper limb function. Results. The two groups did not differ in terms of incidence and prevalence of postoperative complications. The
Ó Society of Surgical Oncology 2020 First Received: 16 March 2020 Accepted: 15 May 2020 S. K. L. de Almeida Rizzi, PT, PhD e-mail: [email protected]
patients with free upper limb exercise 15 days after surgery had less pain, greater shoulder amplitude, and better upper limb function than those who had movement restricted to 90° for 30 days. Conclusion. The postoperative protocol with free shoulder ROM on the 15th day after surgery is safe and beneficial in terms of kinetic-functional recovery and pain control for patients after mastectomy and immediate implant-based reconstruction. Clinical Trials Register. NCT02480842
Breast and reconstructive surgery may influence a patient’s motor function. Larger surgical approaches with axillary lymphadenectomy cause more upper limb dysfunctions such as reduced shoulder range of motion (ROM) and strength, pain, and difficulty performing activities of daily living (ADLs).1 Breast reconstruction per se also leads to possible functional sequelae, which, added to those of oncomammary surgery, can have an impact on the patient’s quality of life. At our institution, most post-mastectomy breast implants are placed in
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