title: Delayed shoulder exercises in reducing seroma frequency after modified radical mastectomy: a prospective randomized study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Karolinska Institute at Danderyd Hospital, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Schultz
authors.forename: M
authors.initials: M
authors.lastname: Barholm
authors.forename: S
authors.initials: S
authors.lastname: Gröndal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D005081:Exercise Therapy; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000534:rehabilitation; D011183:Postoperative Complications / Q000534:rehabilitation*; D011446:Prospective Studies; D012785:Shoulder Joint / Q000503:physiopathology*; D013997:Time Factors