Early rehabilitation in patients operated for breast carcinoma.

The most often complication of breast surgery with dissection of axilla is decrease in the range of shoulder joint of the ipsilateral arm motion, the feeling of heavy arm, secondary lymphedema of the arm, and very rarely pain and weakness of the arm’s muscles. Persistence of these symptoms leads to permanent dysfunction of the arm . Decrease in the range of motion is a consequence of surgery and scarring of the healed wound, which decreases the amount of movement at each joint on the operated side 4, . A reduced range of shoulder joint motion is diagnosed in 2%–51% patients who underwent surgery for breast carcinoma 2, . Secondary lymphedema of the arm is a consequence of mechanical insufficiency of the lymphatic system caused by the surgery and later, by post-irradiation fibrotic changes, and is manifested by abnormal accumulation of interstitial fluid, rich in proteins . In the majority of studies, secondary lymphedema of the arm occurs in 10%–30% of patients following the breast carcinoma therapy . For postoperative complications reduction, numerous rehabilitation programs and instructions were developed with the aim of damage prevention, maximizing the occurred damage (range of motion, muscle power) and minimizing the risk for development of secondary lymphedema of the arm 1–4, . In breast carcinoma patients, rehabilitation has become more significant due to quality of life awareness of the oncological patients . It arises dilemma when to start with the rehabilitation program: most of the authors agree in that the program should start in the first several days after the surgery 1–4, , while the other authors consider that early beginning of rehabilitation in patients with axilla dissection is associated with an increased risk from postoperative complications: longer drainage period, seroma formation, postoperative infection and consequential longer hospitalization 1, 2, . In a controlled, randomized study, a hypothesis that exercises do not increase the risk of occurrence of secondary lymphedema of the arm has been confirmed . Exercises are efficient, safe and preferred interventions in a postoperative period . Early rehabilitation and later home-based exercises program, education 14, , as well as a continuous follow-up of patients 7, 9 were identified as interventions for the improvement of life in women with breast carcinoma in all 4 dimensions: physical, emotional, social and cognitive . Type, duration, frequency and intensity of exercises vary in the studies . Education and follow-up of patients with breast carcinoma enable prevention, detection of early and late occurrences of postoperative damages . A lack of rehabilitation interventions in patients operated for breast cancer is a consequence of no standardized exercises program avalable, so it is necessary to homogenize a reproducible regime .