• Post-Mastectomy Care 
• Breast Reconstruction
  • Why choose Breast Reconstruction?
  • Factors Impacting Breast Reconstruction Decisions
  • Types of Breast Reconstruction
    • Implant Procedures
    • Tissue Transfer or Flap surgery
  • T.R.A.M. Breast Reconstruction Protocol
  • Expansion & Latissimus Flap Breast Reconstruction Protocol

T.R.A.M. Breast Reconstruction Protocol ‘07
Physical Therapy - Rehabilitation

PRE-SURGERY

Initial Baseline Assessment

• Assess Spinal and Appendicular Range of Motion and Strength.
• Basic Cardio-Vascular assessment – Balke Ware sub-max assessment
• Postural Assessment-Encourage symmetry and minimize upper quadrant retraction

Educational Component

• Explain Post-Operative Rehabilitation Program
• Encourage Home Based Assistance for ADL after surgery and establish Emotional Support Network
• Encourage/teach diaphragmatic breathing techniques
• Functional Training Education – Provide instruction in techniques to limit trunk torque after surgery. Set appropriate limits for pushing, pulling and lifting. Teach transfers minimizing trunk saggital/rotational torque

Pre-Operative Exercises

• Initiate Pelvic Stabilization home exercises – stressing Hamstrings, Gluteals, Obliques, 
  Hip abduction/adduction & Pelvic elevators
• General shoulder strengthening/flexibility program

POST-SURGERY

10 Days Or When Drains Are Removed

• Shoulder Girdle Assessment - Start a program of gentle active and active-assisted mobilization of involved shoulder. Gradual full ROM is desired only after all upper quadrant drains are removed
• Progressive Ambulation - Encourage daily walking on level surfaces progressing toward further distances each day. Athletic shoes are recommended. Ascending and descending steps with supervision are encouraged when not fatigued
• Review of Dynamic Functional Postures - All torquing of trunk should be limited-especially in a saggital plane with no stretching of trunk in extension past neutral. Axial rotation is to be limited to 20 degrees bilaterally
• Lymphedema Avoidance Education - Initiate prevention education program if there was lymph node surgery or radiation. Both video and written information will be provided
• Assess for low level abdominal compression after drains are removed

28 Days Post-Operatively

• Shoulder Girdle Assessment – Full active Range of Motion is expected. Assess if scapular-thoracic muscles are tight or stretched. Initiate gentle upper extremity isometrics stressing anterior and posterior musculature
• Upper Extremity Volume Assessment – If Lymphedema is a concern-Bilateral girth as well as volumetric assessment. Possible bio-impedance assessment
• Review of Dynamic Functional Postures -– Continue to limit trunk extension to neutral and 20 degrees of axial rotation
• Begin Non-Weighted Hip Flexion & Abduction and trunk extension exercises. Gentle daily 75% ROM exercises stressing isometric pelvic floor tightening. Stable pelvis is to be stressed
• Progressively Increasing Ambulation and Steps – Pelvis must be dynamically stabilized

Five - Six Weeks Post-Operatively

• Begin Active Rehabilitation – In PT office 2-3 times a week and daily home program
  1. Endurance Training - Heart Rate Monitored stressing aerobic fitness 
     Sub 85% of age predicted maximal heart rate parameter.
  2. Strength Training of Trunk – Saggital/Coronal/Rotational Planes within full available range of motion. - Manual strength grade of 4+/5 is desired
  3. Pelvic Stabilization Exercises – stressing abdominals, gluteals and hamstrings
  4. Active and Passive stretching of trunk in all planes - Gentle anterior chest wall stretching of the medial Pectoralis Major.
  5. Functional Training - Return to Work preparation.

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8080 Old York Road, Suite 208 · Elkins Park, PA 19027
215-782-8760

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