I just had breast cancer surgery. Should I move?

I met an aunt who had just undergone breast cancer surgery in the ward. She said in confusion, "It is said on the Internet that after breast cancer surgery, you cannot stay still. You need to move the arm on the side that was operated on more often and practice climbing the wall with your fingers. But after doing it a few times, I felt a little pain at the wound. I was so scared that I dared not move again." At this time, the rehabilitation department needs to help. Of course, you need to move after breast cancer surgery, but how to move is very particular. Today, let me take you to learn some basic knowledge about breast cancer and its postoperative rehabilitation.

Small knowledge related to breast cancer

Everyone, don't think that breast cancer is far away from you, especially young men and women. In 2021, the American Cancer Society published a "2021 Cancer Incidence and Death Statistics Report" in the "Journal of Clinical Cancer Physicians". According to previous data statistics, breast cancer is expected to remain the leading cause of cancer in women in 2021, accounting for 30% of female cancers, and breast cancer will become the second leading cause of death in female cancer after lung cancer. Although the overall incidence of breast cancer in Chinese women is lower than that in European and American countries, according to screening data, the incidence of breast cancer has been increasing year by year. China has 269,000 new cases of breast cancer and 70,000 deaths each year. The incidence is more inclined to be younger. At the same time, breast cancer is also the leading cause of death in women under 45 years old in my country. At present, although the pathogenesis of breast cancer is still unclear, genetic factors are high-risk factors for breast cancer. In addition, some unhealthy lifestyles, such as overnutrition, obesity, high-fat diet, and excessive drinking, can significantly increase the incidence of breast cancer. According to statistics, the peak age of breast cancer incidence in women in my country is 45-54 years old. The guidelines recommend that for risk groups such as those with a family history, regular breast cancer screening can begin at the age of 40 to enable early detection and early treatment.

Surgical treatment of breast cancer and its complications

According to the different stages and types of breast cancer, the corresponding surgical or conservative treatment methods are selected. Common surgical methods include segmental breast resection, breast-conserving surgery, simple breast resection for breast cancer, and modified radical mastectomy for breast cancer. Different radiotherapy and chemotherapy regimens are selected according to the type of breast cancer after surgery. Some complications in the late stage of breast cancer surgery deserve the attention of rehabilitation personnel. According to relevant literature reports, common surgical complications include: the pectoralis major muscle, pectoralis minor muscle and their corresponding nerves and blood vessels, and axillary lymphatic system may be damaged during the operation. After the operation, numbness, pain, burning sensation in the dermatome area, no sweat in the axilla, lymphedema, scar formation, and muscle contracture and hardening may occur, which will then cause functional disorders such as limited joint movement and decreased muscle strength on the affected side. If no follow-up treatment is given, it will seriously affect the patient's quality of life.

Postoperative rehabilitation assessment after breast cancer surgery

Before rehabilitation treatment intervention, the following aspects can be evaluated in a targeted manner:

1. Upper limb function assessment: measurement of active and passive range of motion of the shoulder joint, pain assessment, and lymphedema of the affected limb (measurement of arm circumference: every 10 cm dimension on the transverse lines of the hand, up to the axilla, multi-segment arm circumference measurement generally determines that if the circumference of the affected upper limb is longer than that of the contralateral upper limb by less than 3 cm, it is considered mild edema, 3-5 cm is moderate edema, and >5 cm is severe edema).

2. Risk assessment of concurrent diseases: risk assessment of cardiovascular and cerebrovascular diseases, dyslipidemia, and fracture events.

3. Lifestyle assessment: body mass index (BMI), physical activity (7-day physical activity questionnaire), daily living activities assessment (modified Bathel index), and others (frequency and quantity of smoking, drinking, etc.).

4. Psychological and social support assessment: Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS).

After a period of rehabilitation training, the patient's condition needs to be re-evaluated to understand the functional improvement and subsequent problems, and to readjust and develop an appropriate treatment plan.

How to carry out postoperative rehabilitation exercises scientifically

Gradual functional training of the affected upper limb is essential for limb function recovery and prevention of postoperative complications. Functional training under rehabilitation guidance at an earlier stage after surgery has been proven to be safe and effective, but the principle of gradual progress must be strictly followed and should not be started in advance at will, so as not to affect wound healing. According to the Research Progress on Rehabilitation Training for Common Complications of Upper Limbs after Breast Cancer Surgery, phased upper limb rehabilitation training is recommended. Patients can start early rehabilitation training 24 hours after surgery, which is mainly divided into three stages:

From surgery to removal of the drainage tube: The patient's incision is less firm. During this period, the patient mainly performs arbitrary active movements of the hand, wrist, and elbow, and isometric contractions of the upper arm in multiple directions of flexion and extension under the guidance of a therapist to prevent muscle atrophy, limited joint movement, and scar contracture in the axilla.

From the time the drainage tube is pulled out to before the stitches are removed: shoulder joint range of motion exercises are mainly performed. Active movements of the shoulder joint in various motion axes, such as flexion, extension, adduction, abduction, internal and external rotation, can be started. The shoulder joint can be raised, straightened, and flexed 90° to prevent the healing surface of the axillary skin from being too tight. After that, the shoulder can be gradually transitioned to the full range of joint movement of the upper arm, such as finger wall climbing, hair combing, and circumduction. Through these exercises, the range of joint movement can be increased. Encourage and guide patients to eat, brush their teeth, and dress with the upper limb on the surgical side.

After stitches are removed: The surgical incision is relatively firm, and a wide range of upper limb and shoulder joint activities can be performed appropriately, with emphasis on strength recovery. Functional exercises can help promote the formation of loose connective tissue and reduce the strength of surgical scar tissue. Based on the movements in the previous stage, the intensity of exercise can be increased. At the same time, elastic bands of different strengths can be used to perform progressive resistance training for the abduction and adduction muscles of the shoulder joint.

While emphasizing the importance of starting exercise as early as possible, there are several points to note: 1. Limit the shoulder abduction angle to more than 30° within seven days after surgery; 2. For patients with severe skin flap necrosis, avoid large-scale exercise within 2 weeks after surgery; 3. When subcutaneous effusion or drainage fluid exceeds 50 ml one week after surgery, the number of exercises and the range of motion of the shoulder joint should be reduced, and abduction should be limited.

The popular science content of this platform has been funded by the China Association for Science and Technology's Science Popularization Department's 2022 National Science Literacy Action Project "National Society Science Popularization Capacity Improvement Project-Rehabilitation Science Popularization Service Capacity Improvement Action Plan"