M.Cestari, S.Amati, F.Appetecchi, L.Curti, M.De Marchi, De Rebotti, C.Tomassi
O.U. Territorial Rehabilitation Domus Gratiae Center - NHS Umbria2 - Terni, Italy

INTRODUTION
Four years ago, in the authors’ laboratory of lymphology, it was decided to focus the attention on patients without clinical evidence of oedema, at risk of developing lymphoedema in the homolateral arm after breast cancer treatment.
The authors planned a preventive protocol that highlighted the importance of primary prevention in order to avoid lymphoedema onset.

MATERIALS AND METHODS
After join lymphologist and physiotherapist assessment consisting of clinical evaluation, a centimetrical/volumetrical measurement of compared arms, a lymphoscintigraphy request, a shoulder functionality evaluation, through Constant-Murley Shoulder Score, and BMI evaluation, patients were included in five different groups after the start-up of a rehabilitative project:

-Informative Group, which includes all patients , whose end-point is the information on lymphoedema and the preventive behavioural rules.                                          -Individual Rehabilitation Treatment which includes patients with limited shoulder functionality who undergo specific treatment after physiatrician and physiotherapist assessment. After improvement the patient is included in the Physical Activity Group.
-Individual Lymphological Section which includes patients with positive lymphoscintigraphy exam (slower radiotracer flow with initial dermal back-flow) and which consists of the review of preventive behavioural rules and a prescription of standard flat sleeve for housework. After this Section the patient is included in the Physical Activity Group.
-Individual post-surgery problems treatment (breast oedema, scar with or without oedema, ecc.). After the treatment the patient is included in the Physical Activity Group.
-Physical Activity Group which includes a physiotherapist and patients without limited shoulder functionality as well as all patients from individual treatments. This Physical Activity Group consists of gymnastics, breathing exercises, ecc.; furthermore, the physiotherapist highlights the importance of physical activity, based upon the patients predisposition and problems, and patients confront their problems with physiotherapist and/or each other.
In cases of slower radiotracer flow, a follow-up of 6 months was required instead of 12 months in cases of normal lymphoscintigraphy.

RESULTS
The preventive protocol has highlighted its usefulness in order to prevent lymphedema onset (9% of patients after 3 years of follow-up) and the physical-psychological well-being achieved through the early and holistic care.

CONCLUSIONS
In the authors’ laboratory of lymphology a protocol of lymphoedema prevention after breast cancer was planned, useful, in their opinion to prevent lymphoedema onset through the compliance of the patients, who must cooperate actively, and a rehabilitative team with early and holistic approach.