Between 1994 and 1995, 344 consecutive patients who underwent modified radical mastectomy were enrolled in the study and randomly assigned to three groups. Group 1 (early group) consisted of 116 patients who began upper arm exercises, including pendulum, wall climbing, and pulley exercises, on the third post-operative day. Group 2 (later group) comprised 115 patients who started the same exercises on the sixth post-operative day. Lastly, Group 3 (delayed group) included 113 patients who initiated the exercises after all the drains were removed.

Patient characteristics, such as age, body weight, operation methods, and pathology, were similar among the three groups. The study found a significant difference in the amount of axillary drainage between the delayed group and the early and later groups (485 ml, 568 ml, 559 ml, respectively, p = 0.032). Interestingly, there were no notable differences in the amount of chest wall site drainage or the number of seroma aspirations across the three groups. The average time for drain removal was seven days for the delayed group and nine days for the early group, with no statistically significant difference (p = 0.124). Although patients in the delayed group experienced slightly limited shoulder range of motion (ROM) in the first month after surgery, ROM returned to normal at three months post-operation, with no discernible difference six months after the procedure.

Based on the findings of this prospective study, it is safe to commence upper arm exercises after the drains in the axilla have been removed following modified radical mastectomy. Early initiation of shoulder exercises does not negatively impact shoulder function at the six-month mark after the surgery. These results provide valuable insights for medical practitioners in developing evidence-based post-operative rehabilitation protocols for patients, ultimately enhancing their recovery and overall well-being. Further research may be warranted to explore the long-term effects of different exercise regimens on shoulder function beyond the six-month period.

Reference: Chen, S. C., & Chen, M. F. (1999). Timing of shoulder exercise after modified radical mastectomy: a prospective study. Changgeng Yi Xue Za Zhi, 22(1), 37-43.