Exercises after breast reconstruction using muscle

Learn about exercises to do after breast reconstruction using muscles from your back. This type of operation is also known as breast reconstruction with a latissimus dorsi flap.

Reconstruction using the tissue from your back

In this operation, your surgeon takes the muscle called the latissimus dorsi from your back and tunnels it under the skin. They move it below your armpit to the front of your body to make a new breast shape. They may also take some skin and fat with the muscle. The surgeon uses the whole muscle. They remove it from where it attaches to your lower back, but leave it attached to your upper arm where its blood supply is. 

The latissimus dorsi muscle helps to bring your arm into your side and backwards. For example, you use it when lifting something down off a high shelf or pulling something towards you. You also use the muscle when you push down to raise your body up, for example when you push yourself out of the bath or a chair.

Other muscles can also do some of the things that the latissimus dorsi muscle does. So after this type of surgery you will still be able to move your arm normally. But you might find there are certain specific activities that you don’t have quite the same strength for on the side of the surgery. This will depend on your lifestyle and any hobbies or sports.

Why you need exercise after reconstruction surgery

The aim of exercising after reconstructive surgery is to help you get back to your normal activities and a full range of movement. It takes time to get over surgery and you are likely to feel tired at first. The exercises will help to keep you moving and stop your shoulder and back getting too stiff or tight.

You start by doing some gentle exercises and slowly build up to full movement over a number of weeks. This allows time for your body to heal. You can usually use your affected arm normally up to shoulder height for light activities from the day after your surgery. Your doctor will tell you if there is any reason why you shouldn't do this.

To avoid stretching your wounds there are some movements you shouldn't do in the first 1 to 2 weeks. Listen to your body. If you feel tired and achy you might need to slow down. Your shoulder, chest and back may feel tight and uncomfortable but it shouldn’t be too painful.

Taking part in the exercises after surgery can help if you are having radiotherapy. It can help improve your movement of your arm and shoulder. This means when you have radiotherapy you are able to get into the same position for every session.

If you do have pain, stop and contact your specialist, physiotherapist or breast care nurse.

Things not to do in the first 2 weeks

There are some things you should try to avoid doing during the first 1 to 2 weeks after surgery. Your surgeon might suggest slightly different timings so check if you are unsure.

Avoid:

• lifting your arm above the height of your shoulder 
• lifting or pushing with your arm on the side you had surgery 
• lifting anything heavier than a bag of sugar 
• pushing yourself up from bed using the arm on the side you had surgery 
• pushing doors open 
• pulling anything towards you, for example pulling washing out of the washing machine

Avoiding these things helps your muscles to heal. It means that while it all settles down you don’t over stretch your wounds or the place where the muscle is now attached.

When you are fastening your bra, do it up at the front, swivel it round, and put your arm on the side you had surgery in first. When you put your coat on, make sure you put the side you had surgery in the armhole first.

The first 2 weeks after surgery

During the first 2 weeks, maintaining a good posture and doing the exercises helps to stop your shoulder, arm and back becoming stiff. This helps you get back to normal activities. Your shoulder, arm and back may feel stiff to start with. But the stiffness will ease off as you do the exercises and start to heal.

It is good to get moving about as soon as possible – gentle walking can help to maintain your fitness, will help you to heal, and make you feel better.

Maintaining a good posture

Try to maintain a good posture while doing the exercises so that you develop a good posture all the time. This helps the muscles get stronger.

You can keep good posture by:

• imagining that you have a piece of string pulling you up tall from the ceiling 
• thinking tall and straight 
• lifting your chest up 

You will probably feel that your back is quite tight – not just across the scar, but sometimes down the whole side of your back that you had surgery. This is quite normal, but uncomfortable, and can take a while to settle down.

Returning to normal activities 

In the first 1 to 2 weeks try to move around normally. You can use your arm normally up to the height of your shoulder but don’t lift it higher.

You can brush your hair and pick up light things, like a cup of tea, with the arm on the side you had surgery.

Change position regularly to stop getting stiff.

You can have sex but don’t lift your arms above your shoulder.

Exercises for the first 2 weeks

You can start doing these exercises from the first day after your surgery.

• Shoulder shrugs – Relax your shoulders. Lift your shoulders up towards your ears slowly and gently. Then slowly relax them back down.

Start with 5 of these every hour. Gradually build up to 10 every hour over about 2 weeks.

• Shoulder rolls – Relax your shoulders. Roll your shoulders forwards and then slowly backwards. When you roll them backwards, squeeze the shoulder blades together at the back. Take a deep breath as you do each exercise.

Start with doing 5 of these every hour and gradually build up to 10 every hour. Repeat every hour for about 2 weeks.

• Shoulder raise – Place your fingertips onto your shoulders. Slowly raise the elbow up to the side, then move it clockwise (forwards), gently circling your arm. Then repeat it the other way.

Repeat the shoulder raises 5 times in each direction. Gradually build up to 10. Repeat every 2 or 3 hours.

• Arm swings – With your arm hanging down slightly in front of you or to the side, slowly draw imaginary circles and lines on the floor. This keeps the armpit area moving.

Start slowly with 5 and with small circles and short lines. Increase the size of the circles and length of the lines over the next two weeks as it feels comfortable to do so. 

From week 3 after surgery

Once the wounds on your back and chest have healed they can become tight and make it more difficult to move normally. Moisturising the scars helps to stop the tightening and makes it easier to move your arm and shoulder.

You shouldn't start to do this before the wound has healed. If you are unsure whether the wound has healed check with your surgeon or nurse before starting any massage.

So once your wound has healed you can massage:

• the area around the scars
• around your shoulder blade
• the area under your armpit

You might find that you have strange sensations and some pain where you had surgery. This is caused by the nerves in the area recovering. Massaging and gently stroking or tapping your scars can help control these feelings. If you can’t reach all of them, ask your partner or a friend to do it for you.

Exercises from about the 3rd week after surgery

You should continue with the exercises you have been doing. You can now also start the following exercises to help you get back a full range of movement in your shoulder. It is normal to feel tight across the wound on your back. This will improve as you continue with the exercises and start on the ones below.

You should do each of the following exercises 5 times to start with. Gradually build up to 10 times. Try to do them 2 or 3 times a day until you can do them sitting or standing. Then you can do them little and often, every 2 to 3 hours.

• Lifting your arm above your head – Lie on your back and hold your arm on the side you had the operation with your other hand. Gently lift your arms as far as you can above your head without increasing your pain. You may feel a pull across the breast area or into your arm. The pull is normal but if it increases your pain don’t lift it so high. Lift as far as is comfortable over the next few days. It will become easier in time and you will gradually be able to lift it higher. As you feel more comfortable you can try this exercise sitting and standing.

• Beach pose – Lie on your back. Put your fingers lightly on your ears, with your elbows in the air above your head. Slowly let your elbows fall back gradually. Gently push them further as long as you don’t increase your pain. You may feel a stretch, which is normal.

• Hand behind your head – sitting in a chair, place the hand on your surgery side onto the back of your head. Then slide your hand down towards the middle of your neck until you feel a stretch into your armpit.

• Hand behind your back – Sitting in a chair, slowly slide the arm on your surgery side behind your back so that the back of your hand touches your bottom. Slowly slide it up your back. Your aim is to slide your hand up to reach your bra strap line. If you are struggling with this, use a towel to help you. Hold one end of the towel in each hand. Use the arm on your fit side to slowly and gently help the arm on your surgery side up your back.

• Arm out to the side and up the wall – Stand up. Slowly take your arm out to the side and reach up towards the ceiling. If you are able to, use the wall to walk your arm up sideways.

Once you can do this easily, try stretching up above your head with your affected arm. Then reach over your head to touch your ear on your fit side. Hold this stretch for a count of 15 to 20.

From 4 weeks

At 4 weeks after your reconstruction surgery you should continue the exercises that you have been gradually building up. You can also start to do these exercises.

• Shoulder blade stretch forwards – Lie on your back. Lift both arms straight up, pointing towards the ceiling. Curl your shoulders round so that they lift off the floor. Try and push the ceiling away so that you feel a stretch into your shoulder blades. Then relax your shoulders and repeat. You can also do this sitting up in a chair. Curl your shoulders forwards and then stretch them back as if you are trying to touch your shoulder blades together at the back.

• Shoulder blade stretch forwards and backwards – Slowly curl your shoulders forward as if you are bringing them together at the front. Then stretch them back and imagine your shoulder blades touching at the back. Start with 5 and increase it to 10 over the next 2 weeks.

• Tree hug with deep breath – Imagine that you are hugging a tree in front of you. Clasp your hands together at the front on either side of the tree. Take a deep breath to stretch the muscles around your shoulder blades.

Activities from 4 weeks after surgery

Slowly you will be able to do more.

Between 4 and 6 weeks after surgery, begin to move your arm and shoulder more. You are aiming for almost a full range of movement. Don’t feel that you have to have a full range of movement by a particular time though. Everyone is different and how long it takes will depend on how your body heals.

Still be careful about heavy lifting with your arm on the side of the surgery. 

From 6 to 8 weeks after the operation you should be at, or almost at, full range of movement and able to do light housework. You can start to lift slightly heavier things but continue to avoid heavy weights. You can also start to increase the amount of exercise you do. For example, you can start to increase the distance you walk and increase the pace. 

If you swim, you can take this up again unless you are having treatments that make your skin sensitive, such as chemotherapy, targeted cancer drugs or radiotherapy. Try to stick to breast stroke at first. After 8 weeks you will be able to do front crawl, back stroke or the butterfly stroke (assuming you could do them before). 

You can also resume sexual activity. There are no restrictions on moving your arm.

After 12 weeks you should be able to do everything you were doing before your surgery including any sports. But do build up gradually.

Speak to your specialist physiotherapist if you are not sure about what you should or shouldn’t be doing. If you don’t have a specialist physiotherapist you can ask your specialist nurse to refer you to one.

Remember that these are guidelines. Always check with your specialist before you start doing these exercises and check that they are happy for you to do them within these timescales.

When to ask for help

If you have any of the following, contact your physiotherapist, specialist, or your breast care nurse:

• a change in colour across the breast area or scar at the back (black or red)
• the surgery area feels hot
• swelling around the breast or your scar
• severe pain
• increased difficulty moving your arm
• difficulty with the exercises either physically or due to worrying about doing them
• any unusual change in the shape of your breast
• sudden breathlessness – this could be a sign of a chest infection
• redness, pain, heat or swelling in the calf or thigh – this could be a sign of a blood clot

Fluid can build up around your breast, under your arm or in your back. This is called a seroma. It can be uncomfortable and may need draining. Contact your breast care nurse or specialist if you think you are developing a seroma. 

When your scar is healing it can stick to the tissue underneath. This can make it more difficult to move your arm and shoulder. It is important to continue with your exercises and the massage, as long as it is not irritating your wound. If you are finding it difficult to reach or massage around the scar, contact your physiotherapist and ask for some scar massage to release it.