This information explains the exercises you’ll do after your mastectomy (breast surgery). Follow these instructions if you had a mastectomy with breast reconstruction, without reconstruction, or after delayed reconstruction.
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.
- Sit comfortably in a chair.
- Take a slow, deep breath through your nose. Let your chest and belly expand.
- Breathe out slowly through your mouth.
Repeat as many times as needed.
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.
You may need to limit your range of motion while you heal after surgery. This is called a range of motion restriction. A member of your care team will tell you your range of motion restriction, if you have one.
When to Do These Exercises
A member of your care team will tell you when it’s safe to start doing these exercises. You may be able to start doing some of them earlier than others.
Do these exercises 3 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
You may need these supplies:
- A stopwatch, timer, or watch with a second hand. You only need this if you’re doing the Back Climb exercise or Hands Behind Neck exercise.
- 4 pieces of dark tape. You only need these if you’re doing Side Wall Crawls or Forward Wall Crawls.
Instructions
Do the exercises in the order they’re listed here. Remember to follow your care team’s instructions for limiting your range of motion and when to start each exercise.
Backward Shoulder Rolls
This is a good exercise to start with. It gently stretches your chest and shoulder muscles.
- Stand or sit comfortably with your arms relaxed at your sides.
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In a circular motion, bring your shoulders forward, up, backward, and down (see Figure 1). Try to make the circle as big as you can and move both shoulders at the same time.
Figure 1. Backward shoulder rolls
- Repeat this movement 5 times. If you feel tightness across your incision or chest, start with smaller circles. Make them bigger as the tightness lessens.
When this exercise starts to feel easier, start doing the movement an extra time. Build up to repeating it 10 times.
Shoulder Wings
This exercise will help you get back outward movement of your shoulder. You can do it while sitting or standing.
- Place your hands on your chest or collarbone.
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Raise your elbows out to the side. Remember not to raise them higher than your range of motion restriction. If you do not have a range of motion restriction, raise them as high as you can, up to shoulder level (see Figure 2).
Figure 2. Shoulder wings with no range of motion restriction
- If you feel discomfort, hold your position and do the deep breathing exercise. If the discomfort passes, raise your elbows a little higher. If it does not, do not raise your elbows any higher.
- Slowly lower your elbows.
- Repeat this movement 5 times. When you’re done, slowly lower your hands.
When this exercise starts to feel easier, start doing the movement an extra time. Build up to repeating it 10 times.
Backward 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.
- Stand with your feet slightly apart for balance. Raise your affected arm out to the side (see Figure 3). Remember not to raise it higher than your range of motion restriction. If you do not have a range of motion restriction, raise it as high as you can without feeling discomfort.
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Make a slow backward circle in the air with your arm. Make sure you’re moving your arm from your shoulder, not your elbow. Keep your elbow straight.
Figure 3. Backward arm circles with no range of motion restriction
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Repeat this movement 5 times. Make each circle larger until they’re as big as you can comfortably make them. Remember not to raise your arm higher than your range of motion restriction, if you have one.
- If you feel any aching or if your arm gets tired, take a break. Keep going when you feel better.
- When you’re done, slowly lower your arm to your side.
When this exercise starts to feel easier, start doing the movement an extra time. Build up to repeating it 10 times.
Forward Arm Circles
Follow the same instructions as for backward arm circles but make slow forward circles.
Be sure to rest your arm for a moment between doing backward and forward arm circles.
W Exercise
You can do this exercise while sitting or standing.
- 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 cannot raise your arms that high, bring them to the highest comfortable position. Remember not to raise your arms higher than your range of motion restriction, if you have one.
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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.
Figure 4. W exercise with no range of motion restriction
- If you feel discomfort, hold your position and do the deep breathing exercise. If the discomfort passes, try to bring your arms back a little further. If it does not, do not reach any further.
- Slowly bring your arms back to the starting position.
- Repeat this movement 5 times. When you’re done, slowly lower your hands.
When this exercise starts to feel easier, start doing the movement an extra time. Build up to repeating it 10 times.
Back Climb
You can do this stretch while sitting or standing. You’ll need a timer or stopwatch.
Figure 5. Back climb
- 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.
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Slowly slide your hands up the center of your back as far as you can. You should feel a gentle stretch in your shoulder area. Remember to breathe normally.
- 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 does not, leave your hands where they are.
- Hold this position for 30 seconds. Use a stopwatch or timer to keep track. After 30 seconds, slowly lower your hands.
When this exercise starts to feel easier, start holding the position for a little longer. Build up to holding it for 60 seconds (1 minute).
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.
- Put your hands together on your lap or in front of you.
- 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. Do not bend your neck. Keep your shoulder blades squeezed together.
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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.
Figure 6. Hands behind neck
- 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 does not, do not move any further.
- Hold the highest position you can for 30 seconds. Use a stopwatch or timer to keep track. Remember to breathe normally. After 30 seconds, slowly bring your elbows back together, slide your hands over your head, and lower your arms.
When this exercise starts to feel easier, start holding the position for a little longer. Build up to holding it for 60 seconds (1 minute).
Side Wall Crawls
You’ll need 2 pieces of tape for this exercise.
You should not 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.
Figure 7. Side wall crawls
- Stand with your unaffected side closest to the wall, about 1 foot (30.5 centimeters) away from the wall.
- 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.
- 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.
- Crawl your fingers up the wall as far as you can. Remember to breathe normally.
- 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 movement 5 times.
- On your last 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.
- If you had surgery on both breasts, repeat the exercise with your other arm.
When this exercise starts to feel easier, start doing the movement an extra time. Build up to repeating it 10 times.
Forward Wall Crawls
You’ll also need 2 pieces of tape for this exercise.
- Stand facing a wall. Your toes should be about 6 inches (15 centimeters) from the wall.
- 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.
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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.
Figure 8. Forward wall crawls
- 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 movement 5 times. Each time you raise your hands, try to crawl a little bit higher.
- On the last 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.
When this exercise starts to feel easier, start doing the movement an extra time. Build up to repeating it 10 times.
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:
- Place 2 or 3 fingers over your scar. Gently move your skin in all directions. Don’t squeeze your breast tissue.
- 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.
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, if you have one.
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Raise your arm above the level of your heart and do hand pumps several times a day. Only do this if it’s within your range of motion restriction.
- 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.
- 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.
If the swelling doesn’t go down within 4 to 6 weeks, call your surgeon or nurse.
