Timing of shoulder exercise after modified radical mastectomy: a prospective study.

Background: There are several factors those contribute to the amount of axillary drainage after modified radical mastectomy. The drains should be removed as early as possible. Whether the active shoulder movement of the lesion side increases the amount of axillary drainage needs to be studied prospectively.

Methods: From 1994 through 1995, 344 consecutive patients were randomly divided into three groups. One hundred sixteen patients in the early group performed upper arm exercises including pendulum, wall climbing and pulley exercises beginning the third post-operative day. One hundred fifteen patients in the later group patients did the same exercises beginning the sixth post-operative day and 113 patients in the delayed group did the same exercises after all the drains were removed.

Results: There were no significant differences in patient characteristics, including age, body weight, operation methods and the pathology in the three groups. The amount of axilla fossa drainage was significantly less in the patients in the delayed group than in the early and later group (485 ml, 568 ml, 559 ml, respectively, p = 0.032). However, there were no differences in the amount of chest wall site drainage or the number of aspiration of seroma among the three groups. The drains were removed on the average of seventh and ninth post-operative day in the delayed and early group patients, respectively (p = 0.124). Although the range of motion (ROM) of the shoulders in the delayed group patients was slightly limited during the first month after operation, ROM returned at 3 months and no difference was found 6 months after operation.

Conclusion: Upper arm exercise can start after the drains in the axilla are removed. The delay does not limit the shoulder function at 6 months after modified radical mastectomy.