Aims and Background We attempted to determine the best method of performing the exercises in rehabilitation after breast cancer surgery and their influence on postoperative complications. Currently, there are no guidelines for these exercises. The scope of this study was to evaluate the effect of two schemes of physiotherapy exercises (directed or free) on shoulder function and lymphatic disturbance in postoperative rehabilitation. Subjects Sixty women who underwent a modified radical mastectomy or quadrantectomy with axillary dissection were randomized into two groups. Methods The physiotherapy technique used was kinesiothera-py. The directed group performed physiotherapy following a regimen of 19 exercises. The free group performed the exercises following the biomechanical physiological movements of the shoulder without a previously defined sequence or number of repetitions. Results The averages of the flexion, abduction and external rotational movements of the shoulder showed better recovery with statistical significance in the directed group compared to the free group. There was no significant difference between the groups in lymphatic disturbance. Conclusion At the end of 42 days of follow-up, the movements of flexion, extension, abduction and external rotation of the shoulder were better rehabilitated in the directed group. The two schemes of exercises were not different with regard to lymphatic disturbance.

The complications were not influenced f by the physiotherapy exercises performed.

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1) described a series of 44 cases showing a not so rare complication that lacked literature references regarding the surgical approach to the axilla: axillary web syndrome (AWS). The concept described was the presence of a network of visible fibrous cords underneath the axillar skin, hardened and painful upon performance of shoulder abduction. The network is always present in the axilla and extends along the medial face of the ipsilateral arm, frequently below the cubital cavity and occasionally until the base of the thumb. Typically there are two or three palpable cords of tissue under the skin which are hardened, painful, and are not erythematic. There is no increase in temperature nor systemic symptoms.A 55-year-old woman, came in the Ferreira de Rezende S/S Physical Therapy Clinic 7 days after the breast surgery with an 18-month diagnosis of systemic erythematic lupus employing cloroquin 400 mg. Her mammography showed a 4 cm long focus of grouped and pleomorphic microcalcifications in the superlateral quadrant of the left breast and images of multiple bilateral nodules. A mammary ultrasound was done that showed multiple, simple bilateral cysts in correspondence with the nodules on mammography, and magnification of the microcalcifications on the left confirmed the initial suspicious diagnosis.The patient underwent a biopsy of the microcalcifications whose pathologic anatomy revealed atypical ductal hyperplasia and a focus of "in situ" ductal carcinoma of 2 mm. Then a mastectomy was performed with axillar dissection. Pathologic examination revealed the absence of residual neoplasia and 22 axillary lymph nodes were negative for metastasis.After 14 postoperative days a pain began in the arm ipsilateral to the surgery that worsened with flexion (160 degrees) and abduction (145 degrees) of the shoulder. Three cords were observed in the examination, which were hardened, fibrous, nonerythematic, and painful, beginning in the axilla and running down the medial face of the arm, reaching the cubital cavity.The algesia and range of movement of flexion (110 degrees) and abduction (80 degrees) of the shoulder worsened significantly around the 22nd day; more evident fibrous cords were noted in the examination and extended to the base of the thumb.Beginning with the 31st postoperative day, the pain progressively improved, with slight restriction of range of movement (130 degrees in flexion and 110 degrees in abduction) of the shoulder and regression of the fibrous cords.On the 83rd postoperative day the patient no longer complained of pain. In the physical examination the fibrous cords had completely disappeared and there was no functional impairment of the arm ipsilateral to the surgery.The main hypothesis relating to AWS physiopathology is lymph vein rupture during the axillar procedure, unrelated to the number of lymph nodes compromised or with the stage of the illness, but solely to the surgery itself. The pathologic anatomy analysis of fibrous cords showed the presence of lymphatic veins and superficially dilated veins ...

A 41-year-old man presented with a 3-year history of a palpable mass in the right breast. He denied trauma, previous surgery, or radiotherapy on the breast. On physical examination, there was a 4 cm wellcircumscribed, lobulated, tender lump in the inner inferior quadrant of the right breast. The lump was not fixed to the skin or deep tissues. No axillary lymphadenopathy was found.Mammography revealed a well-circumscribed intraparenchymal macrolobulated hypodense mass localized in the inner inferior quadrant of the right breast measuring about 4.5 cm × 3.5 cm (Fig. 1). There was no evidence of gynecomastia. Ultrasonography showed a hypoechoic parenchymal mass with undefined borders. An excisional biopsy was performed.Macroscopic examination revealed a well-circumscribed lobulated hemorrhagic nodule measuring 4.0 cm × 3.0 cm, with a spongy cut surface (Fig. 2). Microscopically the lesion consisted of wide cavernous spaces lined by flat endothelial cells and filled with red blood cells (Fig. 3). The cavernous spaces were arranged in multiple large lobules separated from each other by minimal amounts of fibrous tissue without any calcification or lymphocytic reaction. Occasional dilated vascular spaces contained recent or organized thrombi, but with no papillary endothelial hyperplasia. No normal breast tissue was seen at the periphery of the lesion.

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Introduction: Axillary Web Syndrome (AWS) is well described until 3 months postoperative breast cancer surgery. Methods: We report a case of a 47 years old patient that arrived our rehabilitation service with pain and limited shoulder range of movement in the ipsilateral side of a breast cancer surgery. Results: An Axillary Web Syndrome was diagnosed 83 months after the surgery. Conclusion: It is important to mention that AWS might persist for a long time and also affect patients a long time after the surgery.

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