Physiotherapy Advice following Breast Surgery

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1 Physiotherapy Advice following Breast Surgery Exceptional healthcare, personally delivered

2 Name of physiotherapist... Please contact the physiotherapy team if you have any concerns about the advice given in this exercise sheet or about how you are progressing. The physiotherapy team can be contacted on Why do I need to exercise? While you are healing, your shoulder on the side of the operation will not feel able to move to its full extent. If you have had surgery involving your lymph nodes you may develop a feeling of pull or a tight cord in the upper arm which can travel down your arm to your elbow, wrist or hand. This is known as cording and is thought to be related to hardening of the lymph vessels. The aim of these exercises is to achieve your normal range of movement without feelings of pull or stiffness in your arm. Do s and don ts DO use your arm as normally as possible for everyday things such as washing and eating. DO allow your arms to relax by your side as you walk DON T lift heavy objects or perform strenuous tasks after your surgery for four weeks. If you have had a Latissimus Dorsi breast reconstruction do not lift heavy objects for 6 weeks. We advise you to avoid driving for Two weeks (Right side) Three weeks (Left side) You must also be healed. It is advisable to check with your insurance company before beginning to drive again. 2 Physiotherapy Advice Following Breast Surgery

3 Special instructions ONLY if you have had a tissue expander or implant DON T exercise above shoulder height for 2 weeks from starting the exercises. The Specialist Breast Care Team will advise you if this applies to you. DON T start your exercises until at least three days after your surgery. About the exercises To do your exercises effectively, while healing, work to a feeling of pull from your operation site. This may be uncomfortable but do not push through pain. Once healed add the longer stretches described in some of the exercises. The term healed refers to you no longer having dressings and to having a small pink scar. This will be about two weeks after your surgery. Remember, the pictures tend to show a full range of movement. This is what you are aiming for and not what you will be able to do immediately. Creaming and massage Once healed, you will be advised by members of the team to cream and massage your scar lines with a non-perfumed moisturiser. It is also helpful to massage in and around your armpit and upper arm if your operation involved lymph node surgery. Take time to do this for 5 minutes twice a day. Use small circular movements with your fingers and increase the depth of the massage as much as comfort allows. You may also have some areas across the chest or upper arm that feels numb but sensitive. This is due to the disturbance of the nerves during the surgery. Creaming and massage can help to desensitise these areas. Physiotherapy Advice Following Breast Surgery 3

4 When can I stop exercising? In general it will take you around 6 weeks to steadily regain your normal movement the same as your non operated side. It is important for you to persevere until you have your normal movement and are maintaining it easily without stiffness, feelings of pull or discomfort. At this point gradually decrease the number of exercise sessions you are doing each day until you are no longer exercising. If you are having radiotherapy continue with your exercises. Physiotherapy breast surgery group The Physiotherapy team will contact you regarding an appointment to attend the breast surgery physiotherapy group. This is held approximately five weeks after your surgery in Therapies Outpatients, Level 1, Gate 24. At the group you will be reviewed by a physiotherapist who can review your progress and offer further advice and support about progressing your exercises and activities. The group generally lasts 30 minutes. 4 Physiotherapy Advice Following Breast Surgery

5 Starting the exercises Start your exercises after 2 to 3 days to allow time to recover from your surgery. n Do each exercise 10 times in a session n Do 3 sessions of exercises a day n Work slowly and steadily Once you have started your exercises do 1 to 4 for the first 3 days. Then add exercises 5 to 10 (see following pages). 1. With arms relaxed by your sides, shrug your shoulders up and then relax down. 2. Arms relaxed by your sides, circle your shoulders up, round and back. Exercise 1 3. Arms relaxed by your sides, brace shoulders back and relax. Physiotherapy Advice Following Breast Surgery 5

6 4a 4. Place your hands on your shoulders and make a circular movement with your elbow. Enlarge the circle as much as you can. Remember not to go above shoulder height. Up, round and back is best. 4b You may exercise your affected arm alone if you wish. 4c Remember not to take your elbow or hand above shoulder height for two weeks if you have had implants, tissue expanders or a reconstruction. If you have had a wide local excision with or without lymph node removal, or mastectomy without reconstruction, you can continue with exercises 5 to 10 after one week post surgery. 6 Physiotherapy Advice Following Breast Surgery

7 5. With elbow bent, lift your arm out to the side. Progress to doing this with a straight arm once you have healed. 6. Put your affected arm round behind your back and reach up as far as you can. 7a 7. Place your hands behind your neck. Stretch your elbows backwards as far as possible, and then move your elbows forward towards each other. After 4 weeks, if comfortable add a stretch on the last repetition. Try to hold the stretch for a slow count of 30 seconds. 7b Physiotherapy Advice Following Breast Surgery 7

8 8. Reach your hand across to your unaffected shoulder and down your back as far as you can. 9a 9.Clasp your hands in front of your face and reach up towards the ceiling. If you have had a tissue expander or implant only go to shoulder height for two weeks. 9b 10.Stand facing a wall, as close as possible. Walk your fingers up the wall. Walk them down again and repeat. 8 Physiotherapy Advice Following Breast Surgery

9 Once you are healed (i.e. you have no dressings), add exercises 11 and 12. This will be about 2 weeks from your surgery if you have had a wide local excision or mastectomy with or without lymph node surgery. If you have had implants, tissue expanders or a reconstruction, you can start exercises 11 and 12 from 4 weeks, if you are healed and comfortable. 11a 11. Stand with your arms down and palms facing forward. Fully straighten 11b your elbows. Raise your arms upwards and outwards above your head. Your hands should meet at the top eventually. 12. Use a towel or a scarf to stretch up and down behind you as if you were drying your back. Change hands half way through. 12a 12b Physiotherapy Advice Following Breast Surgery 9

10 How to contact us: General enquiries Physiotherapy Department Urgent calls: Out of hours and weekends post discharge, please contact the Gate you were discharged from. If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. This edition published June Review due June NBT002379