Post -Mastectomy Exercise

 Mastectomy Definition:

    Surgery to remove part or all of the breast. There are different types of mastectomy that differ in the amount of tissue and lymph nodes removed.

Types of Mastectomy:

Simple (or total) mastectomy :For a simple mastectomy (also called a total mastectomy), the surgeon removes: all of the breast tissue the skin of the breast the nipple and the areola (the dark area around the nipple) Usually the surgeon will also perform a sentinel lymph node dissection, which means that 1-3 lymph nodes under the arm on the side of the tumor will be removed to check whether the cancer has spread there. The sentinel lymph nodes are the first lymph nodes to which that the cancer might spread.

A procedure called lymphatic mapping is done either the day before, the morning of, or during the surgery to help the surgeon locate the sentinel nodes. This involves injecting a radioactive liquid, a blue dye, or both, underneath the nipple or near the tumor site.

Modified radical mastectomy: 

       For a modified radical mastectomy, the surgeon removes:  

• all of the breast tissue
•  the skin of the breast 
•  the nipple and the areola 

         The surgeon will also perform an axillary lymph node dissection, which means that more than a few lymph nodes (usually about 10) under the arm on the side of the tumor will be removed to check whether cancer has spread there.

Nipple-sparing mastectomy:

      During a nipple-sparing mastectomy, all of the breast tissue is removed, but the nipple, areola, and the skin of the breast is left intact. Lymph nodes are usually removed as well to see if the cancer has spread beyond the breast (unless the mastectomy is prophylactic). Either a sentinel lymph node dissection or an axillary lymph node dissection will be done depending on your specific diagnosis. Also, some tissue from beneath the nipple and areola is removed to check for cancer cells there. If cancer is found in that location, the nipple and usually the areola will need to be removed. This is usually done later on, in a separate procedure. Another reason the nipple may need to be removed in a separate procedure is if it does not have a good enough blood supply and develops necrosis (tissue breakdown).

Skin-sparing mastectomy:

       During a skin-sparing mastectomy, the surgeon removes all the breast tissue, the nipple, and in some cases the areola, but most of the skin over the breast is left intact.

Radical mastectomy:    A radical mastectomy is the most extensive type of mastectomy. For a radical mastectomy, the surgeon removes:  

• all of the breast tissue 
•  the skin of the breast
•  the nipple and the areola
•  the chest wall muscles under the breast
•  some of the lymph nodes under the arm

POST MASTECTOMY EXERCISE:

Raise your arms up to shoulder height, or whatever height you can without pulling on your drains, and lower them again a few times

PURPOSES OF MASTECTOMY EXERCISE

INSTRUCTIONS BEFORE EXERCISE 

GENERAL GUIDELINES DURING EXERCISE 

POST MASTECTOMY EXERCISES:

    

Stage 1: Exercises to do while you still have your drain(s) in place

1. Pump It Up

This exercise helps reduce swelling after surgery by using your muscles as a pump to improve the circulation in your affected arm (on the same side as your surgery).

    

PUMP IT UP

1. Lie on your unaffected side with your affected arm straight out, resting on top of a pillow.
2. Slowly bend your elbow while making a fist at the same time.
3. Next, slowly straighten your elbow while opening your fist at the same time.
4. Repeat this pumping motion 15 to 25 times.

If you had surgery on both sides of your chest, repeat the exercise lying on the opposite side of your body.

2.Shoulder Circles:

This exercise can be done sitting or standing. It’s a good warm-up exercise and can help relieve tension in your shoulders.

SHOULDER CIRCLES

1. Lift both shoulders up toward your ears. Keep your chin tucked in slightly.
2. Gently rotate both shoulders forward, and then slowly down and back, making a circle.
3. Make 5 slow circles in one direction, then switch and make 5 slow circles in the opposite direction.

3.Arm Lifts:

This exercise can be done sitting or standing. It helps improve movement in your shoulders.

ARM LIFT

1. Clasp your hands together in front of your chest. Point your elbows out.
2. Slowly lift your arms upwards until you feel a gentle stretch, but no pain.
3. Hold for 5 to 10 seconds (or 5 deep breaths) and then slowly return to the start position.
4. Repeat 5 to 10 times.

4.Shoulder Blade Squeeze:

This exercise can be done sitting (without resting your back on the chair) or standing. It helps to stretch your chest muscles.

           SHOULDER BLADE SQUEEZE 

1. Hold your arms at your side against your body with your elbows bent.
2. Slowly bring your elbows straight backwards, while squeezing your shoulder blades together to feel a gentle stretch.
3. Hold this position for 5 to 10 seconds (or 5 deep breaths) and then slowly return to the start position.
4. Repeat 5 to 10 times.

Stage 2: Exercises to do after your drain(s) have been removed

You no longer need to do the previous exercises.

1. Wand Exercise

You will need a “wand” to do this exercise – try a broom handle, stick or cane.

Wand Exercise 

1. Lie on your back with your knees bent. Hold the wand with both hands. Your hands should be as wide apart as your shoulders.
2. Lift the wand over your head as far as you can until you feel a gentle stretch, but no pain. Your unaffected arm will help lift the wand higher.
3. Hold for 20 to 30 seconds, and remember to breathe. If you find this stretch is too painful, lower your arms slightly, but continue to hold. Then, gently lower arms to the start position.
4. Repeat 5 to 10 times.
5. To progress, repeat this exercise with your hands slightly wider apart than your hips or shoulders.

2. Wall Climbing

This exercise helps increase movement in your shoulder. Try to reach a little higher on the wall each day. This exercise is done in 2 positions – 

        A) facing the wall 

        B) with your affected side to the wall.

Facing the wall

a. Facing the wall

1. Stand facing the wall.
2. Place the palm of your hand (of your affected arm) flat against the wall.
3. Slowly slide your hand up the wall as high as you can go until you feel a stretch, but no pain. Make sure the movement is only coming from your shoulder and you are not bending at your back to get higher up the wall.
4. Hold for 20 to 30 seconds and remember to breathe. If you find the stretch is too painful, lower your arm slightly, but continue to hold.
5. Slowly slide your hand down the wall to the start position.
6. Do a couple of shoulder rolls to reset, then repeat 3 to 5 times.

If you had surgery on both sides of your chest, repeat this exercise with your other arm.

b. Side wall stretch

1. Stand with your affected side to the wall.
2. Place the palm of your hand flat against the wall at shoulder height.
3. Slowly slide your hand up the wall as high as you can go until you feel a stretch but no pain. Do not rotate your body toward the wall, even if it means you can’t go up as high.
4. Hold for 20 to 30 seconds and remember to breathe. If you find the stretch too painful, lower your arm slightly, but continue to hold.
5. Slowly slide hand down the wall to return to the start position.
6. Do a couple of shoulder rolls to reset, then repeat 3 to 5 times.

3. Corner Wall Stretch

This exercise is more advanced, so be sure to start with a small hip rotation and perform slowly.

1. Stand with your affected arm against the corner of a wall (door frame works as well) with your armpit in the corner and side of your hips pressed against the wall.
2. Make goal post arms (picture 1) with affected arm while keeping armpit and hips glued in the same position against the wall.
3. Take small steps to turn hips away from the wall (picture 2) until you feel a stretch in any areas of tightness while keeping armpit glued to corner of wall (or as close as possible).
4. Hold stretch for 20 to 30 seconds and remember to breathe. If you find the stretch is too painful, back off a little by rotating hips back towards the wall until it feels comfortable, then continue to hold.
5. To come out of stretch, take small steps to return to start position. Then, slide hand down the wall.
6. Do a couple shoulder rolls to reset, then repeat 3 to 5 times.

Remember, it may take 6 to 8 weeks to regain full movement of your arm(s). If you continue to have difficulties regaining full movement in your arm(s) and shoulder(s) after this time, please ask your surgeon for a referral to physiotherapy and occupational therapy for follow up.

If you receive radiation treatment after surgery, it is important to continue with wall climbing exercises and the corner wall stretch throughout radiation. It is recommended to do a set of these exercises before and after radiation each day to maintain your shoulder movement and to prevent side effects such as radiation-induced fibrosis (RIF) which can make your arm movement difficult again.