Evaluation of shoulder girdle strength more than 12 month after modified radical mastectomy and axillary nodes dissection

Single-port insufflation endoscopic nipple-sparing mastectomy in early breast cancer: a retrospective cohort study

Background

Breast cancer is the most common malignancy in female patients. In recent years, more and more studies have focused on how to improve the appearance and the quality of life for patients. This study aimed to compare the oncologic safety, aesthetic results, and upper extremity function between single-port insufflation endoscopic nipple-sparing mastectomy (SIE-NSM) and conventional open mastectomy (C-OM) in early-stage breast cancer treatment.

Methods

In our retrospective cohort, 285 patients with stage I and II breast cancer were categorized into the SIE-NSM group (n=71) and the C-OM group (n=214). We assessed local recurrence, distant metastasis, and upper extremity function across the two groups. The BREAST-Q scale was employed to analyze differences in aesthetic results, psychosocial well-being, and sexual health. The risk of local recurrence was evaluated using multivariable binary logistic regression, while a multivariable linear regression model gauged upper extremity function and aesthetic outcomes.

Results

Local recurrence rates between the two groups were statistically similar (1/71, 1.4% for SIE-NSM vs. 2/214, 0.9% for C-OM, P=0.735), as confirmed by the multivariable binary logistic regression analysis. Neither group exhibited distant metastases. The SIE-NSM group demonstrated higher scores in satisfaction with breasts, chest wellness, psychosocial health, and sexual well-being (P<0.001). The SIE-NSM group also exhibited superior outcomes regarding chest wall/breast pain, shoulder mobility, and daily arm usage (P<0.001). No subcutaneous effusion was reported in the SIE-NSM group, whereas the C-OM group had a 10.7% incidence rate (P=0.004).

Conclusions

SIE-NSM offers comparable oncologic safety to C-OM but provides enhanced satisfaction regarding breast appearance, physical comfort, psychosocial health, sexual health, and improved upper extremity functionality. Consequently, this innovative approach is a suitable surgical alternative for treating early-stage breast cancer.

Influence of Complex Physical Therapy on Physical Fitness and Balance in Women After Unilateral Mastectomy Due to Cancer Treatment

Introduction: As a result of mastectomy, physical fitness deteriorates, balance disorders and lymphoedema of the upper limb occur, which undoubtedly affect the level of stability among women following this surgery. Complex physical therapy in this group of patients is one of the key aspects influencing the level of physical activity among women subjected to surgery. Research objective: The aim of the study was to assess the impact of complex physiotherapy on physical fitness and balance in women following unilateral mastectomy with lymphoedema of the upper limb. Additionally, it was analysed whether wearing an external breast prosthesis affects the postural stability of women after mastectomy. Materials and methods: The study group comprised 30 women post unilateral mastectomy, 51 to 78 years of age, with upper limb lymphoedema. Before starting and after completing the physical therapy programme, the examined women were asked to perform the Timed Up and Go (TUG) Test and the Static Postural Stability Test on the Biodex Balance System platform. The tests were performed at the Posturology Laboratory of the Collegium Medicum, Jan Kochanowski University in Kielce. Results: In the analysis of the results of the Timed Up and Go Test in women following unilateral mastectomy, better results were noted after completion of physiotherapy in all 3 trials (p=0.001, p=0.021, p=0.004), as well as in the Postural Stability Test for all test parameters. The Mann-Whitney U test allowed to indicate a statistically significant difference in the values of the general stability index (p=0.005) and the A/P stability index (p=0.004). Greater body sway dominated in the sagittal plane than in the frontal one (A/P > M/L). On the other hand, in posturographic examination, external prostheses did not affect the postural stability of post-mastectomy women. Conclusions: 1. Systematic motor exercises in women following unilateral mastectomy are an important element of maintaining required physical activity, and they also prevent posture-related disorders; 2. The use of an external breast prosthesis in women after unilateral mastectomy does not significantly cause a change to body posture.

Motor Control Evaluation as a Significant Component in Upper Limb Function Assessment in Female Breast Cancer Patients after Mastectomy

Breast cancer is the most prevalent malignancy among women. Conservative and operative treatment methods are associated with a risk of side effects pertaining to the shoulder complex. The surgery complications including chronic pain, upper limb and chest lymphedema, range of motion limitations, and motor control deficiencies may lead to upper limb function impairment and affect the quality of life negatively. Twenty-three women were examined in the tested group and twenty-two women in the control group. The motor control was assessed with dissociation tests as defined by Comerford and Mottram. In order to assess patient-perceived upper limb disability, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used. The test of glenohumeral (GH) abduction control in frontal plane and in scapular plane and medial rotation control outcomes were found to be statistically significant. It pertains to both: Comparison between groups and analysis within the tested group—body sides comparison. The DASH questionnaire results analysis indicates that there was a higher degree of subjectively perceived disability of upper limb in the tested group. Surgical interventions in the breast cancer treatment and other medical procedures affect the level of motor control and perceived disability of upper limb negatively in this group of patients. Movement faults are statistically more prevalent in the tested group. Movement faults are more prevalent on the operated side in the tested group.

Effect of progressive resistance training on persistent pain after axillary dissection in breast cancer: a randomized controlled trial

PURPOSE

Persistent pain is a known challenge among breast cancer survivors. In secondary analyses of a randomized controlled trial, we examined the effect of progressive resistance training on persistent pain in the post-operative year in women treated for breast cancer with axillary lymph node dissection.

METHODS

We randomized 158 women after BC surgery with Axillary Lymph Node Dissection (ALND) (1:1) to usual care or a 1-year, supervised and self-administered, progressive resistance training intervention initiated 3 weeks after surgery. A questionnaire at baseline, 20 weeks and 12 months assessed the intensity and frequency of pain, neuropathic pain and influence of pain on aspects of daily life. We analysed the effect using linear mixed models and multinomial logistic regression models for repeated measures.

RESULTS

A high percentage of participants experienced baseline pain (85% and 83% in the control and intervention groups respectively) and by the 12 month assessment these numbers were more than halved. A high proportion of participants also experienced neuropathic pain (88% and 89% in control and intervention group respectively), a finding that was stable throughout the study period. The effect on intensity of pain indicators favoured the exercise group, although most estimates did not reach statistical significance, with differences being small.

CONCLUSION

For women who had BC surgery with ALND, our progressive resistance training intervention conferred no benefit over usual care in reducing pain. Importantly, it did not increase the risk of pain both in the short and long term rehabilitative phase.