Mastectomy is defined as surgical removal of breast.
• It involves removal of the breast, the pectoralis muscles, chest fascia and the ipsillateral axillary lymph nodes. It also includes chemotherapy and radiation therapy.
Modified radical mastectomy
• The entire breast, fascia over the chest muscle, and axillary lymph nodes are removed.
• The pectoralis muscles remains intact.
• It involves surgical removal of the entires breast, but the lymphatic system and pectoralis muscles are preserved.
Post operative complication
1. Incisional pain
– A transverse incision made across the chest wall.
– Movement of the arm and tightening of skin along the incision causes pain.
– Radiotherapy and delayed wound healing further increases pain.
2. Cervical and shoulder girdle pain
– Muscle spasm, muscle guarding around the neck and shoulder.
– Frozen shoulder, lymphedem of hand is common after mastectomy.
3. Pulmonary complications
– Postoperative thrombo emboli
– Retention of airway secretion
– It results are to
– Removal of axillary lymph nodes
– Obstruction of lymphatic vessels
– Reduced functional activites and immobility
5. Chest wall adhesion
– It result due to
– Wound infections
– Radiation fibrosis
6. Decreased ROM and weakness of upper limb
– Decreased shoulder and cervical mobility
– Weakness of adductors, pectoralis major of shoulder.
– Weakness of serratus anterior, trapezium and levator scapulae
– Frozen shoulder
– Decreased hand grip strength due to lymphedema.
7. Fatigue and decreased endurance
8. Psychological imbalance
• Benign growth of breast
• Carcinoma of breast
Types of carcinoma
• Sclerous carcinoma
• Duct carcinoma/ infiltrating duct carcionoma
• Paget’s disease of nipple
• To prevent post opertive complications
• To relieve pain
• To regain shoulder ROM and function
• To strengthen weakned muscle
• To prevent respiration and pulmonary complication
• To relieve lymphedema
• Reassurance to the patient
Means of physiotherapy treatment
1. To relieve pain
– Proper positioning
– Pillow supports
– Pressure dressing
2. Prevent pulmonary complications
– Deep breathing exercises
– Coughing and huffing technique with incisional support
– Ankle/toe, log exercise
– Calf pumping exercise to prevent DVT and circulatory complications
– Elevation of involved limb.
3. Prevent lymphedema
– Elevation of the affected upper extremity on pillows
– Pressure bandages, crepe bandage
– Elastic stocking
– Pumping exercise of arm
– Early ROM exercise
– Pneumatic compression can be given
– Mannual lymphatic drainage massage (stroking,efflurage)
– Skin care
4. Prevent postural deformities
– Proper positioning in bed both preoperatively and post operatively
– Mildline and symmetrical postioning of shoulder and trunk
– Postural awarness with use of mirror
– Asking the patient in sitting and standing scapular retraction exercises
– Scapular retraction exercises
5. To relieve muscles spasm and guarding
– Active ROM of cervical spine
– Shoulder shrugging exercise
– Shoulder circle exercise
– Gentle massage to cervical spine
– Moist hear, scar tissue mobilization
– Promote relaxation
6. To regain mobility of upper limb
– Active assisted and active ROM exercises of shoulder elbow and hand.
– After the incision is healed self stretching can be taught .
– Gentle grade I mobilization of shoulder can be given
7. Regain strength and power of upper limb
– Isometric exercise of shoulder
– Progessive resistance training program using Mc Queen or DeLorme’s technique.
– Scapular and glenohumeral stabilization exercises in standing by pushing against the wall.
– Hand gripping exercises
– Use of upper extremity for functional activites
8. Improve tolerance
– Aerobic exercises
– Distance walking, cycling, staircases climbing, treadmill walking.
9. To improve respiratory function
– Deep breathing exercises
– Airway clearance techniques
– Coughing and huffing techniques.