What movements or functions are limited in the upper extremities after a bilateral mastectomy (double mastectomy)?

From the Guidelines

After a double mastectomy, you should avoid taking blood pressure measurements, drawing blood, placing IV lines, or administering injections in the upper extremity on the side(s) of the mastectomy, as this can increase the risk of lymphedema, infection, and other complications, as noted in the guidelines by the American Cancer Society/American Society of Clinical Oncology 1 and the European Society for Medical Oncology 1. The reason for this precaution is that lymph nodes are typically removed during mastectomy (axillary lymph node dissection), which impairs lymphatic drainage from the affected arm(s), creating a higher risk of complications when these procedures are performed, as discussed in the study by the American Cancer Society/American Society of Clinical Oncology 1. Some key points to consider include:

• Avoiding blood pressure cuffs, tight jewelry, or carrying heavy items with the affected arm(s) to prevent lymphedema and other complications, as recommended by the European Society for Medical Oncology 1.
• If medical procedures are absolutely necessary on the affected side, they should be performed with extreme caution and only when no alternative exists, as noted in the guidelines by the European Society for Medical Oncology 1.
• The compromised lymphatic system cannot effectively clear fluids, proteins, or potential pathogens that might be introduced through these interventions, as discussed in the study by the American Cancer Society/American Society of Clinical Oncology 1.
• Physical therapy, including stretching and other exercises, has been shown to be effective for managing postsurgical musculoskeletal symptoms, as demonstrated in the study by the American Cancer Society/American Society of Clinical Oncology 1.
• Supervised, slowly progressive resistance training is safe and effective for breast cancer survivors with regard to lymphedema development, as shown in the study by the American Cancer Society/American Society of Clinical Oncology 1.

From the Research

Upper Extremity Limitations after Double Mastectomy

After a double mastectomy, patients may experience limitations in the upper extremities due to potential lymphedema development. The following points outline some activities that may be affected:

• Lifting heavy objects: Patients may need to avoid lifting heavy objects to prevent exacerbating lymphedema or putting excessive strain on the affected arm 2, 3.
• Repetitive arm movements: Repetitive arm movements, such as those involved in certain sports or occupations, may need to be modified or avoided to prevent lymphedema progression 4, 5.
• Tight clothing: Wearing tight clothing, especially around the affected arm, may need to be avoided to prevent constricting the lymphatic vessels and exacerbating lymphedema 2, 5.
• High-impact activities: High-impact activities, such as contact sports, may need to be avoided to prevent injury to the affected arm or exacerbating lymphedema 3, 6.
• Heavy exercise: Heavy exercise, especially those that involve the upper body, may need to be modified or avoided to prevent lymphedema progression 4, 5.

Lymphedema Management

Effective management of lymphedema is crucial to prevent progression and improve quality of life. The following points outline some management strategies:

• Complete Decongestive Therapy (CDT): CDT, which includes manual lymphatic drainage, exercises, compression therapy, and skin care, has been shown to be effective in reducing lymphedema volume and improving patient outcomes 2, 5.
• Manual Lymphatic Drainage (MLD): MLD has been shown to be beneficial in reducing lymphedema volume and improving quality of life, especially when combined with other therapies 6.
• Compression therapy: Compression therapy, such as wearing compression sleeves, can help reduce lymphedema volume and prevent progression 3, 5.
• Exercises: Gentle exercises, such as those involved in CDT, can help improve lymphatic flow and reduce lymphedema volume 4, 5.
• Skin care: Proper skin care is essential to prevent infection and promote healing in patients with lymphedema 2, 5.