Rehabilitation after breast cancer

Breast cancer (BC) is one of the most common oncological diseases in the world. It is diagnosed in every fifth patient with a diagnosis of "oncology". In Russia, breast cancer ranks first among all types of cancer in women. Women aged 40-60 years are most often ill, but in recent years this boundary has shifted towards patients under the age of 40.

Types of operations for breast cancer

Mastectomy is a radical surgery involving the complete removal of breast tissue. In some cases, both the surrounding breast tissue and the associated lymph nodes are removed. 
Organ-preserving operations involve partial removal of breast tissue with a tumor. Such operations may require removal of the surrounding breast tissue, but to a lesser extent than with mastectomy. Such operations include, for example, lumpectomy, which is the removal of a small cancer site. There is also a quadrantectomy, an operation during which a quarter of the breast is removed. There are also options for partial or segmental mastectomy, involving the removal of more than 1/4 of the breast.
When choosing an operation technique, the stage of the process, the histological and immunohistochemical characteristics of the tumor, age, and the size of the mammary glands are taken into account.

Complications after surgery

The rapid start of rehabilitation makes it possible to reduce or prevent many complications of the early postoperative period. The process should take place under the constant supervision of a doctor — you need to schedule regular scheduled visits to him.
After mastectomy, postmastectomy syndrome may develop, which is characterized by such manifestations as:

• postmastectomy defect (including cosmetic)
• scarring of the axillary area
• brachioplexitis (brachial plexus lesion) and/or neuropathy
• swelling of the upper limb
• psychoemotional problems: anxiety, mental exhaustion, severe depression.

 

Treatment of breast cancer after surgery

Surgical treatment is not always sufficient to stop the tumor process. A number of patients are prescribed additional therapy. This can be radiation and drug therapy. The goal is to target the remaining cancer cells and reduce the risk of recurrence, either to restrain tumor growth or reduce its size.

Pre-rehabilitation

This stage begins immediately after diagnosis. Pre-rehabilitation accelerates the restoration of organ functions, shortens the length of hospital stay after surgery and reduces the likelihood of complications, as well as reduces the risk of death.

Pre-rehabilitation should include:

therapeutic gymnastics aimed at strengthening the muscles of the upper shoulder girdle, as well as general physical training (aerobic and anaerobic exercise). This combination improves overall fitness and helps build muscle mass, while improving quality of life
• psychological help
• informing the patient about the disease and treatment options.

  
Rehabilitation after breast tumor removal

There are three stages in rehabilitation::

1. The preparatory stage. It is aimed at improving general well-being and strengthening the muscular corset, improving the functional state with the help of therapeutic gymnastics
2. Early recovery stage. It is aimed at maintaining the volume of movement in the shoulder joint, reducing postoperative edema. It may include therapeutic gymnastics, massage and physiotherapy (procedures within the framework of the clinical recommendations of the Ministry of Health of the Russian Federation — magnetic therapy, electrotherapy, compression therapy)
3. Late recovery stage. Reconstructive treatment of the consequences of surgery to improve a woman's quality of life. Therapeutic gymnastics and decongestant therapy in case of development of lymphatic edema and to prevent their occurrence. At this stage, the patient also undergoes psychotherapy.

Terms of rehabilitation

The duration of the recovery period depends on which surgery was performed, the type of further therapy, as well as on the general state of health before the operation.

After an organ-preserving operation, it is possible to return to a habitual lifestyle in about two weeks. It will take at least a month to recover from a mastectomy. But these terms do not imply a late stage: if breast reconstruction is carried out, the rehabilitation time increases by up to several months. 

During the recovery process, it is important to eat right, rest enough, avoid overloads, follow the doctor's advice and perform the exercises recommended by him, with which you can restore flexibility and mobility to the joints, improve overall physical condition.

What is important in the postoperative period

To recover faster and return to normal life, you need to pay attention to the following aspects::

• the mammary gland must be protected from pressure and injury
• the weight and volume of the lost tissues must be replaced by reconstructive surgery or a postoperative prosthesis
• reducing the load on the arm from the operated side — it is not recommended to lift things more than 2-3 kg
• regular performance of special exercises, which are selected individually.

Precautions

Attention is required not only by the condition of the wound and the postoperative scar, but also by the hand on the side where the operation was performed. 

Often, removal of lymph nodes during mastectomy provokes lymphostasis or lymphedema, and in simple terms, edema of the upper extremities. This condition can occur both in the first year after surgery and after several years. How to recognize a complication? At first, there is a feeling of discomfort, swelling and heaviness in the arm from the operated side. At the next stage, visible swelling may appear, leading to an increase in arm volume. This condition is dangerous due to recurrent skin diseases (such as erysipelas).

Lymphedema (lymphostasis) is a likely serious consequence of surgery, which can lead to disability. If you notice any of the symptoms of this condition, it is necessary to consult a rehabilitologist as soon as possible and begin decongestant treatment.

To prevent the development of lymphedema, it is of great importance to wear preventive compression knitwear. Compression underwear helps to relieve swelling, reduce pain and improve the quality of life. A rehabilitologist will help you choose the right model of compression underwear. 

The hand on the side of the breast on which the operation was performed requires special care. It is necessary to observe a gentle regime — do not lift heavy objects, and clothes and jewelry should not squeeze it. At night, you should try not to press your hand or lie down on it. And if the swelling has already appeared, then during sleep it is recommended to give the arm an elevated position to improve the outflow of lymph.

To make recovery from breast cancer painless and safe, it is necessary to avoid damage to the skin. The main recommendations for the prevention of postoperative complications:

• avoid significant temperature fluctuations. It is not recommended to visit the sauna, steam room, take hot baths
• temporarily abandon manicure in the salon and prevent damage to the skin of the upper limb
• Reduce the time spent in the sun and be sure to use a sunscreen with SPF. Seasonality does not affect the activity of UVA rays harmful to the skin, which penetrate even through glass.

Constant changes

After surgery, the breast changes forever. After 2-3 months, it is necessary to pick up an exoprosthesis and casual underwear. 

Which prosthesis can I choose?:

• Silicone. An external weighted prosthesis made of silicone is needed to mimic the natural breast tissue. It can improve posture, prevent shoulder drooping and balance problems
• Silicone—free prosthesis is a lightweight prosthesis made of foam or fibrous filler. Non-silicone dentures can be worn during exercise, swimming, and in hot weather.

It is important to wear a prosthesis all the time so that there are no deformations of the body. If worn intermittently, there is a risk of poor posture, curvature of the spine, lowering of the shoulders and displacement of internal organs. This can cause pain.
The bra must securely fix the exoprosthesis. Make sure that it does not constrict the blood and lymph flow. Bras for women after mastectomy have elastic pockets made of spandex inside, they help to hold the prosthesis in place. 


Diet and nutrition regime


There are no reliably studied diets recommended for women after breast cancer treatment. There are generally accepted and fairly simple rules. The diet is small portions several times a day. Food is best steamed, boiled, baked. Vegetables should occupy most of the plate, and protein is also very important — it helps maintain muscle mass. In addition to meat, fish, dairy products, and eggs, protein sources include beans, lentils, nuts, and seeds.
Whole grains, fruits, and berries are good for your health. Unsaturated fats, such as olive oil or nuts, are mandatory in the diet. It is necessary to establish a stable drinking regime at the rate of about 35 ml per kilogram of body weight. 

It is recommended to avoid foods such as:

• caffeinated foods and beverages
• alcohol
• raw or undercooked meat, fish or poultry
• raw or soft-boiled eggs
• unpasteurized dairy products or juices

Physical activity after surgery

It is important to talk to your doctor before starting any exercises to find the right program. Therapeutic gymnastics helps to reduce pain, relax overstressed neck and shoulder muscles, and restore muscle tone. Exercises that increase and maintain the range of motion in the shoulder joints are recommended. Strength training and therapeutic swimming are added later.

In the first months after surgery, it is better to practice under the supervision of a physical therapy doctor. It is important to pay attention to signs that may indicate problems with lymph circulation. If there is even a slight swelling, it is necessary to consult a doctor who will help to avoid serious consequences.

If the lymph nodes have been removed, it is not recommended to keep your hand in one position for a long time, Pilates and yoga classes, which use statistical exercises with a load on your hands, as well as participation in sports games, which involve sudden movements and a high probability of injury, are not welcome.
It is impossible to work with weights on the upper extremities for 6 months after surgery, even if there is no visible swelling. 

 
Psychological help

During the treatment and recovery process, the support of family and friends is extremely important. A woman needs the attention of her loved ones, she wants to feel needed and not feel isolated from society and relatives. 

After surgery, women often have psychological problems associated with a sense of loss of femininity. Immediately after surgery, unstable mood, feelings of inferiority, and shame may occur, which leads to a desire to limit communication with people and social isolation. Along with the realization of a successful outcome of the operation, self-image and self-esteem change. At this time, patients become aware of the consequences of the operation and may experience a sense of their own inferiority.

Memory, attention disorders, and emotional instability are often observed. This is a consequence of psychological trauma after diagnosis and complex treatment. Psychoemotional disorders can interfere with a full life, making recovery difficult.

When undergoing a rehabilitation course, you can contact a psychologist who will help you cope with a difficult period in your life.
 


Pregnancy after breast cancer

A change in the hormonal background during pregnancy, namely, an increase in estrogen levels, may be a cause for concern for a woman who has undergone breast cancer. However, researchers conclude that women who have been treated for breast cancer should not be afraid of pregnancy for fear of recurrence. According to research, pregnancy in such cases does not affect the risk of recurrence of the tumor. 
A study published in December 2022 in the journal Obstetrics & Gynecology tracked the pregnancies of 30,021 California women aged 18 to 45 who were diagnosed with breast cancer from 2000 to 2012. The authors compared these women with a control group of 1,659 healthy women. There were no significant differences in the outcome of childbirth and the health indicators of newborns.


Further observation

A patient who is faced with cancer must undergo follow-up examinations prescribed by a doctor from 4 to 1 times a year during remission.
After initial treatment, a preventive examination should be performed from 1 to 4 times a year, depending on the effect of rehabilitation during the first 5 years. In the future, you need to visit a doctor at least once a year.