Any type of surgery is going to effect the way we move and go about our days. Let's look over the different types of interventions used for breast cancer today and how each surgery can affect our movement.
Breast Conserving Surgery (BCS)
In BCS, only the part of the breast that contains the cancer is removed. Depending on where the cancer is detected, that area is removed along with surrounding tissue. BCS is done in order to try to conserve the original breast tissue. However, sometimes there is still residual cancer cells along the perimeter of tissue which may lead to a mastectomy if the surgeon is unable to remove enough tissue to get clear surgical margins. If the cancer is detected at an early stage, patients can have the option for a BCS and a mastectomy. The main advantages of BCS is that the patient can keep most of their breast tissue. This is often also accompanied by radiation following the treatment. Another common word for this would be a lumpectomy. "Lump" refers to the cancerous tissue, and "ectomy" is defined as "surgical removal of a specified part of the body." Patients are often referred to radiation following a lumpectomy.
Aftercare: Following the surgery, patients tend to leave the hospital on the same day. Gentle range of motion and deep breathing exercises (with surgeons approval) are recommended at least a day after the procedure. Examples of gentle range of motion could be putting your arms behind your head. Since the surgical site is in the chest region, it is more susceptible to losing range of motion immediately following the surgery. Putting your hands behind your head can gently stretch the chest because the chest widens when we place our hands behind us. With deep breathing exercises, we are also passively opening the chest gently as the lungs fill the chest and causes expansion. These are two examples of gentle stretching that are recommended during the early phase of healing.
Things to avoid: repetitive motions using your arm on the surgical side of your body for 2 weeks after the surgery. We want to allow the body to heal well and avoid additional loaded stress to that side of the body. Strenuous activities like biking, jogging, weightlifting, and traditional repetitive aerobic exercises should be avoided for 2-4 weeks, or whenever the doctor has removed restrictions. Walking is highly encouraged as a low impact option.
Side effects related to training
Pins and Needles feeling in armpit with removed lymph nodes can cause discomfort with certain shoulder exercises
Infections can be present, check resting heart rate for abnormal elevations regularly can be a subtle indictor if you are not feeling well.
Lymphedema can happen when lymph nodes have been damaged, or removed. It is good to incorporate small repetitive exercises with minimal resistance to promote fluid movement. Also be sure to do exercises that are non-restrictive and promote lymph drainage.
Skin tightness/adhesions can cause restrictions in range of motion. Be aware of current range of motion limitations and build from there.
Muscular weakness (check serratus anterior) that causes instability of the shoulder girdle if axillary nodes have been removed
Total/Simple Mastectomy
A mastectomy is a surgical removal of the breast and nipple. With a mastectomy, patients generally leave the hospital same day as the surgery itself. Occasionally some may stay up to 2 days. A full recovery may take up to two months.
Side effects related to training
Pins and needles feeling in armpit with removed lymph nodes
Infections
Lymphedema (from radiation and/or lymph node removal)
asymmetry of the breast muscle tissue
temporary or permanent nerve damage
muscular weakness (check serratus anterior) which can cause instability of the shoulder girdle if axillary nodes are removed
Modified Radical Mastectomy
The breast, nipple, many of the axillary lymph nodes, and the lining over the chest muscle is surgically removed. Because this is more invasive, the hospitalization time is at least 1-2 days and longer if immediate reconstruction of the breast is performed. A full recovery can take up to 2 months. Recovery exercises should include gentle range of motion and deep breathing (with surgeon's permission).
Exercise considerations
Avoid anything strenuous - biking, jogging, weightlifting, or aerobic exercise for 4-6 weeks. This also includes basic housework and activities of daily living (ADL)
Do not lift over 2 pounds for 4-6 weeks
Walking is essential to recovery! Include this as a daily activity.
Surgery will likely cause reduced shoulder blade stabilization and the ability to rotate the shoulder upward. Examples of upward rotation are overhead lifts, arm raises in front of the body, and lateral raises.
Implants following Surgery
One stage - Implant is immediately put in following surgery
Two stage - Temp implant/Expander is placed and is then inflated to slowly fill the expander over several months to allow the skin flaps to stretch.
Recovery times: 4-6 weeks with deep breathing and basic dynamic stretches like shoulder rolls, shrugs, and arm circles 1 day after surgery (with surgeon's permission)
Avoid pushing or pulling exercises while the expanders are in place that may engage the pectoral muscles
Walking is essential to recovery
3-4 weeks post surgery, patients can begin weightless shoulder range of motion exercises to assist with flexion, extension, abduction, internal and external rotation. If no expanders are currently in place and physician's clearance approved, patients will want to begin gentle chest stretches and resume light housework.
Avoid strenuous activities like biking, jogging, weightlifting, or aerobic exercise for 6-8 weeks.
Avoid lifting over 2 pounds for the first 6-8 weeks, or until cleared by physician
Latissimus Dorsi Flap (LAT) Flap
The Latissimus Dorsi from the back is moved to the front of the chest by tunneling through the arm pit section and then out the mastectomy scar in the front. The implant can be placed above or below the pectoral muscle. The skin from the back is placed in the front with all the blood vessels in tact. a LAT Flap can be used in delayed or immediate reconstruction, with tissue expanders for staged construction, with implants for immediate reconstruction, or alone as an autogenous flap.
Concerns for exercise: Most hospitalizations lasts for 4 days. Full recovery may take 4-8 weeks. For the first two weeks, exercise precautions need to be taken to avoid the following movements
Lifting the affected arm above shoulder height during abduction exercises.
Lifting or pushing with affected arm
Lifting anything heavier than 1 pound with affected arm
Pushing yourself onto a bed with the affected arm
Pushing doors with affected arm
Pulling anything with the affected arm
Because the latissimus dorsi has been moved, exercises such as lat pulldowns should be removed moving forward.
Exercise Recommendations you should follow 1 day after surgery with surgeon's permission
Begin deep breathing exercises
Simple exercises like shoulder shrugs, shoulder rolls, and arm circles
Walking is essential to a smooth recovery and should be implemented into a daily routine in the recovery period
Exercise Recommendations 3-4 weeks post surgery
weightless shoulder ROM exercises in flexion, extension, abduction, internal rotation, and external rotation
Gentle chest stretches and light housework
Avoid strenuous activities such as biking, jogging, weightlifting, or aerobic exercise for 12 weeks.
Do not lift anything over 2 pounds for 6-8 weeks
Trans Rectus Abdominis Myocutaneous (TRAM) Flap
The rectus abdominis muscles (commonly known as your abs) are pulled up and tunneled through the upper abdomen to form a breast mound on the chest. The skin is sewn into place with all the nerves and blood vessels in tact.
Concerns for exercise: Most hospitalizations lasts for 5-7 days. Full recovery may take up to a year. For the first two weeks, exercise precautions need to be taken to avoid the following movements
Lifting affected arm above shoulder height
Lifting or pushing with affected arm
Lifting anything heavier than one pounds with affected arm
Pushing yourself up from bed using affected arm
Pushing doors open with affected arm
Pulling anything with affected arm
Exercise Recommendations you should follow 1 day after surgery with surgeon's permission
Deep breathing exercises
Simple exercises like shoulder shrugs, shoulder rolls, and arm circles
Walking is essential to a smooth recovery and should be implemented into a daily routine in the recovery period.
Exercise Recommendations 3-4 weeks post surgery
weightless shoulder ROM exercises in flexion, extension, abduction, internal rotation, and external rotation
Gentle chest stretches and light housework
Avoid strenuous activities such as biking, jogging, weightlifting, or aerobic exercise for 12 weeks.
Do not lift anything over 2 pounds for 6-8 weeks
Common side effects
Difficulty standing upright
Lordotic posture due to lack of strength in the abdominal region and over compensating lower back muscles and spinal stabilizers
Because the rectus abdominals are in the front section of the core, things like "crunches" are not recommended. However, you still should work the overall core (Low back, sides, static holds)
In summary, these are the most common surgical interventions used for breast cancer and how each intervention can cause movement restrictions and things to consider. Exercise during and after breast cancer can be done if we take steps to analyze the types of treatment performed and their average recovery times. Paired with your physician's recommendations, a Cancer Exercise Specialist can help design a program that best fits your needs.
Disclaimer: The recommendations for this article are pulled directly from the Cancer Exercise Training Institute (CETI). Although they are the most current research based recommendations, they do not constitute an exercise prescription. You should speak with your doctor prior to engaging in any sort of diet or exercise program. There is no one-size-fits-all approach to exercise, but working with a Medical and/or Cancer exercise specialist and your doctor can help create a one-size-fits-you approach based on your unique situations.
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