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Exercises After Breast Surgery

This information describes how to perform arm and shoulder exercises, a breathing exercise, and scar massage after your breast surgery.

Ask your surgeon when it's safe for you to start doing these exercises.

If you had breast surgery without reconstruction, you may do the exercises in this booklet on the first day after your surgery, as long as your surgeon tells you it's safe.

A video demonstrating how to perform exercises after breast surgery without reconstruction can be found on MSK's website at: www.mskcc.org/videos/exercises-after-breast-surgery-without-reconstruction.

If you had breast surgery with reconstruction, talk with a member of your plastic surgery team about when it’s safe to do each of these exercises. A member of your plastic surgery team will also tell you how much you need to limit your range of motion after your surgery: 45, 60, or 90 degrees. You may find it helpful to write in your restriction below the illustration of the exercises.

Videos demonstrating how to perform exercises after breast surgery with reconstruction can be found on MSK's website.

If you've had reconstruction using a tissue expander, visit: www.mskcc.org/videos/exercises-after-breast-surgery-reconstruction-using-tissue-expander.

If you've had reconstruction using tissue transfer, visit: www.mskcc.org/videos/exercises-after-breast-surgery-reconstruction-using-tissue-transfer.

Deep Breathing Exercise

Exaggerated deep breathing can help you relax and ease discomfort and tightness around your incision. This is also a very good technique to relieve tension during the day.

To perform this technique, sit comfortably in a chair and take a slow, deep breath through your nose. Let your chest and belly expand. Now, exhale slowly through your mouth. You can repeat this several times.

Arm and Shoulder Exercises

Performing arm and shoulder exercises will help you regain full range of motion on the side where you had your surgery, which is called the affected side. With full range of motion, you will be able to:

  • Move your arm over your head and out to the side

  • Move your arm behind your neck

  • Move your arm to the middle of your back

Do 10 repetitions of each exercise below 5 times a day until you have regained full range of motion and can use your arm as you did before surgery in all of your normal activities. This includes activities at work, at home, and in recreation or sports. If you had limited movement in your arm before surgery, your goal will be to regain as much movement as you had before.

If you quickly regain full range of motion, continue doing these exercises once a day. This is especially true if you feel any tightness in your chest, shoulder, or under your affected arm. These exercises can help prevent scar tissue from forming in your armpit and shoulder. Scar tissue can limit your arm movements later.

If you continue to have difficulty moving your shoulder 4 weeks after your surgery, tell your surgeon. He or she will determine if you need further rehabilitation, such as physical or occupational therapy.

Before you begin, gather the following supplies:

  • 4 pieces of tape (to mark your progress on a wall)

  • A stopwatch, timer, or watch with a second hand (you will need to hold some of the exercises for a full minute)

Shoulder rolls

The shoulder roll is a good beginning exercise, since it provides a gentle stretch to the chest and shoulder muscles. If your surgeon says it's safe, you can start doing this exercise on the first day after your surgery.

  • Stand or sit comfortably with your arms relaxed at your sides (see Figure 1).

  • In a circular motion, bring your shoulders forward, up, backward, and down. Try to make the circle as large as you can and get both of your shoulders to move at the same time.

  • If you have some tightness across your incision or chest, begin with smaller circles, but increase the size as the tightness lessens. You may find that this direction is a little tighter across your chest than the forward direction, which you'll perform next. This will get better with practice.

  • Now, switch directions and do 10 shoulder rolls in the forward direction. Bring your shoulders backward, up, forward, and down.

Shoulder wings

If you had breast surgery with reconstruction, the shoulder wings exercise (see Figure 2) will help you regain outward movement of your shoulder. You can perform this exercise while sitting or standing.

  • Place your hands on your chest or collarbone.

  • Raise your elbows out to the side.

  • Slowly lower your elbows.

  • After 10 repetitions, slowly lower your hands back down to your lap.

 

If you experience discomfort while performing this exercise, hold your position and do the deep breathing exercise. If the discomfort doesn't go away, do not raise your elbows any higher.

Arm circles

If you had surgery on both breasts, do this exercise with both arms, one arm at a time. Do not do this exercise with both arms at the same time. This will put too much pressure on your chest. If your surgeon says it's safe, you can start doing this exercise on the first day after your surgery.

  • Stand with your feet slightly apart for balance. Raise your affected arm out to the side as high as you can (see Figure 3). Begin making slow, backward circles in the air with your arm. Be sure the movement is occurring at your shoulder and not at your elbow. Keep your elbow straight.

  • Increase the size of the circles until they are as large as you can comfortably make them. Be sure to complete at least 10 full backward circles. If you feel any aching or if your arm is tired, take a break. Continue doing the exercise when you feel better.

  • Slowly lower your arm to your side. Rest your arm for a moment.

  • To perform the second part of the exercise, raise your affected arm out to the side as high as you can. Begin making slow, forward circles.

  • Increase the size of the circles until they are as large as you can comfortably make them. Be sure to complete at least 10 full forward circles. If you feel any aching or if your arm is tired, stop before 10 circles.

  • Lower your arm to your side.

W exercise

The W exercise can be done standing, sitting, or lying on your back. Doing this exercise with your back against the wall may help you position yourself properly. If your surgeon says it's safe, you can start doing this exercise on the first day after your surgery.

  • Form a “W” with your arms out to the side and palms facing forward (see Figure 4). Try to bring your hands up so that they are even with your face. If you can't raise your arms that high, bring them to the highest comfortable position.

  • Pinch your shoulder blades together and downward, as if you are squeezing a pencil between your shoulder blades.

  • If you feel discomfort in the area near your incision, stop at that position and do the deep breathing exercise. If the discomfort passes, try to bring your arms back a little further. If the discomfort does not pass, do not reach any further. Hold the furthest position you can and squeeze your shoulder blades together for 5 seconds.

  • Slowly bring your arms back down to the starting position. Repeat this exercise 10 times

Back climb

The back climb can be performed in a sitting or standing position. You can start doing this exercise on the first day after your surgery. If you had breast surgery without reconstruction, or if you had breast surgery with reconstruction using a tissue expander, you can start doing this exercise on the first day after your surgery as long as your surgeon tells you it's safe. If you had a different type of reconstructive surgery, ask a member of your plastic surgery team when it's safe to do this exercise.

  • Place your hands behind your back and grasp the hand on your affected side with your other hand (see Figure 5). If you had surgery on both breasts, use whichever arm moves most easily to assist the other. Perform this stretch for one arm at a time only; do not perform the stretch with both arms at the same time.

  • Slowly slide your hands up the center of your back as far as possible. Hold the highest position for 1 minute.

  • If you feel pulling or stretching near your incision, stop at that position and do the deep breathing exercise. If the tightness goes away, try to slide your hands up a little further. If it's still there, do not slide your hands up any further.

  • Hold the highest position you can for 1 minute. You should feel a gentle stretch in your shoulder area.

  • After 1 minute, slowly lower your hands.

Hands behind neck

The hands behind neck exercise may be performed in a sitting or standing position. If you had breast surgery without reconstruction, you can start doing this exercise on the first day after your surgery, as long as your surgeon tells you it's safe. If you had breast surgery with reconstruction, ask a member of your plastic surgery team when it's safe to do this exercise.

  • Stand or sit comfortably with your feet on the floor. Clasp your hands together on your lap. Slowly raise your hands toward your head, keeping your elbows together in front of you and not out to the sides (see Figure 6). Keep your head level; do not bend your neck or head forward.

  • Slide your hands over your head until you reach the back of your neck. When you get to this point, spread your elbows out to the side. Hold this position for 1 minute. If you are not able to get into this position, reach up and stretch your elbows back as best you can.

  • If you have some tightness across your incision or chest, hold your position and do the deep breathing exercise. If the tightness decreases, continue with the movement. If the tightness stays the same, hold the position you are most comfortable in for 1 minute.

  • Breathe normally. Do not hold your breath as you stretch your body.

  • Slowly come out of the stretch by bringing your elbows back in front of you and sliding your hands over your head. Then, slowly lower your arms to your lap.

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Forward wall crawls

You will need 2 pieces of tape for the forward wall crawl exercise. If you had breast surgery without reconstruction, you can start doing this exercise on the first day after your surgery as long as your surgeon tells you it's safe. If you had breast surgery with reconstruction, ask a member of your plastic surgery team when it's safe to do this exercise. Stand facing a wall. Your toes should be about 6 inches from the wall (see Figure 7).

  • Reach as high as you can with your unaffected arm and mark that point with a piece of tape. This will be the goal for your affected arm. If you had surgery on both breasts, set your goal using the arm that moves most comfortably.

  • Place both hands against the wall at a level that's comfortable. Crawl your fingers up the wall as far as possible, keeping them even with each other. Try not to look up toward your hands or arch your back.

  • When you get to the point where you feel a good stretch, but not pain, do the deep breathing exercise.

  • Return to the starting position by crawling your fingers back down the wall.

  • Repeat the wall crawl 10 times. Each time you raise your hands, try to crawl a little bit higher.

  • On the tenth crawl, use the other piece of tape to mark the highest point you reached with your affected arm. This will allow you to see your progress each time you do this exercise.

As you become more flexible while doing this exercise, it may be necessary to take a step closer to the wall so that you can reach a little higher.

Side wall crawls

You will also need 2 pieces of tape for the side wall crawl exercise. If you had breast surgery without reconstruction, you can start doing side wall crawls on the first day after your surgery as long as your surgeon tells you it's safe. If you had breast surgery with reconstruction, ask a member of your plastic surgery team when it's safe to do this exercise. Stand with your unaffected side facing the wall, about a foot away from the wall (see Figure 8).

 

  • Reach as high as you can with your unaffected arm and mark that point with a piece of tape. As with the forward wall crawl, this will be the goal for your affected arm. If you've had surgery on both breasts, set your goal using the arm that moves most comfortably.

  • Turn your body so that your affected side is now facing the wall. Crawl your fingers up the wall as far as possible. When you get to the point where you feel a good stretch, but not pain, do the deep breathing exercise. Return to the starting position by crawling your fingers back down the wall.

  • Repeat this exercise 10 times.

  • On your tenth crawl, use the other piece of tape to mark the highest point you reached with your affected arm. This will allow you to see your progress each time you do the exercise.

You should not feel pain while doing this exercise. It is normal to feel some tightness or pulling across the side of your chest. Focus on your breathing until the tightness decreases. You should breathe normally throughout this exercise. Do not hold your breath.

Also, be careful not to turn your body toward the wall while doing this exercise. Keep your body at a 90-degree angle to the wall.

Scar Massage

Many women feel uncomfortable touching their skin in the area of their scar. It is very important that you become comfortable moving the skin over this area. Moving the skin will help improve the circulation and soften the tissue.

Do not start doing the massage until your incision has fully healed and your nurse tells you it's safe. There should be no open wounds or scabbed areas. The area of the scar may be numb or extra sensitive at first. Both of these feelings are normal after surgery.

To do the massage, place 2 or 3 fingers over the scar and gently move the skin in all directions. Pick up your fingers and move them an inch or two over, and then repeat the massage. Do not squeeze your breast tissue. Do this massage once a day for 5 to 10 minutes.

Swelling

After your surgery, you may have some swelling or puffiness in your hand or arm on your affected side. This is normal and will usually go away on its own. If you notice swelling in your hand or arm, raise your arm above your head several times a day while doing hand pumps. The elevation and pumping action of the muscles help drain the fluid out of your arm. To do hand pumps, slowly open and close your fist 10 times.

You may also elevate your arm a few times a day for about 20 minutes at a time. To elevate your arm while sitting or while lying on your back, rest your arm on a few pillows next to you. Your arm should be raised above the level of your heart. Do not hold your arm over your head for more than a few minutes. This can cause the muscles of the arm to get tired.

If you are able to sleep on the opposite side of where you had your surgery, you may place 1 or 2 pillows in front of you and rest your arm on them. If the swelling does not go down within 4 to 6 weeks, call your doctor or nurse.

If you have any questions about the exercises or any other information presented here, please call the Rehabilitation Service at (212) 639-7833.