Effectiveness of an early healthcare program and post-operative management of the upper limb to deal with associated complications in sentinel node surgery in women with breast cancer.

INTERVENTION: 24 hours after receiving surgical treatment, the relevant nurse addresses the patients who have been operated on to explain a series of precautions and recommendations for an adequate recovery, which include: advice on the incorporation of activity in daily life, care of surgical wounds, basic precautions, amongst which are: monitoring of temperature once a day and use of a recommended compressive bra without cups, hygiene, nutrition, and medicine prescribed by a doctor, as well as mention of certain actions to be avoided. All this information is contained in a document which the nurse will hand over on discharge. The treatment group will receive a 4‐week program on post‐surgery sanitary education and upper limb management. The control group will only receive information 24 hours after the previously‐mentioned operation on hospital grounds. Following the first session, the physiotherapist and patient will meet for further sessions depending on the patient's availability. One month after the initial physiotherapy treatment, the patient should have completed the program, which includes 6 sessions of one hour of duration, distributed in 3 phases : Phase 1. Functional recovery. 3 Sessions. The objective of this stage is to normalize muscular tone, improve lymphatic drainage and the complete mobility of the upper limb, minimizing any residual limitation. In this stage, the following is carried out: Perform a program of exercises, using oral and graphic information to explain exercises focusing on functional recovery and centered on lymphedema prevention, as well as postural hygiene and individualized exercises depending on the patient's progress. These exercises consist of respiratory movements, particularly diaphragmatic breathing, and can be accompanied by upper limb movements, like stretching, and progressive assisted active exercises. With these exercises, global functionality is obtained, as well as muscular work, minimizing paresthesia symptoms in the upper limbs. Phase 2. Scar treatment. 2 sessions. In this phase the following will be carried out: ‐ The first session will take place at least 2 days after the removal of stitches, where scar‐cleaning will be shown to gently eliminate scabbing, and reduce marks (Vaseline, showering, drying, antiseptic application). ‐ The presence of hypertrophic or retractile scarring, or the appearance of clamps will be avoided. ‐ The normalization of surrounding areas, using massage therapy and kinesitherapy with the aim of giving elasticity and avoiding adhesions. Emphasis is put on hardened areas. ‐ Ensure that adequate interior clothing is worn, which fits but doesn't press excessively, because apart from discomfort it can provoke liquid accumulation in the sub‐axillary area. To end these sessions, underarm stretching will be performed, keeping in mind that discomfort may be produced, but not pain. The patient is asked to move the hand of the affected arm to the ear on the opposite side, and cause stretching by pushing the affected elbow backwards, or, starting in the same posture, gently apply pressure on the affected underarm with the opposite hand, to induce further elasticity. Phase 3. Informative sessions. 1 session. CONDITION: Breast cancer Lymphedema Mobility Musculoskeletal pain Tissue adherences PRIMARY OUTCOME: Change in range in joint mobility of the homolateral shoulder, assessed by a goniometry. INCLUSION CRITERIA: ‐ Women between the ages of 25 and 65 years who have had sentinel node surgery. ‐ Women without a history of recurrences of breast cancer. ‐ Have medical authorization to participate. ‐ Have verbal communication capabilities. It is addressed to patients, family members and carers. A brief anatomical‐physiological review of the lymphatic system will be carried out, explained in a simple way for people unfamiliar with the subject. Patients will learn what changes are produced following surgery, and events that could take place after such. They risk developing lymphedema. They will be provided with information on how to improve management of the lymphatic system (avoiding deterioration), and to stimulate functionality, as well as how to avoid risks that can contribute to it's depletion, which can occasionally trigger lymphedema. SECONDARY OUTCOME: Change in pain associated with movement of the upper homolateral limb, assessed by the VAS and SPADI scales. Change in recovery muscular strength in the homolateral upper limb, assessed by dynamometry. Change in women´s quality of life, assessd by the EORTC QLQ‐BR23 scale. Proportion of participants with no appearance of long‐term lymphedema, assessed by telephone calls. Proportion of participants with no appearance of myofascial adherence, assesseed by the MAP‐BC scale. Proportion of participants with no hypertrophic scar, assessed by the POSAS scale. Proportion of participants wth no appearance of a lymphatic cord on the damaged upper limb, assessed by palpation.