Exercise after mastectomy and breast reconstruction: a guide

Both physical activity and rest are important after mastectomy or breast reconstruction surgery. Your body is recovering from a serious procedure that takes time, patience and the right exercise program tailored to your specific needs in order to heal and feel better.

Performing specific exercises after mastectomy or breast reconstruction can help maintain range of motion in your shoulder and arm, relieve stiffness and pain, and reduce swelling.

Even something as simple as combing or brushing your hair or reaching behind your back to touch under your shoulder blades is considered critical post-surgery exercise.

The important thing is to gradually resume exercise to avoid overloading the system. Here we review exercise considerations, physical activity during the first week, cardio exercise, and strength training after mastectomy or breast reconstruction surgery.

Exercising after a mastectomy or breast reconstruction often depends on restrictions put in place by the surgeon, says Diana Garrett, DPT, OCS, CLT, CSCS at Saint John’s Cancer Institute.

“Some surgeons prefer only light activity after surgery for two to three weeks, so getting your doctor’s clearance on what you can and cannot do is critical,” she says.

Physical activity also depends on the type of surgery and your general state of health. In general, it’s best to avoid vigorous exercise and heavy lifting so your wounds have a chance to heal, says Constance M. Chen, MD, board-certified plastic surgeon and breast reconstruction specialist.

“In a healthy person, it takes six to eight weeks for complete healing to occur,” says Dr. Chen.

Overall, the American Cancer Society recommends starting slow and only progressing when you’re ready (1). They also suggest working with a cancer exercise specialist or physical therapist to make sure you’re doing the exercises correctly.

During the first week after mastectomy (with or without breast reconstruction), Dr. Chen says it’s important to walk so you can move your muscles and get your lungs and legs working again. However, you should avoid vigorous and repetitive movements that prevent healing.

Because breast surgery is linked to shoulder and scapula dysfunction, Garrett says it’s critical to regain full mobility after surgery. Some of the best exercises Garrett does with his patients the week after mastectomy or reconstruction are:

  • Ddiaphragmatic breathing (ventral breathing): You can practice this several times a day while sitting or lying down. Start by breathing deeply while expanding your chest and stomach. Relax and then breathe. Do this about four to six times, several times a day.
  • Spinching of the scapula: In a seated position, place your arms at your sides with your elbows bent. Squeeze your shoulder blades together to bring your elbows behind you. Hold the position for a few seconds, then return to the starting position. Repeat five times.
  • Raises assisted by the arms: Use the uninvolved arm to lift the surgical side arm above the head until a stretch is felt. You can do this several times a day.
  • Elbow opener or elbow wing: You can do this lying on the floor or in bed. Place your hands behind your head. Your elbows will point towards the ceiling. Spread your elbows and lower yourself to the floor. Do this five to seven times.

In addition to the above movements, the American Cancer Society recommends lying down and raising the surgical side arm above heart level for 45 minutes to help relieve swelling. Try to do this two to three times a day. You can also open and close your hand 15 to 20 times and bend and straighten your elbow to help relieve swelling (1).

Gentle stretches, arm circles, seated side bends, and shoulder rolls are other exercises you can do within a week of surgery.

All exercises should be painless. Garrett says you should feel a stretch, but if there’s pain, don’t go that far in the stretch. Try to do these exercises every day.

Because of the scarring of the sutures, Garrett says you’ll likely delay cardiovascular exercise until cleared by the surgeon.

According to Chen, if you are healthy and healing well, you should be able to resume cardio exercises two months after surgery. However, you should consult your surgeon to make sure it is suitable for your specific situation.

Walking is a great activity to incorporate for the first few months until your doctor clears you to move on to more vigorous cardiovascular exercise.

Cardio exercise guidelines for breast reconstruction are similar to mastectomy. That said, since there is more than one type of breast reconstruction surgery, the exercises you perform will depend on the type of surgery you had. Your surgeon will give you recommendations based on your procedure.

The American Cancer Society recommends adding strength training to your routine about four to six weeks after surgery (1). You can perform exercises with a small set of weights or resistance bands.

Once cleared by your doctor to add strength training exercises to your routine, you’ll want to aim for two days a week, as recommended by the American Cancer Society and the American College of Sports Medicine.

Many times after surgery, Garrett says the pectoral muscles tend to be shortened and tight. While stretching the chest muscles helps, she says it’s also beneficial to strengthen the back muscles and the area between the shoulder blades.

“Strengthening these muscles will help improve overall posture and upper body strength,” says Garrett. She recommends using an assortment of resistance bands and dumbbell exercises to target specific muscles such as the rhomboids, latissimus, lower and middle trapezius, and rotator cuff muscles.

Additionally, Garrett suggests incorporating core reinforcement to improve overall postural control.

Strength exercise guidelines for breast reconstruction are similar to those for mastectomy. However, as mentioned earlier, there is more than one type of breast reconstruction surgery and the exercises you perform will depend on the type. Your surgeon will give you recommendations based on your procedure.

When performing exercises in the weeks following mastectomy and breast reconstruction surgery, you should only do what is comfortable for you. It may take some trial and error to determine your pain threshold, but when in doubt, stop if you feel any discomfort.

It’s normal to feel some tightness in your chest and armpits, but the American Cancer Society says this should decrease the more you exercise (1).

Also try to exercise when your body is warm, like after a shower, and be sure to wear loose, comfortable clothes.

If you are exercising alone and you experience any of the following symptoms, stop what you are doing and contact your doctor (1).

  • worsening pain
  • feel like you’re weakening
  • loss of balance or fall
  • having a new feeling of heaviness or pain in your arm
  • unusual swelling that gets worse, or headache, dizziness, tingling, or blurred vision

Exercising after breast surgery is a crucial step in recovery. Be sure to go slowly and only do movements that feel comfortable to you.

Your doctor should provide you with a treatment plan that includes specific exercises to perform immediately and for the first few weeks after surgery.

If possible, ask about working with a trained physiotherapist in post-surgery rehabilitation. They can help you with the exercises, make sure you’re doing the moves correctly, and design a long-term fitness routine that supports your recovery. Soon, you’ll be well on your way to regaining strength and cardiovascular health.

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