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

Mammographyis the process

of using low-energy-X-rays to
examine the humanbreastand
is used as a diagnostic and a
screening tool. The goal of
mammography is the early
detection ofbreast 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 selfexamination(BSE) is
ascreening methodused
in an attempt to detect
earlybreast 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 isusuallytreated
withsurgeryand 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 themetastasizing cancercellswould be
expected to drain intois removed.
Modifiedradical 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

Phychological
Consequences 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

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 and
required 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 (03 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 timeconsuming. 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 (45 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 selfservice.

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-educationof the bodyposture.
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.
Simontons programme
Musicotherapy
Aromatherapy
Activities at the pool
Relaxation gymnastics
Psychological care

Re-educationof the bodyposture.

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 afterlymph
node
dissection,surgeryand/orradiation
therapy, in which damage to the
lymphatic system is caused during
the treatment of cancer, most
notablybreast cancer. In many
patients withcancer, 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
bloods 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 longstretch 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 Taping
Kinesio 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).

THANK YOU