Breast cancer is one of the most important malignant tumors endangering women's life and health in the world. Research shows that breast cancer has become the most common cancer among women in the world with a incidence rate of 11.6%. At present, surgery is still the main treatment method for breast cancer, but complications such as subcutaneous hydrops, flap necrosis, incision infection and lymphedema are easy to occur after surgery, among which lymphedema is one of the most common complications after breast cancer surgery, with an incidence of 9.4%~54.0%.
1、 Why does upper limb lymphedema occur?
The destruction of lymph nodes and lymphatic vessels after breast cancer surgery will cause the obstruction of lymphatic return pathway, leading to the accumulation of protein rich lymph in soft tissue, and the swelling of upper limbs and armpits, which will lead to limb deformity, activity dysfunction, anxiety, depression, irritability and other psychological problems.
2、 What are the manifestations of lymphedema?
3、 The destruction of lymph nodes and lymphatic vessels caused by breast cancer surgery and radiotherapy has blocked the return of lymph rich in high protein. The swelling of upper limbs and armpits caused by abnormal accumulation in soft tissues will cause local depression when pressing the edema part. Edema is most pronounced in the afternoon or evening, and after resting overnight, most or all of the swelling subsides. Severe cases include abnormal thickening of limbs, thickening and keratinization of the skin, and obvious deformities in appearance, which seriously affect the patient's daily movements, life, and work.
3、 How should edema be prevented?
1. Correct surgical approach
When doctors perform surgical treatment on patients, they should choose the correct surgical approach based on the patient's specific condition.
It is particularly important to note that the surgical scope should not be blindly expanded, but should be minimized as much as possible. For example, improved radical surgery can be used to treat patients. The improved radical surgery preserves the pectoral muscles, reducing the surgical scope and effectively preventing the occurrence of upper limb lymphedema.
2. Avoid intravenous infusion and blood pressure measurement in the affected limb. During venipuncture, it can cause inflammation of the axillary vein intima, leading to fibrosis and thickening of the patient's vessel wall. In severe cases, it can also cause occlusion of the patient's vessel wall, hindering venous return and causing upper limb lymphedema. Therefore, it is necessary to avoid administering intravenous fluids and measuring blood pressure to the affected limb of the patient, in order to effectively prevent postoperative upper limb lymphedema.
3. Actively engage in functional exercises on the affected upper limb after surgery
Effective functional exercises can promote lymphatic circulation in patients. First, let me tell you what activities can be done before removing the drainage tube.
1-2 days after surgery, focus on practicing clenching fists, stretching fingers, and bending wrists on the affected limb. This exercise can be done while lying in bed or sitting with the shoulder joint and keeping the upper arm still. The fingers should be opened, clenched, rotated inward, rotated outward, and the wrist should be moved up and down (5-7 points/time, 3-4 times/day).
3-4 days after surgery, during forearm extension and flexion exercises, the affected arm naturally droops with the palm facing forward - slowly lift the forearm upwards, trying to touch the affected shoulder with fingertips - then slowly lower it down (practice 6-8 points/time, 5-6 times/day).
5-7 days after surgery, focus on practicing the movement of the affected limb's fingers touching the opposite shoulder and the same ear. When practicing the movement of the affected limb's fingers touching the opposite shoulder, with the help of medical staff or a healthy hand, support the affected elbow joint, bend the elbow joint, and slowly raise the forearm, so that the affected limb's fingers can touch the opposite shoulder to the greatest extent possible; Using the same method, touch the same ear as much as possible (practice 6-8 points/time, 5-6 times/day)
After removing the drainage tube, we can start shoulder joint movement.
What activities can be done after removing the drainage tube?
Shoulder joint movement, with the shoulder joint as the axis, slowly raise the affected limb forward and upward, so that the affected limb exceeds the head and is as straight as possible - then slowly lower it down; Continue to perform rotation, abduction, and other movements with the shoulder joint as the axis and the affected limb arm as the axis.
When doing wall climbing exercises, the patient stands next to a wall or professional assistive device, uses the fingers of the affected limb to slowly climb up along the wall or professional assistive device, gradually raising it to a height that they can reach, and then slowly lowering it.
Exercise is a gradual process, so don't rush to avoid affecting the healing of the wound. Rehabilitation exercise requires moderate daily activity and should not be tiring. Be sure to be moderate and avoid excessive fatigue that may cause accidental strains.
Special reminder: For patients with special circumstances, exercise time should be reduced or delayed as appropriate. For patients with severe skin flap damage, significant rehabilitation exercises should be avoided within 2 weeks after surgery; For subcutaneous fluid accumulation or drainage exceeding 50ml within one week after surgery, reduce the number of exercises and lower the range of shoulder joint movement (restrict rotation, abduction, and other movements); For skin grafting or latissimus dorsi flap reconstruction, it is necessary to delay the movement of the shoulder joint.
In addition, effective manual massage can alleviate the condition of lymphatic obstruction in patients, thereby effectively promoting lymphatic reflux in the affected upper limb and improving the condition of upper limb lymphedema. It should be noted that the massage needs to be performed by a professional masseur.