Subscribe to RSS
Download PDF
DOI: 10.5999/aps.2021.00500
The effect of early arm exercise on drainage volume after total mastectomy and tissue expander insertion in breast cancer patients: a prospective study
Authors
Background In prosthesis-based breast reconstruction patients, the drain tends to be kept in place longer than in patients who undergo only mastectomy. Postoperative arm exercise also increases the drainage volume. However, to preserve shoulder function, early exercise is recommended. In this study, we investigated the effect of early exercise on the total drainage volume and drain duration in these patients.
Methods We designed a prospective randomized trial involving 56 patients who underwent immediate breast reconstruction following mastectomy using tissue expanders. In each group, the patients were randomized either to perform early arm exercises using specific shoulder movement guidelines 2 days after surgery or to restrict arm movement above the shoulder height until drain removal. The drain duration and the total amount of drainage were the primary endpoints.
Results There were no significant differences in age, height, weight, body mass index, or mastectomy specimen weight between the two groups. The total amount of drainage was 1,497 mL in the early exercise group and 1,336 mL in the exercise restriction group. The duration until complete removal of the drains was 19.71 days in the early exercise group and 17.11 days in the exercise restriction group.
Conclusions Exercise restriction after breast reconstruction did not lead to a significant difference in the drainage volume or the average time until drain removal. Thus, early exercise is recommended for improved shoulder mobility postoperatively. More long-term studies are needed to determine the effect of early exercise on shoulder mobility in prosthesis-based breast reconstruction patients.
The authors wish to thank Medical Illustration and Design, which is part of the Medical Research Support Services of Yonsei University College of Medicine, for its all-artistic support related to this work.
Publication History
Received: 22 March 2021
Accepted: 07 July 2021
Article published online:
22 May 2022
© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
REFERENCES
- 1 Hack TF, Kwan WB, Thomas-Maclean RL. et al. Predictors of arm morbidity following breast cancer surgery. Psychooncology 2010; 19: 1205-12
- 2 Sclafani LM, Baron RH. Sentinel lymph node biopsy and axillary dissection: added morbidity of the arm, shoulder and chest wall after mastectomy and reconstruction. Cancer J 2008; 14: 216-22
- 3 Bendz I, Fagevik Olsen M. Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection: a randomised controlled trial. Breast 2002; 11: 241-8
- 4 Abe M, Iwase T, Takeuchi T. et al. A randomized controlled trial on the prevention of seroma after partial or total mastectomy and axillary lymph node dissection. Breast Cancer 1998; 5: 67-9
- 5 Xue DQ, Qian C, Yang L. et al. Risk factors for surgical site infections after breast surgery: a systematic review and metaanalysis. Eur J Surg Oncol 2012; 38: 375-81
- 6 de Haan A, Toor A, Hage JJ. et al. Function of the pectoralis major muscle after combined skin-sparing mastectomy and immediate reconstruction by subpectoral implantation of a prosthesis. Ann Plast Surg 2007; 59: 605-10
- 7 Crosbie J, Kilbreath SL, Dylke E. et al. Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement. Phys Ther 2010; 90: 679-92
- 8 Shamley D, Lascurain-Aguirrebena I, Oskrochi R. et al. Shoulder morbidity after treatment for breast cancer is bilateral and greater after mastectomy. Acta Oncol 2012; 51: 1045-53
- 9 Lee KT, Hong SH, Jeon BJ. et al. Predictors for prolonged drainage following tissue expander-based breast reconstruction. Plast Reconstr Surg 2019; 144: 9e-17e
- 10 Lim YM, Lew DH, Roh TS. et al. Analysis of factors that affect drainage volume after expander-based breast reconstruction. Arch Plast Surg 2020; 47: 33-41
- 11 Hashemi E, Kaviani A, Najafi M. et al. Seroma formation after surgery for breast cancer. World J Surg Oncol 2004; 2: 44
- 12 Del Bianco P, Zavagno G, Burelli P. et al. Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lymph node dissection for breast cancer patients: results of the sentinella-GIVOM Italian randomised clinical trial. Eur J Surg Oncol 2008; 34: 508-13