Breast Cancer is the second most common type of cancer, and the leading cause of cancer death in women. Among the treatments is the mastectomy, bringing negative physical and psychological consequences in the lives of these women, significantly reducing their quality of life.

Objective: to verify the physiotherapeutic procedures most used in postoperative breast after mastectomy surgery.

Methods: Literature review between 2007 and 2017, through consultation of national and international scientific articles in the following databases: Google Academic, lilacs, medline, Pubmed and Scielo, taking into account the key words: physiotherapy, cancer Of breast, mastectomy, mamoplasty, quality of life.

Results: 18 articles were identified in which the following modalities were identified: Complex Decongestive Therapy (CDT), Manual lymphatic drainage, Kinesioterapia, Low power laser, Ultrasound, Pneumatic compression, Manual therapy, Kinesio Taping and High voltage electrical stimulation.

Conclusion: CDT is the most used and effective technique, however, combining several techniques leads to a more complete, globalized and efficient treatment, showing that physiotherapy is essential in all phases of treatment, significantly improving the quality of Life of the mastectomized woman.

Keywords: physiotherapy, breast cancer, mastectomy, mammoplasty, quality of life

Cancer is characterized by disorganized and chaotic cell growth that results from genetic changes inherited or acquired by the action of certain environmental, chemical, radioactive, viral and hormonal agents named carcinogens, which thereby initiate the process of tumorigenesis.¹ Breast cancer is the second most common form of cancer in the world and the leading cause of death by cancer among females. It mainly affects women aged between 40 and 60 years.^1,2 The main risk factors are genetics and external, such as environment, living habits, eating habits, age, menarche, exposure to estrogen, radiation, obesity, sedentarism and environmental toxins.^1,2

According to the World Health Organization (WHO), about 40% of deaths could be prevented by eliminating or minimizing exposure to carcinogens. Primary prevention consists in promoting health and avoiding external risk factors. Secondary prevention involves actions aimed at early diagnosis of the disease. The main objectives of treatments are to cure, prolong survival and improve the quality of life (QoL) of patients.¹ Primary treatment for breast neoplasm is a surgical intervention called mastectomy, whose goal is tumor removal. The most commonly used surgical procedure is modified radical mastectomy, in which the entire breast is removed, along with axillary lymph nodes.^1,3,4 After mastectomy, women face a psychological trauma. These feelings lead them to explore the possibilities of breast reconstruction, in order to reconstitute their body image, with improvements to QoL and well-being, so it should be considered as an integral part of breast cancer treatment.⁵

Treatment-associated morbidities include paresthesia of the axillary region and the lateral wall of the thorax, pain, enlargement of upper limb, reduction of shoulder’s range of motion, limitation of daily living activities (DLAs), and interference in QoL.⁶ Patients undergoing physical therapy have their recovery time reduced and return more quickly to their daily, occupational and sports activities, as well as can reacquire movement amplitude, strength, good posture, coordination, self-esteem and, mainly, minimize possible postoperative complications and increase their QoL.³ In the preoperative phase, the work of musculature maintenance is important, besides a previous evaluation of the patient’s overall conditions. The post-surgical treatment aims at a significant improvement in skin texture, absence of fibrotic nodulation, reduction of edema, pain relief, minimization of possible tissue adhesions, rapid recovery of areas with hypoesthesia, that is, less of complications and acceleration of patient’s return to daily activities.^7,8

The main physical therapy resources used to achieve that, are: manual lymphatic drainage, ultrasound, cryotherapy, laser therapy, electrotherapy, active exercises and complex decongestive therapy (CDT), which is fundamental to the recovery process.⁷ Because of the high incidence of breast cancer, and the search for a treatment that ranges from tumor removal surgery to breast reconstruction surgery focusing on significant improvement in QoL, there is a need to verify the most used physical therapy procedures in mastectomy post-operative period.

Literature review was carried out in Scholar Google, LILACS, MEDLINE, PubMed and SciELO databases, in search for publications written in Brazilian Portuguese, English and Spanish languages and published from 2007 to 2017, using the following keywords in both Brazilian Portuguese and in English: physiotherapy, breast cancer, mastectomy, mammoplasty, quality of life, Our search included studies describing the most frequent physical therapy interventions after mastectomy in breast cancer which had been written in Brazilian Portuguese, English or Spanish.

After the full reading of the articles found, we selected the ones meeting the inclusion criteria. When selecting and analyzing the material, a table was drawn up with the following information of studies: author, year, journal,

journal impact factor, study’s objectives, procedures and results. Eighteen articles describing the most frequent physical therapy modalities after mastectomy surgery were selected (Table 1).

Breast cancer is the second most common cancer worldwide. About 22% of new cases are accounted each year, corresponding to a significant number of deaths among adult women.^2,27 In Brazil, cancer is considered a serious public health problem due to gradual increase in incidence and mortality.²⁸ Concomitant to medical treatment, a multidisciplinary approach is required, considering not only pathological conditions, but also physical, psychological, social and professional rehabilitation, aiming at maintaining and improving the QoL of patients. Hence, physical therapy plays a fundamental role in this stage of treatment for mastectomized women, since it can help in early functional recovery and in the prophylaxis of sequelae, in addition to reducing recovery time, thus collaborating with women’s reintegration into society without functional limitations.³ After surgery, the patient may present, among other complications, upper limb lymphedema. Signs and symptoms associated with lymphedema are: increased limb diameter, tightening of the skin, stiffness, decreased motion range, sensory disturbances and impairment of functional tasks.²⁵

Marques et al.,⁹ reported the importance of manual lymphatic drainage (MLD) in the treatment of lymphedema, resulting in its reduction, improvement of sensitivity and range of motion, and reduction of cicatricial adhesions, providing an improvement in the patient’s QoL. It has been proven effective and, when associated with other techniques such as CDT, achieved better results. Reduction of lymphedema observed by Tacani et al.,¹⁰ was due to the use of CDT, which consists of combined use of MLD, skin care, compression bandaging, kinesiotherapy and selfmassage. When supplemented by manual techniques, vacuotherapy, transcutaneous electrical nerve stimulation (TENS), and adapted therapeutic exercises, it also improved cicatricial adhesions. Brito et al.,²⁹ highlighted that, in most treatment programs, lymphedema treatment is based on CDT. Kinesio taping has been used as an innovative resource in the treatment of lymphedema, as it can drain body fluids. Pivetta et al.,²⁰ reported a significant reduction of lymphedema in groups that used Kinesio taping either alone or in association with other techniques. High-voltage stimulation may increase venous blood flow and edema absorption, since negative polarity has sufficient intensity to provide muscle contractions, producing a pump effect in lymphatic flow.^22,23

A study by Garcia et al.²², using high-voltage stimulation, showed significant reduction in lymphedema, as well as reports by the volunteers of improvement in their overall picture when it comes to increased mobility and decreased weight sensation. Mastectomized patients should be encouraged to maintain unrestricted exercise, performing resistance training with fewer repetitions and lower load on the affected limb, or with lymphedema. Associating exercises with relaxation techniques, to provide patients with both physical and emotional improvement, brings benefits to treatment of lymphedema.²⁹ Practicing physical exercise during cancer treatment has contributed with improvements in psychological, social and physical aspects of patients; however, it is important to consider which exercises can be performed by this public.¹³ The knowledge about benefits of physical therapy and the resources offered by the physical therapist is still limited, especially when it comes to the preoperative period, since Flores et al.,³⁰ verified that the frequency of referrals of patients by plastic surgeons to physical therapists was 40 and 90% in the pre- and postoperative periods, respectively. Pacheco et al.,²⁶ emphasized the importance of physical therapy in all recovery phases of mastectomized women. However, the best results occur when there is early intervention by the physical therapy team.

In conclusion, CDT was proven the most used and efficient technique. However, combining several techniques leads to a more complete, global and efficient treatment, thus showing that physical therapy is essential in all phases of treatment, that is, in the preoperative and postoperative periods, significantly improving the QoL of mastectomized women.

This work would not have been possible without the collaboration, stimulation and commitment of my family and my academic advisor. I would like to express my gratitude and appreciation to everyone directly or indirectly contributed to making this work a reality. To all of you, my sincere “thank you”.

Authors declare that there is no conflict of interest.

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