Problems associated with physiotherapeutic management of patients after breast cancer surgery

Breast cancer (BC) is the most frequent malignant neoplasm in women in Poland and its treatment majorly depends on the degree of disease progression. Surgery is the main radical therapy of BC. In most cases, this therapy involves mastectomy with excision of the lymphatic system of the axilla. Breast-saving treatment is used in patients at early stages of breast cancer. This treatment involves excision of the primary tumour within the broders of the unchanged tissue and of the axillary lymphatic system followed by breast irradiation. The majority of early and late complications of surgery are due to the axillary lymphadenopathy, the sequel of surgical therapy. Early inpatient rehabilitation is initiated on the day of the surgery and aims at prevention of the following states: hypo-ventilation and inflammatory pulmonary complications, thrombo-embolioc complications, early post-operation oedema, restrictions in movements in the shoulder joint and acute psychotic syndromes. It also prepares the patient for every-day activities, anti-oedema preventive care and teaches performance of physical exercises. Late rehabilitation conducted at home, as outpatient care or during balneological treatment is a continuation of the early rehabilitation. It involves improvement of shoulder functioning, prevention of incorrect posture, anti-oedema care and providing psychological support. Regular motor exercises improve functioning of the extremity ipsilateral to the side of breast surgery, prevent incorrect posture and the associated ailments. The majority of problems are associated with the therapy of late lymphoedema of the upper limb. Physiotherapeutic management results in measurable effects: amelioration of spontaneous lymph outflow, reduction of oedema size, improvement in limb agility reduction of ailments; it is, however, not always sufficient. Effectiveness of various management approaches is still a subject of discussion.