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As can be seen from the above tables, in Group A cords disappeared within two months in 90% of the patients with Grade 0 and 1 AWS; patients with G2 and G3 AWS also showed a greater reduction of symptom intensity (hypofunction, pain, tightness, cords visibility) compared to the control group.
Group A also shows reduced incidence of local inflammation, improved scar healing and faster resolution of pain compared to the control group. Regarding side effects, 30% of the women in group A complained about having a hard time taking too many drops, capsules and tablets.
After two months of close observation, patients still suffering from cording symptoms underwent manual treatments such as dissection of the scar, mobilization of the clavicle and shoulder, acupressure, laser therapy and taping (13).
We did not use the stretching movements and rupture of the cords that plastic and reconstruction surgeons implement in other breast units to decrease tension in the arm extension, since our experience shows these can lead to repercussions in fibrotic networks sometimes combined with transient lymphatic stasis. The gentle approach of manual lymph drainage, implemented with non-standard methods (some therapists followed the Leduc method, others the Vodder method, others still a personalized method) proved more suitable compared to the traumatic manual rupture of the cords.
A psychomotor and psychological approach by dedicated therapists was required for those patients showing significant sensory-motor and haptic (tactile and exploration) weakness. Women themselves stated that when they were diagnosed cancer, it had been a dramatic and all-involving experience.
G2 and G3 cording, still present after two months, required a cyclic motor and manual rehabilitation therapy and constant clinical follow-up, especially for patients who had undergone chemotherapy and showed moderate to severe anxiety-depression disorders.
CONCLUSIONS
Quadrantectomy and SLNB, which is considered a low invasive and side effect-free technique, often results in outcomes that might escape regular breast screening. We tend to forget that this operation affects the body of women who have been shocked by cancer diagnoses.
Incision of the skin and the fascia can indeed lead to an increase in reactivity of fibroblast adhesion, of reticular and collagen fibers and consequent hardening of cords that affect the arm and / or chest. Such incision is often made in patients showing sensory- motor and haptic changes in the upper limb.
Sensory-motor alterations caused by the trauma of diagnosis and by the symbolic value of the operation, as well as pre-surgery fascial tightness should encourage breast specialists to carry out further research and develop preventive protocols aimed at solving local, systemic and emotional traumas.
AWS in breast cancer is not a simple injury resulting from the scalpel cutting through the connective area. It involves the different vision and emotions of women about the tumor and tightness in their arm that suddenly no longer interacts with the world.
Breast specialists and rehab therapists shall have to consider carefully the deep meanings that cancer arouses in women
and then assess the outcome which in turn leads to other emotional implications. They have to combine anti- inflammatory
and mesenchyme-draining therapies with mood-stabilizing
and anti-anxiety treatments, planning manual and perceptual-motor rehabilitation.
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 75 - 2017
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