A 38-year-old female was admitted to the hospital for bilateral modified radical mastectomies with right axillary lymph node dissection secondary to breast cancer. She had 10 right axillary lymph nodes removed. She opted for a prophylactic mastectomy on the left because she is positive for the BRCA1 gene mutation. She is going to have reconstructive breast surgery at a later date. She is a stay-at-home mom with two children who are 2 and 5 years old. She has a supportive husband and her parents live close by and they enjoy watching the children during the day. She has always experienced good health—running 5 times per week and taking yoga classes. Her cancer diagnosis came as quite a shock to her and she is anxious about her appearance, regaining her strength, lymphedema, and her prognosis.
How would this individual's contextual factors influence or change your patient management?
What precautions should be taken during physical therapy examination and interventions?
Identify the psychological factors apparent in this case.
Identify referrals to other medical team members.
- AXILLARY LYMPH NODE DISSECTION: Surgical removal of lymph nodes from the axilla to remove cancerous cells and for diagnostic purposes
- BRCA1 AND BRCA2 GENE MUTATIONS: Normal BRCA1 and BRCA2 genes repair breast cell damage and keep cells growing normally; when these genes mutate, they function abnormally and increase breast cancer risk; BRCA1 and BRCA2 gene mutations cause 5% to 10% of breast cancers1
- CLASS I COMPRESSION GARMENT: Compression sleeve used in the treatment of upper extremity lymphedema that provides 20 to 30 mm Hg of pressure
- LYMPHEDEMA: Abnormal increase of protein-rich fluid in the interstitium that can lead to inflammation, infection, and indurated tissue
- MODIFIED RADICAL MASTECTOMY: Removal of breast, surrounding tissue, and lymph nodes that are affected by cancer
- PROPHYLACTIC MASTECTOMY: Removal of breast that is not thought to contain cancerous cells in order to reduce the risk for cancer occurring in this region
- SENTINEL LYMPH NODE DISSECTION: Biopsy of the first lymph nodes that receive lymphatic drainage from a tumor; if these lymph nodes contain cancerous cells, a more extensive axillary dissection may occur. If sentinel nodes do not contain cancerous cells, then additional nodes do not need to be removed.
- SEROMA: Collection of clear serous fluid that may occur after surgery
Explain appropriate guidelines to reduce the risk of lymphedema.
Prescribe an appropriate exercise program for the patient status/post bilateral mastectomy.
Identify appropriate medical referrals for the patient status/post mastectomy.
PT considerations during management of the breast cancer survivor status/post bilateral mastectomy with right axillary lymph node dissection:
- General physical therapy plan of care/goals: Prevent or minimize loss of shoulder range of motion (ROM), and strength; decrease cervical and thoracic pain; decrease scar tissue and fascial restrictions
- Physical therapy interventions:...