Upper-limb rehabilitation and lymphedema in breast cancer survivors: A narrative review

Abstract

Introduction: Breast cancer surgery may cause pain, loss of upper-limb mobility and strength, and lymphedema, with consequences that may persist beyond the immediate postoperative period. Objective: To critically analyze physical therapy strategies for functional recovery and for the prevention, early detection, and treatment of lymphedema after breast surgery. Methods: A narrative review was conducted through searches in PubMed/MEDLINE, PEDro, the Cochrane Library, and SciELO in August and September 2026. Guidelines, systematic reviews, and clinical trials applicable to the postoperative trajectory were prioritized; 20 publications composed the synthesis. Results: Early and graded programs favored range of motion and function. However, one review found a higher short-term incidence of lymphedema with early mobilization, with low to very low certainty and substantial heterogeneity. In the available studies, progressive resistance exercise, generally supervised and monitored, did not consistently increase the onset or exacerbation of lymphedema; evidence differs between people only at risk and those with established lymphedema. Structured surveillance programs in which subclinical changes triggered compression may reduce progression in selected groups. Compression, exercise, skin care, and self-management form the treatment core, whereas the additional benefit of manual lymphatic drainage remains uncertain. Conclusion: The evidence supports early, progressive, and individualized rehabilitation in the settings studied, but uncertainty remains regarding optimal timing and composition. Surveillance should be linked to access to intervention, and management should consider risk, stage, symptoms, and function.