Breast Cancer Research and Treatment

, Volume 90, Issue 3, pp 263–271 | Cite as

Delayed versus immediate exercises following surgery for breast cancer: a systematic review

  • Delva R. Shamley
  • Karen Barker
  • Vanessa Simonite
  • Anna Beardshaw



Seroma formation, wound healing and fluid drainage are a concern for both surgeons and patients. Excessive fluid production can result in seroma formation, and inadequate drainage of seromas is known to cause infection, pain, discomfort and longer periods of hospitalisation. Postoperative exercises given to maintain movement of the arm are believed to increase the amount of fluid production following surgery. This review aimed to determine whether a program of delayed exercises reduces the risk of seroma formation, fluid loss and hospital stay, without loss of arm movement.


A systematic review. RCTs of early versus delayed shoulder mobilisation after surgery in females with breast cancer were included in the review. Outcomes. One or more measurements of shoulder range of motion, wound complications, fluid drainage volumes and incidence of seroma formation. Design. Randomised controlled trials, control group of delayed exercise/mobilisation. Validity assessment was carried out using a data extraction form based on the CONSORT statement. Study characteristics recorded include sample size, intervention, control, period of exercise delay, surgical procedure and conclusions drawn. Data synthesis was carried out using random effects and weighted mean differences to test for heterogeneity and combined effects.


12 RCTs were included in the review of which 6 were included for meta-analysis. Delaying exercises significantly decreases seroma formation (OR=0.4; 95%CI 0.2–0.5; p=0.00001). No significant differences were found for drainage volume or hospital stay.


Current evidence from RCTs supports the use of a delayed program of arm exercises to reduce seroma formation. Clinical and statistical inconsistencies between studies did not allow any conclusions to be drawn regarding the effects of delayed exercises on fluid drainage, hospital stay and immediate or long term ability to move the arm.


breast cancer meta-analysis RCTs systematic review upper limb exercises 


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  1. 1.
    Aitken, DR, James, AG 1997Seromas and physiotherapy after mastectomyAnn Surg Oncol4293297Google Scholar
  2. 2.
    Chen, S, Chen, M 1998Timing of shoulder exercises after modified radical mastectomy: a prospective studyChang Gung Med J223742Google Scholar
  3. 3.
    Riddell, VH 1948Radical mastectomy: the technique and the complicationsBr J Surg36113129PubMedGoogle Scholar
  4. 4.
    Abe, M, Iwase, T, Takeuchi, T 1998A randomised controlled trial on the prevention of seroma after partial or total mastectomy and axillary lymph node dissectionBreast Cancer56770CrossRefPubMedGoogle Scholar
  5. 5.
    Flew, TJ 1979Wound drainage following radical mastectomy: the effect of restriction of shoulder movementBr J Surg66302305PubMedGoogle Scholar
  6. 6.
    Lotze, MT, Duncan, MA, Gerber, MD 1981Early versus delayed shoulder motion following axillary dissectionAnn Surg193288295PubMedGoogle Scholar
  7. 7.
    Der Horst, CH, Kenter, JA, Jong, MT 1985Shoulder function following early mobilisation of the shoulder after mastectomy and axillary dissectionJ Surg37105108Google Scholar
  8. 8.
    Rodier, JF, Gadonneix, MD, Dauplat, MD 1987Influence of the timing of physiotherapy upon the lymphatic complications of axillary dissection for breast cancerInt Surg72166169PubMedGoogle Scholar
  9. 9.
    Dawson, I, Stam, L, Heslinga, JM 1989Effect of shoulder immobilisation on wound seroma and shoulder dysfunction following modified radical mastectomy: a randomised prospective clinical trialBr J Surg76311312PubMedGoogle Scholar
  10. 10.
    Wingate, L, Croghan, I, Natarajan, N 1989Rehabilitation of the mastectomy patient: a randomised, blind, prospective studyArch Phys Med Rehabil702124PubMedGoogle Scholar
  11. 11.
    Jansen, R, Geel, A, Groot, H 1990Immediate versus delayed shoulder exercises after axillary lymph node dissectionAm J Surg160481484PubMedGoogle Scholar
  12. 12.
    Petrek, JA, Peters, MP, Nori, S 1990Axillary lymphadenectomy. A prospective, randomised trial of 13 factors influencing drainage, including early or delayed arm mobilisationArch Surg125378383PubMedGoogle Scholar
  13. 13.
    Knight, CD,Jr, Griffen, FD, Knight, CD,Sr 1995Prevention of seromas in mastectomy wounds. The effect of shoulder immobilisationArch Surg13099101PubMedGoogle Scholar
  14. 14.
    Schutz, I, Barholm, M, Grondal, S 1997Delayed shoulder exercises in reducing seroma frequency after modified radical mastectomy: a prospective randomised studyAnn Surg Oncol4293297Google Scholar
  15. 15.
    Moher, D, Schiltz, KF, Altman, DG 2001The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trialsLancet35711911194PubMedGoogle Scholar
  16. 16.
    Egger, MDavey Smith, GAltman, DG eds. 2001Systematic reviews in health care: meta-analysis in contextBMJ Publishing companyLondonGoogle Scholar
  17. 17.
    Der Simonian, R, Laird, N 1986Meta-analysis in clinical trialsControl Clin Trials7177188Google Scholar
  18. 18.
    Bailey, KR 1987Inter-study differences: how should they influence the interpretation and analysis of results?Stat Med6351358PubMedGoogle Scholar
  19. 19.
    Sterne, JAC, Gavaghan, D, Egger, M 2001Publication and related bias in meta analysis: power of statistical tests and prevalence in the literatureJ Clin Epidemiol5311191129Google Scholar
  20. 20.
    Thompson, SG 2001Where and how sources of heterogeneity should be investigatedEgger, MDavey Smith, GAltman, D eds. Systematic Reviews in Health Care: Meta-analysis in ContextBMJ PublishingLondon157175Google Scholar
  21. 21.
    Brosseau, L, Balmer, S, Tousignant, M 2001Intratester and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictionsArch Phys Med Rehabil82396402PubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Delva R. Shamley
    • 1
  • Karen Barker
    • 2
  • Vanessa Simonite
    • 3
  • Anna Beardshaw
    • 4
  1. 1.Research Fellow, Oxford Radcliffe Hospitals Trust Charity Programme Lead, Physiotherapy, School of Health and Social CareOxford Brookes UniversityMarstonUK
  2. 2.Physiotherapy Research Unit Nuffield Orthopaedic CentreNHS TrustOxfordUK
  3. 3.Department of Mathematical SciencesOxford Brookes UniversityOxfordUK
  4. 4.Physiotherapy DepartmentJohn Radcliffe HospitalOxfordUK

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