The implemented protocol (self-management interventions) includes several parts. First part was informing in which patients were informed face-face about the development and risk factors of lymphedema before and after surgery (first and second day). Educational themes: symptoms and signs of lymphedema, development mechanisms and risk factors of lymphedema, evaluation of lymphedema, prevention of possible infections, skin care, protecting the arm and the breast from traumas, having ideal weight, and exercising. Second part include lymphedema evaluation, in which measuring for the upper extremity circumference was done in the hospital using the metric measuring tape. The measurement was taken at four locations; specifically, metacarpophalangeal joints, at the wrist, 10 cm above and below the elbow joint. Third part was exercising program in which the patients during the first 24 hours after surgery were instructed to perform hand squeezing exercises with a medium-level stress ball four times a day, squeezing 15 times each. The researcher estimated the appropriate amount of exercise and start time for the patient based on their physical state and general health all over the post-operative period. Patients were instructed to perform active and passive arm exercises three to six times per day at start, gradually increasing to ten, shifting from passive to active within 30-60 minutes. Patients were instructed to warm up before exercising to prevent muscular damage and divide activities into 10-15-minutes sessions in case of pain. Fourth part was about simple lymphatic drainage where during patient massage, the researcher showed and taught deep diaphragmatic breathing exercises, neck drainage, afflicted side axillary drainage, and upper extremity drainage. Before the massage began, the patients practiced breathing exercises. To activate the lymphatic system, breathing exercises were initially done 3 times a day for 3 minutes, then increased to 3 times a day for 5 minutes in the months following.
