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Exercising after Mastectomy

Andrea Branas, PT, MSE, MPT, CLT

April 23, 2014

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Question

How quickly can a client begin exercising a shoulder after a mastectomy?  Are there specific exercises to perform with the upper extremity to minimize scarring?  How often should the exercises be performed?

Answer

If you are seeing patients post-surgically, you will want to talk to the surgeon.  After a mastectomy, you also want to think about other surgical procedures the patient may be having or may have had.  Some women will have a mastectomy without concurrent surgeries; however, a lot of women are now getting reconstruction at the time of surgery or getting spacers in planning for implants.  The short answer is that you want to wait until after the drains are removed.  You want to see that the patient is starting to get healing of their tissues. 

As far as specific exercises to perform with the upper extremity to minimize scarring, there is no research on specific guidelines that you can follow.  Most surgeons have some recommendations.  What we have done is give our surgeons the exercises and general range of motion activities that we recommend.  We do not want the patients doing anything that is going to cause impingement of the shoulders.  Our surgeons, at one point, were giving out shoulder abduction, but we got rid of that and gave them a more appropriate shoulder flexion exercise.  We have found that, in general, wall walking is not a good exercise post mastectomy.  If a patient does not have good range of motion, as they walk their arm up the wall, they will just elevate their shoulder girdle and will end up with an impingement.  I would stay away from wall walking.  Sometimes sitting in a chair and doing trunk forward flexion and walking the arm forward on the table will actually give great shoulder flexion and allows the scapula to separate from the shoulder flexion movement.  


andrea branas

Andrea Branas, PT, MSE, MPT, CLT

Andrea Branas is a lead physical therapist at Good Shepherd Penn Partners in Philadelphia, PA.  Andrea works in the Abramson Cancer Center at the University of Pennsylvania Health System providing patient care, education, leadership and training in the area of cancer rehabilitation.  Andrea’s areas of clinical expertise include lymphedema, pelvic floor rehabilitation, breast cancer rehabilitation and exercise for cancer related fatigue. In her current role, Andrea uses her expertise to help cancer survivors reach their physical potential by promoting rehabilitation starting at the time of cancer diagnosis.  She is currently a collaborator on an NIH Funded Dissemination grant to look at strength training for survivors of breast cancer.   Andrea has served as a guest lecturer for women’s health and cancer content at Arcadia and Widener Universities and the University of Medicine and Dentistry in New Jersey DPT programs. Andrea received her Masters degree in Physical Therapy from the University of the Sciences in Philadelphia in 1998 and her Master’s of Science in Engineering degree from the University of Pennsylvania in 1991.  She is currently working towards her transition DPT at Arcadia University. 


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