Exercises After Your Mastectomy With Immediate Lymphatic Reconstruction (ILR)

This information explains the exercises you’ll do after your mastectomy. Follow these instructions if you had ILR but did not have breast reconstruction.

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Deep Breathing Exercise

Deep breathing can help you relax and ease discomfort and tightness around your incision (surgical cut). It’s also a good way to relieve stress during the day.

  1. Sit comfortably in a chair.
  2. Take a slow, deep breath through your nose. Let your chest and belly expand.
  3. Breathe out slowly through your mouth.

Repeat as many times as needed.

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Arm and Shoulder Exercises

Doing arm and shoulder exercises will help you get back your full range of motion on your affected side. Your affected side is the side where you had your surgery. Your range of motion is how much you can safely move a part of your body. With full range of motion, you’ll 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

For the first 2 weeks after your surgery, don’t raise your arm higher than 90 degrees. This is called a 90-degree range of motion restriction. You can straighten your elbow, but don’t raise your arm past this height.

When to do these exercises

Start doing the first 5 exercises right away after your surgery. Two weeks after your surgery, start doing the last 3 exercises too.

Do these exercises 5 times a day until you can move your affected arm the way you did before surgery. After that, keep doing them once a day. This is especially important if you still feel tightness in your chest, shoulder, or under your affected arm. These exercises can help keep scar tissue from forming in your armpit and shoulder. Scar tissue can limit your arm movements later.

If you still have trouble moving your shoulder 4 weeks after your surgery, tell your surgeon. They’ll tell you if you need more rehabilitation, such as physical or occupational therapy.

Supplies

During the first 2 weeks after your surgery, you’ll need a stopwatch, timer, or watch with a second hand. You’ll use this to time some of the exercises.

Starting 2 weeks after your surgery, you’ll also need 4 pieces of dark tape. You’ll use these to mark your progress with some of the exercises.

Instructions

Do the exercises in the order they’re listed here.

Shoulder rolls

This is a good exercise to start with. It gently stretches your chest and shoulder muscles.

  1. Stand or sit comfortably with your arms relaxed at your sides.
  2. Start with backward shoulder rolls. In a circular motion, bring your shoulders forward, up, backward, and down (see Figure 1). Do this 10 times.
  3. Switch directions and do 10 forward shoulder rolls. Bring your shoulders backward, up, forward, and down. Do this 10 times.

Try to make the circles as big as you can and move both shoulders at the same time. If you feel tightness across your incision or chest, start with smaller circles and make them bigger as the tightness lessens. Backward shoulder rolls might feel a little tighter than forward shoulder rolls. This will get better with practice.

Figure 1. Backward shoulder rolls

Figure 1. Backward shoulder rolls

Shoulder wings

This exercise will help you get back outward movement of your shoulder. You can do it while sitting or standing.

  1. Place your hands on your chest or collarbone.
  2. Raise your elbows out to the side. Raise them as high as you can, up to shoulder level (see Figure 2).
  3. Slowly lower your elbows.
  4. Do this 10 times. Then, slowly lower your hands.

If you feel discomfort while doing this exercise, hold your position and do the deep breathing exercise. If the discomfort passes, raise your elbows a little higher. If it doesn’t pass, don’t raise your elbows any higher. Finish the exercise raising your elbows only high enough to feel a gentle stretch and no discomfort.

Figure 2. Shoulder wings

Figure 2. Shoulder wings

Arm circles

If you had surgery on both breasts, do this exercise with one arm at a time. Doing it with both arms at once will put too much pressure on your chest.

  1. Stand with your feet slightly apart for balance. Raise your affected arm out to the side.
    • For the first 2 weeks after your surgery, don’t raise your arm higher than 90 degrees (shoulder level).
    • Starting 2 weeks after your surgery, raise your arm as high as you can without feeling discomfort (see Figure 3).
  2. Start making slow backward circles in the air with your arm. Make sure you’re moving your arm from your shoulder, not your elbow. Keep your elbow straight.
  3. Make each circle larger until they’re as big as you can comfortably make them. Remember not to raise your arm higher than shoulder level during the first 2 weeks after your surgery.
  4. Do 10 full backward circles. Then, slowly lower your arm to your side. Rest your arm for a moment.
  5. Follow steps 1 to 4 again, but this time make slow forward circles.

If you feel any aching or if your arm is tired while doing this exercise, take a break. Keep going when you feel better.

Figure 3. Backward arm circles

Figure 3. Backward arm circles

W exercise

You can do this exercise while sitting or standing.

  1. Form a “W” with your arms out to the side and palms facing forward (see Figure 4). Try to bring your hands up so they’re even with your face. If you can’t raise your arms that high, bring them to the highest comfortable position.
  2. Pinch your shoulder blades together and downward, as if you’re squeezing a pencil between them. Keep squeezing them together and downward for 5 seconds.
  3. Slowly bring your arms back to the starting position.
  4. Repeat this movement 10 times. Then, slowly lower your hands.

If you feel discomfort while doing this exercise, hold your position and do the deep breathing exercise. If the discomfort passes, try to bring your arms back a little further. If it doesn’t pass, don’t reach any further. Finish the exercise squeezing your arms back enough to feel a gentle stretch and no discomfort.

Figure 4. W exercise

Figure 4. W exercise

Back climb

You can do this stretch while sitting or standing. You’ll need a timer or stopwatch.

  1. Place your hands behind your back. Hold the hand on your affected side with your other hand (see Figure 5). If you had surgery on both breasts, use the arm that moves most easily to hold the other.
  2. Slowly slide your hands up the center of your back as far as you can. If you feel tightness near your incision, stop at that position and do the deep breathing exercise. If the tightness lessens, try to slide your hands up a little further. If it doesn’t, leave your hands where they are.
  3. Hold the highest position you can for 1 minute. Use your stopwatch or timer to keep track. You should feel a gentle stretch in your shoulder area. Remember to breathe normally.
  4. After 1 minute, slowly lower your hands.
Figure 5. Back climb

Figure 5. Back climb

‌ Do not do the following 3 exercises (hands behind neck, side wall crawls, and forward wall crawls) during the first 2 weeks after your surgery. Start doing them 2 weeks after your surgery.

 

Hands behind neck

You’ll need a timer or stopwatch for this stretch.

The first few times you do this stretch, do it lying comfortably on your back on your bed. Place a pillow under your head. It may also be helpful to roll up a small or medium towel and place it under the middle of your back, along your spine. This will help open up the front of your chest.

Once you’re comfortable doing this stretch while lying on your back, you can do it while sitting or standing.

  1. Put your hands together on your lap or in front of you.
  2. Slowly raise your hands toward your head. Keep your elbows together in front of you, not out to the sides (see Figure 6). Keep your head level. Don’t bend your neck. Keep your shoulder blades together squeezed together.
  3. 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 sides.
    • If you feel tightness across your incision or chest, hold your position and do the deep breathing exercise. It’s OK to rest your hands on your head if you need to.
    • If the tightness lessens, continue with the movement. If it doesn’t, don’t move any further.
  4. Hold this position for 1 minute. Use your stopwatch or timer to keep track. Remember to breathe normally.
  5. After 1 minute, slowly bring your elbows back together. Slide your hands over your head and slowly lower your arms.
Figure 6. Hands behind neck

Figure 6. Hands behind neck

Side wall crawls

You’ll need 2 pieces of tape for this exercise.

You shouldn’t feel pain while doing this exercise. It’s normal to feel some tightness or pulling across the side of your chest. Focus on your breathing until the tightness lessens.

Be careful not to turn your body toward the wall while doing this exercise. Make sure only the side of your body faces the wall.

If you had surgery on both breasts, start with step 3.

  1. Stand with your unaffected side closest to the wall, about 1 foot (30.5 centimeters) away from the wall.
  2. Reach as high as you can with your unaffected arm. Mark that point with a piece of tape (see Figure 7). This will be the goal for your affected arm.
  3. Turn your body so your affected side is closest to the wall. If you had surgery on both breasts, start with either side closest to the wall.
  4. Crawl your fingers up the wall as far as you can. Remember to breathe normally.
  5. When you get to the point where you feel a good stretch, but not pain, do the deep breathing exercise.
  6. Return to the starting position by crawling your fingers back down the wall.
  7. Repeat steps 4 to 6 ten times.
  8. On your 10th crawl, use a piece of tape to mark the highest point you reached with your affected arm. This will let you see your progress each time you do the exercise.
  9. If you had surgery on both breasts, repeat the exercise with your other arm.
Figure 7. Side wall crawls

Figure 7. Side wall crawls

Forward wall crawls

You’ll also need 2 pieces of tape for this exercise.

  1. Stand facing a wall. Your toes should be about 6 inches (15 centimeters) from the wall.
  2. Reach as high as you can with your unaffected arm. 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.
  3. Place both hands against the wall at a level that’s comfortable. Crawl your fingers up the wall as far as you can, keeping them even with each other (see Figure 8). Try not to look up toward your hands or arch your back.
  4. When you get to the point where you feel a good stretch, but not pain, do the deep breathing exercise.
  5. Return to the starting position by crawling your fingers back down the wall.
  6. Repeat the wall crawl 10 times. Each time you raise your hands, try to crawl a little bit higher.
  7. On the 10th crawl, use the other piece of tape to mark the highest point you reached with your affected arm. This will let you to see your progress each time you do this exercise.

As you become more flexible, you may need to take a step closer to the wall. This will let you reach a little higher.

Figure 8. Forward wall crawls

Figure 8. Forward wall crawls

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Scar Massage

You may feel uncomfortable touching your skin in the area of your scar. It’s very important to get comfortable moving your skin over this area. Moving your skin will help your blood flow and soften the tissue.

Don’t start doing scar 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 massage your scar:

  1. Place 2 or 3 fingers over your scar. Gently move your skin in all directions. Don’t squeeze your breast tissue.
  2. Pick up your fingers and move them 1 or 2 inches (2.5 to 5 centimeters) in each direction around your scar. Repeat the massage.

Do this massage once a day for 5 to 10 minutes.

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Tips for Managing Swelling

After your surgery, you may have some swelling or puffiness in your hand or arm on your affected side. This is normal and usually goes away on its own.

If you notice swelling in your hand or arm, follow the tips below to help the swelling go away. Remember to stay within your range of motion restriction.

  • Raise your arm to the side a few times a day for about 20 minutes at a time. To do this, sit or lie down on your back. Rest your arm on a few pillows next to you so it’s raised above the level of your heart.
  • If you’re able to sleep on your unaffected side, you can place 1 or 2 pillows in front of you and rest your affected arm on them while you sleep.
  • Starting 2 weeks after your surgery, raise your arm above the level of your heart and do hand pumps several times a day.
    • To do hand pumps, slowly open and close your fist 10 times. This will help drain the fluid out of your arm.
    • Don’t hold your arm straight up over your head for more than a few minutes. This can cause your arm muscles to get tired.

If the swelling doesn’t go down within 4 to 6 weeks, call your surgeon or nurse.

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