The American Cancer Society estimates that one in nine women will develop breast cancer at some time during her life. Almost every form of breast cancer will involve some type of surgery, and this can range from a small wedge of breast tissue that is excised to complete removal of the breast. Partial mastectomy and lumpectomy are terms that are used synonymously, and in this surgery the lump and part of the surrounding tissue is removed. The amount of breast tissue that is removed is variable, and the surgeon might do a lymph node dissection as well. A total mastectomy involves complete removal of the breast. A modified radical removes the breast and some of the lymph nodes; however the pectoral muscles remain in1act. A radical mastectomy removes the whole breast, underlying muscles (pectoralis major and minor) and all of the lymph nodes. Options that are available in some instances allow for immediate breast reconstruction with implants or expanders.

Rehabilitation medicine can play an important role in the post operative management of those who have had any of these surgeries. Some of the rehabilitation specialists that might become involved include physiatrists (doctors that specialize in rehabilitation medicine), physical therapists, occupational therapists, psychologists, and social workers. You have been diagnosed with cancer, a life-threatening illness, and this affects many aspects of your life. Rehabilitation following any type of surgery on the breast involves emotional, psychological and physical healing. Physical therapy deals with the physical component of this disease, but can indirectly affect your emotional and psychological well-being also. . The following will discuss the role of physical therapy after breast surgery as a result of cancer.

WHAT SPECIFIC PROBLEMS REQUIRE PHYSICAL THERAPY INTERVENTION?

Problems that can occur as a result of the surgery and subsequent radiation include but are not limited to pain, lymphedema, decreased range of motion and strength in your arm, and decreased soft tissue mobility secondary to scarring at the incision site. It is important to note that not everyone will develop complications post-operatively. 1f they do occur, symptoms may .range from very minimal to severe. Ideally a physical therapist should evaluate you early in the hospital setting to try to reduce the incidence of these clinical problems. Should these problems persist, physical therapy is often recommended on an outpatient basis to establish a long term plan of care.

WHAT CAUSES PAIN AND WHAT CAN BE DONE BY A THERAPIST?

Post-operative pain can develop for a variety of reasons. Pain at the incision site is most common and is dependent on the type of surgery that is performed. Often as a result of this pain, it becomes comfortable to hold your arm at your side in a protected position. This promotes muscle guarding, particularly in the pectoralis major and minor muscles and stiffness in the shoulder. Pain and muscle spasm may also develop in the neck and shoulder blade region as a result of this muscle guarding. Muscles such as the levator scapulae, teres major and minor and infraspinatus often become tender to palpation and this can also restrict active range of motion in the shoulder. Physical therapy can help to decrease muscle guarding and pain early on to restore normal flexibility and use to the shoulder, In severe cases one might develop a "frozen shoulder" in which flexibility is greatly diminished in all planes and thus function in activities of daily living is severely impeded.