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A prospective model of care for breast cancer rehabilitation: postoperative and postreconstructive issues.

Abstract

Appropriate and timely rehabilitation is vital in the recovery from breast cancer surgeries, including breast conserving surgery, mastectomy, axillary lymph node dissection (ALND), and breast reconstruction. This article describes the incidence, prevalence, risk factors and time course for early postoperative effects and the role of prospective surveillance as a rehabilitation strategy to prevent and mitigate them. The most common early postoperative effects include wound issues such as cellulitis, flap necrosis, abscess, dehiscence, hematoma, and seroma. Appropriate treatment is necessary to avoid delay in wound healing that may increase the risk of long-term morbidity, unduly postpone systemic and radiation therapy, and delay rehabilitation. The presence of upper quarter dysfunction (UQD), defined as restricted upper quarter mobility, pain, lymphedema, and impaired sensation and strength, has been reported in over half of survivors after treatment for breast cancer. Moreover, evidence suggests that survivors who undergo breast reconstruction may be at higher risk of UQD. Ensuring the survivor's optimum functioning in the early postoperative time period is critical in the overall recovery from breast cancer. The formal collection of objective measures along with patient-reported outcome measures is recommended for the early detection of postoperative morbidity. Prospective surveillance, including preoperative assessment and structured surveillance, allows for early identification and timely rehabilitation. Early evidence supports a prospective approach to address and minimize postoperative effects.

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  • Authors

    McNeely ML, Binkley JM, Pusic AL, Campbell KL, Gabram S, Soballe PW

    Source

    Cancer 118:8 Suppl 2012 Apr 15 pg 2226-36

    MeSH

    Adult
    Age Factors
    Aged
    American Cancer Society
    Breast Neoplasms
    Congresses as Topic
    Exercise
    Female
    Follow-Up Studies
    Humans
    Longitudinal Studies
    Lymphedema
    Mammaplasty
    Mastectomy
    Middle Aged
    Pain, Postoperative
    Physical Therapy Modalities
    Postoperative Care
    Postoperative Complications
    Prospective Studies
    Quality of Life
    Recovery of Function
    Risk Assessment
    Survival Rate
    Time Factors
    Treatment Outcome
    United States

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    22488697