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Physical Rehabilitation after Breast Cancer

Breast cancer is ranked as one of the most common types of cancer affecting Singaporean women today. (Singapore Cancer Registry, Interim Report, Trends In Cancer Incidence In Singapore 2004-2008).

Disease free survival after diagnosis and treatment  has been reported to be between 63%-74% at 10 years, with overall survival rates of 63-86% (Jacobsen et al, 1995). Therefore, the focus of rehabilitation is to optimise the quality of care and survival, as well as quality of living for women diagnosed with breast cancer.

There are generally two types of mastectomies which are performed, depending on the clinical presentation & histological results; the simple mastectomy, where breast tissue is removed, and the radical mastectomy, where  breast tissue and the underlying muscle in the chest is removed (this may be needed if cancer has spread to the chest wall muscles).

The table below illustrates common surgical procedures that  may be performed for breast cancer patients.

Table 1: Summary of surgical procedures for breast cancer


Surgical Procedure


Breast biopsy (lumpectomy)         

Excision of breast lump

Breast conservation (wide       local excision; quadrantectomy; tylectomy; partial mastectomy)

Excision of tumour & surrounding breast tissue to give an adequate surgical margin from cancer cells. Axillary dissection performed in conjunction

Axillary dissection

Removal of lymph nodes

Simple mastectomy

Excision of all the breast tissue

Modified radial mastectomy (Patey)/MRM

Excision of all the breast tissue, axillary dissection & pectoralis minor muscle

Radial Mastectomy (Halsted)

As for modified radial mastectomy with the excision of pectoralis major muscle

Extended radial mastectomy

As for radial mastectomy with the excision of underlying chest wall(ribs); a split skin graft is required to cover the surgical defect on the chest wall

Breast reconstruction (implants or myocutaneous flap

1. Surgical implant (saline) with/ without prior use of tissue expanders

2. Skin & muscle flap (latissimus dorsi, rectus abdominis) with/without intact blood supply is used to reconstruct the breast, nipple reconstruction/ prosthesis required.

The aim of breast cancer treatment is to eradicate local disease & control the development of further disease, thus enhancing the survival of women diagnosed. However, there are many potential problems that may occur in women who have been treated for breast cancer, such as:

•    Decreased shoulder movements & function
•    Wound infection & delayed wound healing in the early post-operative period
•    Seroma development on the anterior chest or axilla after wound drains are removed
•    Lymphedema of the arm &/ or breast
•    Neural disorders such as sensory disturbances and nerve entrapment in the arm
•    Fibrosis of the skin & muscle of the chest wall after radiotherapy
•    Local recurrence or metastatic spread of breast cancer

The degree of difficulty that patients encounter with any of these complications varies with the extent of the disease, surgical procedure, age and co-existing problems. 

Physiotherapy in breast cancer

Physiotherapists can therefore play a significant role in the identification, prevention and/or management of the problems mentioned above, and also assist in the support of women before, during & after the treatment and the follow-up period for breast cancer. 

Early physiotherapy intervention is essential to an efficient recovery. In most cases, patients are referred to physiotherapy immediately after surgery.  After a thorough evaluation is completed, a treatment plan is designed to meet individual needs and goals.

Physiotherapy may include education and advise regarding posture, active/ passive and auto assisted range of motion exercises in helping the patient to regain her preoperative shoulder range & function. In addition appropriate strengthening exercises, massage, prescription of compression or supportive garments, scar mobilization, designing a safe home exercise programme for the individual, and education about lymphedema and its prevention & an awareness of early signs and symptoms are also important roles that the physiotherapists.

Table 2: shows a detailed general physical rehabilitation and management care plan for mastectomy.


Physiotherapy Management Care Plan



Assessment – shoulder ROM, functional questionnaire, limb size

Education – post-operative presentation & Exercises, preliminary lymphedema education


Hand/elbow exercises – start immediately

Shoulder movement- if no axillary dissection has been performed, start immediately post-op & progress within discomfort to full ROM; if axillary dissection has been performed, start at surgeon’s request or when wound drainage is < 100ml/24 hours or there is a marked decrease in drainage over 24 hour period; restricted to < or equal to 100 degrees for first 2 days of movement and gradually increase ROM using a limit of a discomfort rating of 3/10

Lymphedema prevention education progress as appropriate for each patient




Review home programme and limitation of activities initially, re-measure shoulder ROM, functional questionnaire and limb size.



Progress exercises and stretches, advise on functional activity progressions, lymphedema prevention education, re-measure shoulder ROM, functional questionnaire and limb size.




Assess effects of therapy and modify or progress exercises/ stretches. Advise return to pre-operative function & activity levels.

FOLLOW-UP AT 3,6,12,18,24 MONTHS

Assess progress with measurement of shoulder ROM, functional questionnaire and limb size. Modification of exercises as appropriate.


If you have any concerns or wish to discuss the above matters in more depth, feel free to arrange a consultation with our physiotherapist.

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Very professional and caring Therapists. My left foot has been hurting for a month. After 3 sessions, 80% of the pain is gone. I just need one more session and I think I should be fine. Thank you very much.
I had an excellent sports massage by Wan Ling, which was very different from the usual massage I've tried elsewhere. Wan Ling skillfully and systematically loosened every muscle in my upper back and neck over the course of an hour. If anyone is seeking relief from tense muscles, I would highly recommend making an appointment with Wan Ling.
Came to see Xue Ting with a broken shoulder for the last 6 weeks and was impressed with her attentiveness and ability to make me feel me feel comforted in my condition . Very dedicated and good therapist indeed .
They adopt a scientific and personal approach. The therapists put in a lot of effort to diagnose the issue before attending to it. Overall, I would strongly recommend their professionalism and methods.
Really good sports massage! Booking process was efficient too :)
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Thoughtful and sincere service. Highly recommended!
My mum received her first Apos treatment. We intend to continue until her hip muscles become strong. We believe in the treatment as we saw how amazing it was. The idea was simple. Really love that she can be herself again, for long term. The hip and knee cap operations offers 15yrs. Hence we reject the cost and short-life. My wish is that the treatment cost can be lowered and more are aware of this treatment. God bless and thank you team.
Look for Soo, he is a great physiotherapist . Always communicating and always asking for my feedback. I’m on the right path to recovery all thanks to Soo. Two thumbs up.
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I have been experiencing knee pains lately especially walking up and down the stairs. The pain was so bad that I was very concern. I chanced upon CoreConcept on FB and book an appointment with them at Camden Medical Centre. My therapist was Ken Liew, he is very professional and knowledgeable. He did a thorough job to assess my condition. To my surprise I felt immediate relieved on my knee after the first session with him! Amazing! Looking forward to my next session. 😊
Hi I am Sally and I am in my late sixties. I have endured a year of thigh(joint) pains and thought that it must be due to old age. Visited Core Concepts at Novena and after only 2 sessions, my condition improved so much that I was able to climb stairs easily again. THANKS to my Physiotherapist Samuel Ong who is extremely polite, professional and knowledgeable.
I have had several sports related injuries and Core Concepts has saved me and put me "back to new" each times! The therapists are excellent - knowledgeable and professional, and the receptionists (Carol, Adiqah and Rin) are always friendly and helpful. They even give me oreo cookies for my children! :)
A very friendly and professional physiotherapist as well as receptionist within the clinic. Jordan Cave is very patient to help my right knee to recover.
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Extremely friendly staff and therapists! Folks Novena Square are just simply smiley and happy. Coming here towards the end of the work day always brings up my mood. Therapist and coach are fabulous. My condition improve so much that I can even start to train up some of my predominately unrealized problems. Highly recommended!
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I am working with Yiren on my knee after my ACL/MCL reconstruction and recovery has been good! He does a thorough job to assess my progress each session and challenges me to push myself to get to various milestones. He's extremely friendly and helpful despite my many questions. Thanks!
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The best physiotherapist ever. Cheryl is really good. Doesn't shortchange me of time and make sure I feel better before she lets me go. The front desk staff are great too. Very accomodating and friendly. Thank you Carol and Farrah. Only thing if they can give instructions to how to go to their place will be great. Usually only unit number but do give some details like mrt exits and directions to lift and such will be excellent. Coz I almost got lost in 2 different places. Overall still love core concept because of Cheryl! Thank you Cheryl!!
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Knowledgeable and brilliant!
-emails with advertisement and birthday wishes came, but they didn't think that their customer (with 4/10 sessions remaining in his package) would have expected a reminder of ANY kind if his package was already expiring. I asked the clerk from my last visit how many sessions I had remaining, and she told me 4, with no update on the expiry at all. -assumed I wanted a physiotherapy (PT) appointment when my past SMS have always been for sports massage (SM); whenever I asked for "available slots", they would give me the slots for SM. yet they suddenly gave me the list of available slots for PT ytd. I'm also to blame for not verifying and reading their long SMS carefully.-their masseuse is very good though, skilful and respectful. They ask important questions to understand their client before starting on the SM. I'd still return even though the administrative process is lacking.

You can easily request for a physiotherapy or fitness appointment through any of the 3 convenient ways below with your preferred date, time and clinic location. Our staff will be happy to help allocate you to the first available appointment slot that best fits your convenience.

via Telephone

Call our central-line at
+65 6226 3632

via SMS

SMS your name, preferred date, time and clinic location to +65 9232 2661

via Email or Online Form

Email your preferred physiotherapy appointment slot to enquiry@coreconcepts.com.sg or

Physiotherapy & Functional Wellness