title: 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.
authors.affiliation: Department of Physical Therapy and Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada. mmcneely@ualberta.ca
authors.forename: Margaret L
authors.initials: ML
authors.lastname: McNeely
authors.forename: Jill M
authors.initials: JM
authors.lastname: Binkley
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Campbell
authors.forename: Sheryl
authors.initials: S
authors.lastname: Gabram
authors.forename: Peter W
authors.initials: PW
authors.lastname: Soballe
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000570:American Cancer Society; D001943:Breast Neoplasms / Q000401:mortality / Q000534:rehabilitation* / Q000601:surgery*; D003226:Congresses as Topic; D015444:Exercise / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008209:Lymphedema / Q000209:etiology / Q000534:rehabilitation; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation*; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation*; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000534:rehabilitation; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States