Exercises after breast reconstruction using implants

Why you need to do exercises

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

Begin 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 or nurse will let you know if there is any reason why you shouldn't do this.

Listen to your body. If you feel tired and achy you may need to slow down. Your shoulder and chest may feel tight and uncomfortable but you should not have uncontrollable pain. If you do have pain, stop and contact your surgeon.

Things not to do in the first 2 weeks

There are some things you should try to avoid doing during the first 2 weeks after surgery.

• Don’t lift your arm above the height of your shoulder or stretch behind your back.

• Don’t lift anything heavier than a bag of sugar.

You might not realise that some everyday things can strain your muscles. Avoid doing any of the following with your arm on the side of your surgery:

• pushing yourself up off the bed

• pushing doors open

• pulling things towards you, such as pulling washing out of the washing machine

• reaching behind you

In the first few weeks after surgery there is a risk that the implant might move slightly. Avoiding these things helps to prevent this. It also allows your muscles and wound to slowly stretch and heal.

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 few weeks, maintaining a good posture and doing the exercises below helps to stop your shoulder and arm getting stiff. This helps you get back to normal activities.  Always, check with your surgeon about when you can do these exercises.

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.

Maintain a good posture

Try to maintain a good posture when you are doing the exercises below. This helps to stop you becoming round-shouldered and helps to strengthen your muscles. You can do this by:

• imagining you have a piece of string pulling you up tall from the ceiling

• thinking ‘tall and straight’

• lifting your chest up

• keeping your shoulders down and relaxed

Exercises

These exercises help to stop you developing stiffness in your arm and shoulder in the first 1 to 2 weeks. They also help get you back to moving your arm normally while giving you time to heal.

• 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 and gradually build up to 10 every hour over the first three 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. Repeat every hour over the first 3 weeks.

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

You are aiming to get your elbow level with your shoulder. You may not be able to do this at first but don’t worry. Try to increase the height each time you do the exercises until you get level with your shoulder.

Start with 5 and build up to 10 in each direction. Repeat every 2 or 3 hours over the course of the next 3 weeks.

• 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 with 5 and build up to 10 in each direction over the next 3 weeks. Repeat every 2 or 3 hours. Increase the size of the circles and length of the lines over the next two weeks size as it feels comfortable to do so.

• Body turns (rotations) – cross your arms across your body so that your hands are placed lightly on your shoulders. Slowly turn to look to the left and then to the right.

Start with 5 and build up to 10 in each direction over the course of 3 weeks. Repeat every 2 or 3 hours.

Returning to normal activities

In the first 1 to 2 weeks, you can use your arm up to shoulder height for light activities, such as face washing, hair brushing and eating. But avoid lifting your arm above the height of your shoulder. Don’t lift anything heavy, but you can use your arm to lift a cup of tea.

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.

When you are sitting, try to change position regularly. This can help to stop you stiffening up.

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

From 3 to 4 weeks after surgery

Check with your surgeon about when you can start these exercises. They might want you to follow slightly different timescales.

Continue with the exercises you have been doing. And you can now start the following exercises to help you get back to a full range of movement in your shoulder. It is normal to feel tight and bruised across your chest wall. This improves as you continue with the exercises and start on the ones below.

For the exercises below, start with doing 5 of each every 2 to 3 hours. Work up to 10 of each of them over the next two weeks. You need to start gradually and slowly so that you don’t strain your arm.

• 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. When you can do this easily, do it sitting in a chair.

• Walking your fingers up the wall – stand facing a wall and walk your fingers up it slowly. You may feel tightness, but it shouldn't be painful. If it is very painful, tell your specialist physiotherapist or breast care nurse.

If you find this exercise difficult, stand with the side you had your operation next to a worktop. Standing still, put your hand on the worktop. Then slowly walk your body backwards keeping your hand where it is.

• Walk your fingers up the wall sideways – stand with the side you had the operation next to the wall. Walk your fingers up the wall so that the palm of your hand is facing the wall.

• Beach pose – lie on your back. Put your fingers lightly on your ears, with your elbows pointing up towards the ceiling. Slowly let your elbows fall out to the side: a bit like when you are lying on a beach.

• Chest stretch – stand up, keeping your arms relaxed and straight by your side. Then slowly take your arms behind you, as if you are trying to touch your hands together at the back.

You can now start to do normal things such as housework, gradually building up the amount. You can usually start to drive, as long as you can do an emergency stop and manage the gear stick and handbrake. Always check with your insurance company before driving.

At 6 weeks

After 6 weeks you should be able to do most normal activities. Heavy lifting might still be difficult. If you are struggling to build up strength you might need some extra exercises from a specialist physiotherapist. If you don’t have a physiotherapist, you can ask to be referred to your local physiotherapy outpatient department for advice and guidance.

Keep trying to maintain and build up your general fitness levels. Keep walking and gradually increase the distance and pace gradually. The amount you are able to do will depend on your fitness levels before your surgery.

Keep doing the exercises, even when you have full movement in your shoulder. This is especially important if you have had, or are going to have radiotherapy. On some days your shoulder might feel stiffer than on others. This is quite normal and can last for between a year and 18 months. Rarely it can last for longer.

When to ask for help

You should contact your healthcare team if you have any of the following at any point:

• any redness or a change in skin colour in your breast

• heat or swelling

• severe pain

• worsening movement of your arm

• difficulty doing the exercises

• a change in the shape of the new breast

• increasing tightness across your shoulder

• shortness of breath that is not resolving

• any redness, pain, heat or swelling in the calf or thigh

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

If you have any of the signs above, you may need to reduce the number of exercises that you are doing or find a different way of doing them. If you are worried, please speak to your breast care nurse, consultant, GP or physiotherapist.

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