研究背景: 隨著乳腺癌患者存活率的不斷上升及其存活時間的不斷延長，癌病倖存已成為一個重要的慢性疾病管理問題。之前在該領域的研究主要集中於生活質量的測量。然而，癌病倖存研究應該超出這一範疇而更好地去瞭解乳腺癌倖存者的真實體驗。癌病倖存是一個新興而複雜的概念，它包含了動態的、多維的以及社會文化的觀點。但是，衛生專業人員受限於現有的知識未能為中國大陸乳腺癌患者的長期倖存做好準備。 / 研究目的: 本研究目的是從中國大陸女性的視角詳盡闡述乳腺癌倖存者的親身體驗。具體研究目標包括：1）乳腺癌倖存者的生活質量；2）與乳腺癌倖存者生活質量相關的因素；3）乳腺癌患者的倖存體驗；4）社會人口學及臨床學特徵對於乳腺癌倖存體驗的影響；5）建立一種與文化相關的概念模型用以解釋中國婦女乳腺癌患者的倖存體驗。 / 研究方法: 本研究採用混合研究方法，分兩個階段進行。先是定量法（第一階段），其次是定性法（第二階段）。第一階段是對乳腺癌倖存者其生活質量及相關因素進行橫斷性調查。測量工具包括生活質量-癌症倖存者量表及社會支持問卷簡表。該階段的調查結果將指導第二階段的目的性抽樣並建立半結構式訪談計劃。第二階段是對選定倖存者進行深入訪談以探究她們的癌症倖存體驗。採用內容分析法對訪談數據的潛在及顯性內容進行分析。然後對不同定義組中的定性數據進行比較，探索社會人口學及臨床學特徵對乳腺癌倖存體驗的影響。最後對定量和定性數據進行對比和比較，以確定並探討癌病倖存體驗的組成元素和模型開發。 / 研究結果：在完成第一階段的100位倖存者中，平均年齡為53.75 歲 (SD=7.27)，治療完成後存活時間的中位數為44 個月 (四分位範圍=23-61)。總體生活質量平均值為6.55，範圍3.68 - 8.89。在身體分量表中顯示生活質量最高值，而在靈性分量表找到其最小值。多元回歸分析表明，存活期的長短、對社會支持的滿意度以及家庭年收入與生活質量均顯著相關。 / 29位倖存者完成了第二階段的研究。結果顯示用於描述倖存經驗的七個範疇，包括：體驗令人痛苦的症狀；與不確定性進行抗爭；在女性特質及性行為上的改變；忍受社會壓力；被關照和支持；反思和個人成長；生存並向前發展。定性數據的比較顯示，對於存活時間低於5年，或者家庭年收入較低，亦或感知的生活質量較低的女性，她們傾向於報告負面的倖存經驗。通過提取定量和定性階段上主要的研究結果建立一個概念模型，用以解釋中國女性是如何理解乳腺癌倖存經驗的。它表明，乳腺癌倖存經驗在本質上是多維的。治療完成後，乳腺癌患者在生活變化上會有消極與積極的雙重性，會對生活質量評估產生影響。此外，乳腺癌倖存經驗也不是一成不變的。它是一個動態的應對過程，具有幾種策略以應對癌症導致的生活變化。 / 研究結果：本研究對中國文化背景下乳腺癌倖存經驗提供了證據。本研究全面而深入的瞭解乳腺癌患者倖存經驗，並為進一步發展測量工具以及具備文化敏感性的心理干預提供了基礎，以解決中國女性的倖存經驗的問題。 / Background: With the increasing survival rate and length of survival in breast cancer, cancer survivorship has become an important chronic illness management issue. Previous studies in this area mainly focus on appraisal of quality of life (QOL). However, cancer survivorship studies should go beyond QOL to better understand breast cancer survivor’s experience of living with the disease. Cancer survivorship appears as an emerging but complex concept incorporating dynamic, multidimensional, and socio-cultural perspectives. Little information exists addressing breast cancer survivorship experience in mainland China that impedes health professionals’ ability to deliver quality of cancer care. / Aim: To develop an understanding of breast cancer survivorship experience from the perspective of mainland Chinese women. Specific objectives included exploring 1) women’s perceived QOL; 2) factors associated with women’s QOL; 3) women’s perception of breast cancer survivorship experience; 4) the influence of socio-demographic and clinical characteristics on the women’s perception of their survivorship experience after breast cancer; and 5) to develop a culturally relevant conceptual model to explain Chinese women’s breast cancer survivorship experience. / Methods: A mixed methods study with two phases was conducted, quantitative approach (Phase One) followed by qualitative approach (Phase Two). Phase One was a cross-sectional survey on Chinese breast cancer survivors to investigate their QOL and its associating factors. Instruments included Quality of Life -- Cancer Survivor Scale and six-item Social Support Questionnaire. Findings in this phase contributed to inform the purposive sampling and develop a semi-structured interview schedule for Phase Two. In-depth interviews on selected survivors were conducted to explore their perceptions of cancer survivorship experience. Content analysis was used to analyze both latent and manifest meaning of interview data. Comparisons of qualitative data across defined groups were made to explore the influence of socio-demographic and clinical characteristics on breast cancer survivorship experience. Quantitative and qualitative data were compared and contrasted to identify and explore elements in cancer survivorship experience and model development. / Results: Among 100 survivors who completed Phase One, the mean age was 53.75 years (SD=7.27), and the median length of survivorship since completion of treatment was 44 months (IQR=23-61). The mean overall QOL was 6.55, with a range of 3.68 -8.89. The highest QOL was found in the physical subscale, and the lowest in the spiritual subscale. Multivariate regression analysis identified that length of survivorship, satisfaction with social support, annual household income were significantly associated with QOL. / Twenty-nine survivors completed Phase Two. Seven categories emerged describing the survivorship experience included experiencing distressful symptoms; struggling with uncertainty; alterations in femininity and sexuality; living with social stress; being cared for and supported; reflections and personal growth; and surviving and moving forward. Comparisons of qualitative data revealed that women with less than five years of survivorship, or low annual household income, or low perceived QOL tended to report negative survivorship experience. A conceptual model was developed by drawing the key findings of quantitative and qualitative phases to explain how Chinese women perceive the breast cancer survivorship experience. It reveals that breast cancer survivorship experience is multidimensional in nature, with a duality for the negative and positive aspects of life changes after completion of treatment, contributing to influence appraisal of QOL. Furthermore, breast cancer survivorship experience is not static but a dynamic coping process with several strategies for dealing with life changes that result from cancer. / Conclusions: The study provides evidence of several components of breast cancer survivorship within Chinese cultural context. This offers a comprehensive and insightful understanding of the experience after surviving breast cancer, and a basis for further inquiry for developing an instrument and culturally sensitive psychosocial intervention to address Chinese women’s survivorship experience. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Cheng, Huilin. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 252-283). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes inchludes Chinese. / Chapter CHAPTER ONE --- INTRODUCTION --- p.1 / Background of the study --- p.2 / Breast cancer incidence --- p.2 / Breast cancer diagnosis and treatments --- p.3 / Breast cancer survival --- p.5 / Cancer survivorship --- p.7 / Overview of cancer survivorship --- p.7 / Breast cancer survivorship research --- p.10 / Rationale for the study --- p.12 / Purpose of the study --- p.13 / Organization of the thesis --- p.13 / Chapter CHAPTER TWO --- LITERATURE REVIEW --- p.15 / Literature search --- p.15 / Search strategy --- p.15 / Selection criteria --- p.16 / Definition of cancer survivor --- p.17 / Concept of cancer survivorship --- p.18 / Concept of quality of life (QOL) --- p.22 / Definitions --- p.22 / Measurements --- p.25 / Generic instrument --- p.26 / Cancer-specific instrument --- p.26 / Cancer survivor-specific instrument --- p.27 / Distinctions between cancer survivorship and QOL --- p.29 / Quantitative studies on breast cancer survivorship --- p.30 / Overall QOL and QOL across different domains of breast cancer survivors --- p.30 / Overall QOL --- p.30 / Physical effect --- p.31 / Psychological effect --- p.34 / Social effect --- p.36 / Spiritual effect --- p.37 / Factors affecting the QOL of breast cancer survivors --- p.40 / Socio-demographic factors --- p.41 / Clinical factors --- p.42 / Social support --- p.47 / Ethnicity --- p.49 / Methodological critique of quantitative studies --- p.52 / Qualitative studies on breast cancer survivorship --- p.54 / Multidimensional nature of breast cancer survivorship --- p.54 / Dynamic nature of breast cancer survivorship --- p.57 / Influence of ethnicity on breast cancer survivorship --- p.60 / Methodological critique of qualitative studies --- p.62 / Mixed methods study on breast cancer survivorship --- p.63 / Summary --- p.65 / Chapter CHAPTER THREE --- METHODOLOGY --- p.67 / Study aim and objectives --- p.67 / Definitions of terms --- p.68 / An overview of mixed methods research --- p.69 / Philosophical foundation of mixed methods research --- p.71 / Research design: Sequential explanatory mixed methods --- p.72 / Overview of the selected design --- p.72 / Justification for the selected design --- p.74 / Integration of data from Phases One and Two --- p.76 / Study setting --- p.78 / Description of the Phase One study method --- p.79 / Sampling --- p.80 / Sample size --- p.80 / Sampling criteria --- p.80 / Instruments --- p.81 / Socio-demographic and clinical characteristics --- p.81 / Perceived social support --- p.81 / QOL --- p.82 / Sexual QOL --- p.85 / Willingness to participate in Phase Two --- p.86 / Data collection procedures --- p.86 / Quantitative data analysis --- p.87 / Descriptive analysis --- p.87 / Regression analysis --- p.88 / Description of the Phase Two study method --- p.88 / Sample and sampling --- p.89 / Sampling and selection criteria --- p.89 / Sample size --- p.90 / Data collection method --- p.91 / Semi-structured face-to-face interview --- p.91 / Interview schedule --- p.92 / Data collection procedure --- p.93 / Qualitative data analysis --- p.94 / Content analysis --- p.94 / Comparative analysis in qualitative research --- p.97 / Ensuring rigor of qualitative inquiry --- p.99 / Justification for using validity and reliability --- p.99 / Strategies for achieving validity --- p.100 / Strategies for achieving reliability --- p.101 / Ethical considerations --- p.101 / Pilot study --- p.102 / Pilot study of Phase One --- p.102 / Pilot study of Phase Two --- p.104 / Chapter CHAPTER FOUR --- FINDINGS FOR PHASE ONE --- p.106 / Characteristics of participants --- p.106 / Socio-demographic characteristics --- p.106 / Clinical characteristics --- p.108 / Perceived social support --- p.110 / QOL --- p.111 / Physical domain --- p.112 / Psychological domain --- p.113 / Social domain --- p.114 / Spiritual domain --- p.115 / Sexual domain --- p.116 / Factors associated with QOL --- p.117 / Differences in overall QOL and QOL domains by socio-demographic and clinical characteristics, as well as perceived social support --- p.118 / Factors associated with overall QOL and different QOL domains --- p.126 / Participants’ willingness to participate in Phase Two of the study --- p.129 / Contribution of Phase One findings to the development of Phase Two --- p.132 / Selection criteria for purposive sampling --- p.132 / Development of interview schedule --- p.134 / Summary --- p.135 / Chapter CHAPTER FIVE --- FINDINGS FOR PHASE TWO --- p.137 / Characteristics of participants --- p.137 / Categories identified from content analysis --- p.140 / Experiencing distressful symptoms --- p.142 / Memory and concentration problems --- p.142 / Lymphedema --- p.142 / Fatigue --- p.143 / Struggling with uncertainty --- p.144 / Fear of recurrence --- p.144 / Fatalism --- p.145 / Unpredictability of illness --- p.146 / Alterations in femininity and sexuality --- p.147 / Poor body image --- p.147 / Changes in sexual activity --- p.149 / Living with social stress --- p.150 / Being stigmatized --- p.150 / Financial burden --- p.151 / Being cared for and supported --- p.152 / Family members and close friends --- p.153 / Cancer self-help group --- p.154 / Workplace --- p.155 / Health professionals --- p.155 / Reflections and personal growth --- p.156 / Re-prioritizing life perspectives --- p.156 / Change in personal character --- p.157 / Gaining inner strength --- p.158 / Surviving and moving forward --- p.159 / Performing self-care --- p.159 / Attitude towards having cancer --- p.160 / Hope for the future --- p.162 / Sense of normalcy --- p.163 / Comparison of categories and subcategories by selected characteristics --- p.164 / Comparison of categories between participants with high- and low-perceived QOL --- p.164 / Comparison of categories between participants with high- and low-annual household income --- p.167 / Comparison of categories between participants with short- and long- term survivorship --- p.169 / Summary --- p.170 / Chapter CHAPTER SIX --- DISCUSSION --- p.171 / Purpose of integration --- p.171 / Convergent findings --- p.172 / Complementary findings --- p.173 / Socio-demographic background of the participants --- p.174 / Clinical characteristics of the participants --- p.176 / Women's perception of QOL --- p.178 / Women's perceived levels of overall QOL and specific domains --- p.178 / Overall QOL --- p.178 / QOL in the physical domain --- p.179 / QOL in the psychological domain --- p.180 / QOL in the social domain --- p.181 / QOL in the spiritual domain --- p.182 / QOL in the sexual domain --- p.183 / Factors associated with women’s perceived levels of QOL --- p.184 / Socio-demographic factors influencing women’s perceived QOL --- p.184 / Clinical characteristics influencing women’s perceived QOL --- p.185 / Women's perception of social support and QOL --- p.186 / Social network and support --- p.186 / Social network and QOL --- p.188 / Satisfaction with social support and QOL --- p.189 / Women's perception of the breast cancer survivorship experience --- p.190 / Symptom distress --- p.191 / Uncertainty --- p.192 / Body image --- p.194 / Sexuality --- p.196 / Cancer-related stigma --- p.197 / Financial burden --- p.198 / Meaning in life --- p.200 / Self-identity --- p.202 / Fatalism --- p.203 / Attitude towards having cancer --- p.205 / Self-care/self-management --- p.206 / Hope --- p.207 / Summary --- p.208 / Chapter CHAPTER SEVEN --- A CONCEPTUAL MODEL TO EXPLAIN CHINESE WOMEN’S BREAST CANCER SURVIVORSHP EXPEREINCE --- p.210 / Overview of the proposed conceptual model --- p.210 / Content of the conceptual model --- p.211 / Function of the conceptual model --- p.212 / Perceived negative life change --- p.218 / Symptom distress --- p.218 / Uncertainty --- p.219 / Concern about body image --- p.220 / Cancer-related stigma --- p.222 / Financial burden --- p.223 / Perceived positive life change --- p.224 / Meaning in life --- p.224 / Positive self-identity --- p.225 / Social support --- p.226 / Co-existence of perceived negative and positive life changes --- p.228 / Perceived quality of life --- p.228 / Coping --- p.229 / Fatalistic voluntarism --- p.230 / Maintaining hope --- p.231 / Positive attitude --- p.232 / Performing self-care/self-management --- p.233 / Comparison between previous theory and the present model --- p.234 / Summary --- p.238 / Chapter CHAPTER EIGHT --- CONCLUSION --- p.239 / Limitations --- p.239 / Implications for nursing practice --- p.243 / Recommendations for future research --- p.248 / Conclusion --- p.251 / REFERENCE --- p.252 / APPENDIX --- p.284

INTRODUÇÃO: A mastectomia é um procedimento que pode gerar diversas repercussões tanto físicas quanto emocionais. Atualmente há uma tendência para que a reconstrução da mama seja realizada o quanto antes com o objetivo de amenizar o impacto psicológico da doença. Na literatura são escassos os estudos sobre os efeitos da mastectomia e da reconstrução mamária na postura. Ainda na literatura é possível observar que não há um consenso sobre a qualidade de vida, imagem corporal e autoestima em mulheres submetidas à mastectomia com e sem reconstrução da mama. OBJETIVO: Avaliar a postura, qualidade de vida, imagem corporal e autoestima em mulheres com mastectomia sem reconstrução e com reconstrução imediata da mama. METODOLOGIA: Participaram do estudo 76 mulheres com idade entre 35 e 70 anos diagnosticadas com câncer de mama e submetidas à mastectomia, sendo divididas em dois grupos: sem reconstrução da mama (MSR; n=38) e com reconstrução mamária imediata com retalho abdominal (M+RI; n=38). Para a avaliação da postura foram localizados e demarcados pontos anatômicos específicos para a obtenção de fotografias em vista anterior, posterior, lateral direita e esquerda. As fotografias foram analisadas pelo Software para Avaliação Postural (SAPO). Na avaliação da qualidade de vida foi utilizado o questionário Short- Form Health Survey; na imagem corporal o Questionário de Imagem Corporal após o Câncer de Mama e a autoestima foi avaliada pela Escala de Autoestima de Rosenberg. O nível de significância estabelecido foi de alfa= 0,05. RESULTADOS: Na avaliação postural o grupo MSR apresentou maior ângulo no alinhamento vertical do tronco, na vista lateral esquerda (4,2 vs. 3,1; p=0.05). Para as demais variáveis do alinhamento postural as diferenças não foram significativas. O grupo MSR apresentou na avaliação da qualidade de vida menor capacidade funcional (66,3 vs. 76,4; p=0,01). Na avaliação da imagem corporal e autoestima não foram encontradas diferenças estatisticamente significativas. CONCLUSÃO: As mulheres com mastectomia sem reconstrução mamária apresentam na vista lateral esquerda o ombro posicionado mais posteriormente em relação ao trocânter maior do fêmur, apontando para uma rotação de tronco e apresentam menor capacidade funcional na avaliação da qualidade de vida. Ter ou não realizado a reconstrução imediata da mama não comprometeu a imagem corporal e autoestima / INTRODUCTION: Mastectomy is a procedure that can generate diverse physical and emotional repercussions. Currently, there is a tendency to perform breast reconstruction as soon as possible in order to mitigate the psychological impact of the disease. There are few studies in the literature on the effects of mastectomy and breast reconstruction on body posture. However, it has been observed that there is no consensus regarding the quality of life, body image, and self-esteem of women undergoing mastectomy, with or without breast reconstruction. OBJECTIVE: The aim of this study was to evaluate posture, quality of life, body image, and self-esteem in women with mastectomy without reconstruction and with immediate breast reconstruction. METHODS: The study included 76 women, 35-70 years of age, who were diagnosed with breast cancer and underwent mastectomy. The women were divided into two groups: without breast reconstruction (MSR, n=38) and with immediate breast reconstruction with an abdominal flap (M+IR, n=38). To assess body posture, specific anatomical points for obtaining photographs were located and marked in anterior, posterior, and right and left side views. The photographs were analyzed using Postural Assessment Software (PAS/SAPO). The Short-Form Health Survey was used to assess quality of life, body image was assessed with the Questionnaire Body Image after Breast Cancer, and self-esteem was assessed with the Rosenberg Self-Esteem Scale. The significance level was set at alfa=0.05. RESULTS: A higher angle of vertical alignment of the trunk in the left lateral view was observed in the MSR postural assessment group (4.2 vs 3.1; p=0.05). Differences in the other postural alignment variables were not significant. Lower functional capacity in the quality of life assessment was also observed in the MSR group (66.3 vs. 76.4; p=0.01). No statistically significant differences were found in the body image and self-esteem assessments. CONCLUSION: In the left side view, women with mastectomy without breast reconstruction presented with the shoulder positioned more posteriorly in relation to the greater trochanter, indicating trunk rotation. In addition, they exhibited lower functional capacity in quality of life. Body image and self-esteem were not affected by whether or not breast reconstruction was performed

INTRODUÇÃO: O tratamento do câncer de mama está associado à morbidade do membro superior, com complicações que têm um impacto significante na qualidade de vida das pacientes. O OBJETIVO deste trabalho foi traçar um protocolo de tratamento fisioterapêutico para prevenir as morbidades após cirurgia de câncer de mama. CASUÍSTICA E MÉTODOS: Este estudo avaliou 132 mulheres com a intervenção da fisioterapia em dois momentos: no primeiro pós-operatório (PO) e entre o 10º - 15º dia do PO. Reavaliações foram feitas nos meses 1, 2, 3, 4, 5, 6 e após um ano do PO. RESULTADOS: O grupo de intervenção precoce mostrou uma recuperação mais rápida da amplitude de movimentos e apresentou menor morbidade em relação ao grupo tardio. CONCLUSÃO: O protocolo fisioterapêutico preconizado, tanto precoce quanto tardio, é eficaz. A recuperação da função do membro superior e o menor índice de morbidades mostram que a fisioterapia deve sempre ser instituída nas pacientes que se submetem à cirurgia de câncer de mama. / INTRODUCTION: The breast cancer treatment is always linked with the morbidity of the upper limb with complications that will have an enormous impact in the quality of life of the patients submitted to breast cancer treatment. Objective : the objective of this study was to develop a physiotherapy protocol in order to prevent morbidities after breast cancer treatment METHODS: This study evaluated 132 patients submitted to physiotherapy sessions in two different moments: 1 st day post surgery and at the 10-15 th day . Follow-ups were made on months 1, 2, 3, 4, 5, 6 and after a year. RESULTS: The earlier group showed a faster recovery of arm range of motion and had less arm morbidity. CONCLUSÃO: O RESULTS: G1 showed a faster flexion and abduction ROM recovery and had less morbidity as compared to the other group. The arm circumferences in the early intervention group had lower values as compared to the late intervention group. CONCLUSION: The physiotherapy protocol used in the study showed its efficacy. The upper arm ROM was recovered and both groups had less arm morbidity.

INTRODUÇÃO: A mastectomia é um procedimento que pode gerar diversas repercussões tanto físicas quanto emocionais. Atualmente há uma tendência para que a reconstrução da mama seja realizada o quanto antes com o objetivo de amenizar o impacto psicológico da doença. Na literatura são escassos os estudos sobre os efeitos da mastectomia e da reconstrução mamária na postura. Ainda na literatura é possível observar que não há um consenso sobre a qualidade de vida, imagem corporal e autoestima em mulheres submetidas à mastectomia com e sem reconstrução da mama. OBJETIVO: Avaliar a postura, qualidade de vida, imagem corporal e autoestima em mulheres com mastectomia sem reconstrução e com reconstrução imediata da mama. METODOLOGIA: Participaram do estudo 76 mulheres com idade entre 35 e 70 anos diagnosticadas com câncer de mama e submetidas à mastectomia, sendo divididas em dois grupos: sem reconstrução da mama (MSR; n=38) e com reconstrução mamária imediata com retalho abdominal (M+RI; n=38). Para a avaliação da postura foram localizados e demarcados pontos anatômicos específicos para a obtenção de fotografias em vista anterior, posterior, lateral direita e esquerda. As fotografias foram analisadas pelo Software para Avaliação Postural (SAPO). Na avaliação da qualidade de vida foi utilizado o questionário Short- Form Health Survey; na imagem corporal o Questionário de Imagem Corporal após o Câncer de Mama e a autoestima foi avaliada pela Escala de Autoestima de Rosenberg. O nível de significância estabelecido foi de alfa= 0,05. RESULTADOS: Na avaliação postural o grupo MSR apresentou maior ângulo no alinhamento vertical do tronco, na vista lateral esquerda (4,2 vs. 3,1; p=0.05). Para as demais variáveis do alinhamento postural as diferenças não foram significativas. O grupo MSR apresentou na avaliação da qualidade de vida menor capacidade funcional (66,3 vs. 76,4; p=0,01). Na avaliação da imagem corporal e autoestima não foram encontradas diferenças estatisticamente significativas. CONCLUSÃO: As mulheres com mastectomia sem reconstrução mamária apresentam na vista lateral esquerda o ombro posicionado mais posteriormente em relação ao trocânter maior do fêmur, apontando para uma rotação de tronco e apresentam menor capacidade funcional na avaliação da qualidade de vida. Ter ou não realizado a reconstrução imediata da mama não comprometeu a imagem corporal e autoestima / INTRODUCTION: Mastectomy is a procedure that can generate diverse physical and emotional repercussions. Currently, there is a tendency to perform breast reconstruction as soon as possible in order to mitigate the psychological impact of the disease. There are few studies in the literature on the effects of mastectomy and breast reconstruction on body posture. However, it has been observed that there is no consensus regarding the quality of life, body image, and self-esteem of women undergoing mastectomy, with or without breast reconstruction. OBJECTIVE: The aim of this study was to evaluate posture, quality of life, body image, and self-esteem in women with mastectomy without reconstruction and with immediate breast reconstruction. METHODS: The study included 76 women, 35-70 years of age, who were diagnosed with breast cancer and underwent mastectomy. The women were divided into two groups: without breast reconstruction (MSR, n=38) and with immediate breast reconstruction with an abdominal flap (M+IR, n=38). To assess body posture, specific anatomical points for obtaining photographs were located and marked in anterior, posterior, and right and left side views. The photographs were analyzed using Postural Assessment Software (PAS/SAPO). The Short-Form Health Survey was used to assess quality of life, body image was assessed with the Questionnaire Body Image after Breast Cancer, and self-esteem was assessed with the Rosenberg Self-Esteem Scale. The significance level was set at alfa=0.05. RESULTS: A higher angle of vertical alignment of the trunk in the left lateral view was observed in the MSR postural assessment group (4.2 vs 3.1; p=0.05). Differences in the other postural alignment variables were not significant. Lower functional capacity in the quality of life assessment was also observed in the MSR group (66.3 vs. 76.4; p=0.01). No statistically significant differences were found in the body image and self-esteem assessments. CONCLUSION: In the left side view, women with mastectomy without breast reconstruction presented with the shoulder positioned more posteriorly in relation to the greater trochanter, indicating trunk rotation. In addition, they exhibited lower functional capacity in quality of life. Body image and self-esteem were not affected by whether or not breast reconstruction was performed

INTRODUÇÃO: O tratamento do câncer de mama está associado à morbidade do membro superior, com complicações que têm um impacto significante na qualidade de vida das pacientes. O OBJETIVO deste trabalho foi traçar um protocolo de tratamento fisioterapêutico para prevenir as morbidades após cirurgia de câncer de mama. CASUÍSTICA E MÉTODOS: Este estudo avaliou 132 mulheres com a intervenção da fisioterapia em dois momentos: no primeiro pós-operatório (PO) e entre o 10º - 15º dia do PO. Reavaliações foram feitas nos meses 1, 2, 3, 4, 5, 6 e após um ano do PO. RESULTADOS: O grupo de intervenção precoce mostrou uma recuperação mais rápida da amplitude de movimentos e apresentou menor morbidade em relação ao grupo tardio. CONCLUSÃO: O protocolo fisioterapêutico preconizado, tanto precoce quanto tardio, é eficaz. A recuperação da função do membro superior e o menor índice de morbidades mostram que a fisioterapia deve sempre ser instituída nas pacientes que se submetem à cirurgia de câncer de mama. / INTRODUCTION: The breast cancer treatment is always linked with the morbidity of the upper limb with complications that will have an enormous impact in the quality of life of the patients submitted to breast cancer treatment. Objective : the objective of this study was to develop a physiotherapy protocol in order to prevent morbidities after breast cancer treatment METHODS: This study evaluated 132 patients submitted to physiotherapy sessions in two different moments: 1 st day post surgery and at the 10-15 th day . Follow-ups were made on months 1, 2, 3, 4, 5, 6 and after a year. RESULTS: The earlier group showed a faster recovery of arm range of motion and had less arm morbidity. CONCLUSÃO: O RESULTS: G1 showed a faster flexion and abduction ROM recovery and had less morbidity as compared to the other group. The arm circumferences in the early intervention group had lower values as compared to the late intervention group. CONCLUSION: The physiotherapy protocol used in the study showed its efficacy. The upper arm ROM was recovered and both groups had less arm morbidity.