Background: Seromas and impaired shoulder function are well-known complications after modified radical mastectomy for breast cancer. Early postoperative physiotherapy is a common treatment to avoid shoulder dysfunction. The aim of this study was to evaluate if the frequency of postoperative seromas could be reduced, without increasing shoulder dysfunction, by delayed postoperative shoulder exercises.
Methods: In a prospective study 163 patients with breast cancer undergoing modified radical mastectomy were randomized to physiotherapy starting on postoperative day 1 or day 7. Patients were seen by the surgeons and the physiotherapists during hospital stay and in the outpatient department. Seromas and other complications were registered by the surgeons. The physiotherapists instructed the patients pre- and postoperatively and assessed shoulder function.
Results: There was a significantly higher incidence of postoperative seromas in the group of patients that started physiotherapy postoperative day 1 (38%) compared to the group that started physiotherapy postoperative day 7 (22%) (p<0.05). There was no significant difference between the groups in the late outcome of shoulder function.
Conclusion: The incidence of seromas after modified radical mastectomy for breast cancer is reduced by delaying shoulder exercises one week postoperatively. Earlier postoperative physiotherapy is not necessary to avoid impaired shoulder function.
Breast neoplasm modified radical mastectomy postoperative complications seroma physiotherapy
This is a preview of subscription content, log in to check access.
Bryant M, Baum M. Postoperative seroma following mastectomy and axillary dissection.Br J Surg 1987;74:1187.PubMedGoogle Scholar
Watt-Boolsen S, Jacobsen K, Blichert-Toft M. Total mastectomy with special reference to surgical technique, extent of axillary dissection and complications.Acta Oncol 1988;27:663–5.PubMedGoogle Scholar
Pollard R, Callum KG, Altman DG, Bates T. Shoulder movement following mastectomy.J Clin Oncol 1976;2:343–9.Google Scholar
Cady B. Total mastectomy and partial axillary dissection.Surg Clin North Am 1973;53:313–8.PubMedGoogle Scholar
Hosmer DW, Lemeshow S.Applied logistic regression. New York: John Wiley & Sons, 1989.Google Scholar
Lotze MT, Duncan MA, Gerber LH, Woltering EA, Rosenberg SA. Early versus delayed shoulder motion following axillary dissection. A randomized prospective study.Ann Surg 1981;193:288–95.PubMedGoogle Scholar
Jansen RFM, van Geel AN, de Groot HGW, Rottier AB, Olthuis GAA, van Putten WLJ. Immediate versus delayed shoulder exercises after axillary lymph node dissection.Am J Surg 1990;160:481–4.PubMedGoogle Scholar
Petrek JA, Peters MM, Nori S, Knauer C, Kinne DW, Rogatko A. Axillary lymphadenectomy. A prospective, randomized trial of 13 factors influencing drainage, including early or delayed arm mobilization.Arch Surg 1990;125:378–82.PubMedGoogle Scholar
Dawson I, Stam L, Heslinga JM, Kalsbeek HL. Effect of shoulder immobilization on wound seroma and shoulder dysfunction following modified radical mastectomy: a randomized prospective trial.Br J Surg 1989;76:311–2.PubMedGoogle Scholar
Oertli D, Laffer U, Haberthuer F, Kreuter U, Harder F. Perioperative and postoperative tranexamic acid reduces the local wound complication rate after surgery for breast cancer.Br J Surg 1994;81:856–9.PubMedGoogle Scholar
Vinton AL, Traverso W, Jolly PC. Wound complications after modified radical mastectomy compared with tylectomy with axillary lymph node dissection.Am J Surg 1991;161:584–8.CrossRefPubMedGoogle Scholar
Say CC, Donegan W. A biostatistical evaluation of complications from mastectomy.Surg Gynecol Obstet 1974;138:370–6.PubMedGoogle Scholar
Watt-Boolsen S, Nielsen VB, Jensen J, Bak S. Postmastectomy seroma. A study of the nature and origin of seroma after mastectomy.Dan Med Bull 1989;36:487–9.PubMedGoogle Scholar