Post- Mastectomy Exercises

Definition

Exercises are done by patients who have undergone mastectomy or surgical removal of one or both breasts to avoid possible movement restrictions, contractures and lymph edema.

Purposes

• To increase blood circulation.
• To increase muscle strength.
• To prevent joint stiffness and contractures.
• To restore full range of motion of arms.

Importance of Post-mastectomy Exercises

Exercises after mastectomy help to:

• Regain and maintain normal movement of arms and shoulders.
• Decrease the side effects of surgery and help to get back to normal activities.
• Reduce after surgery limitations in shoulder range of motion.
• Reduce pain in chest wall, shoulders and neck.
• Return to daily activities faster such as wearing dress, bathing etc.
• Keeps muscles strong.
• Improves overall well-being.

Articles needed for Different Exercises

1. A rod or broom stick.
2. A squeeze ball.

Patient instructions

• Begin exercises like deep breathing the day after surgery as appropriate and advised by the doctor.
• Plan to take pain medications 20 to 30 minutes before starting exercises.
• Do the exercises three times a day, every day, until you have regained full range of motion in your arm(s).
• Try to do the exercises daily at the same time as far as possible, for example, before breakfast, lunch and dinner.
• Wear comfortable, loose clothing.
• Exercise after a warm shower, whenever possible, when the muscles are warm and relaxed.
• Breathe deeply and often as you do each exercise.
• Do the exercise until you feel a slight stretch and no pain?
• Do not exercise too much in the early weeks following surgery.
• If you have more pain or discomfort than before, you may be doing too much exercise.

General guidelines for exercises

Start the following exercises 3 to 7 days after surgery when your doctor says it is alright:

• Use the hand on your affected side to comb hair, bathe, get dressed and eat.
• With your arm raised, open and close your hand 15-20 times.
• Bend and straighten your elbow several times.
• Bend your elbow and touch your opposite shoulder a few times.
• Raise your arm up to shoulder height or whatever is tolerable without putting strain on your drains. Repeat 3 to 4 times.

Practice deep breathing exercise at least six times a day:

• This exercise will help maintain normal movement of chest making it easier for your lungs to work. Further exercise can be started a week or more after surgery after your doctor says it is alright.
• Wear comfortable loose clothing when doing the exercise.
• Do the exercise slowly until you feel a gentle stretch and hold each stretch till the end of the motion and slowly count to five.
• Do each exercise 5-7 times and try to do the exercise correctly.
• Do the exercise twice a day until you get back to your normal flexibility? Continuing to do some exercises during the months after surgery can help you keep good mobility of your hand.
• Be sure to take deep breaths, in and out as you do each exercise.
• The exercises are set up so that you start them lying down, move to sitting and finish them standing up.

Stage 1. Exercise

These are exercises that can be taken while the drains are still in place.

1. Pump it Up

This exercise helps reduce swelling after surgery by using the muscles as a pump to improve the circulation in the affected arm.
Steps:

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

2. Shoulder Circles/shoulder Rolls

This exercise can be done sitting or standing. This can help relieve tension in the shoulders.

• Lift both shoulders up toward your ears, keeping the chin tucked in slightly.
• Gently rotate both shoulders forward, arm slowly down and back making a circle.
• Make five slow circles in one direction, then switch and make five slow circles in the opposite direction.

3. Arm Lifts

This exercise can be done sitting or standing, it helps improve movement in shoulders.

• Clasp the hands together in front of chest. Point the elbows out.
• Slowly lift the arms upwards until you feel a gentle stretch, but no pain.
• Hold for 5-10 seconds and then slowly return to the start position.
• Repeat 5-10 times.

4. Shoulder Blade Squeeze

This exercise helps increase your shoulder blade movement. This can be done sitting (without resting the back on the chair) or standing.

• Hold the arms at the side, against body with elbows bent.
• Slowly bring the elbows straight backwards, while squeezing the shoulder blades together to feel a gentle stretch.
• Hold this position for 5-10 seconds and then slowly return to the start position.
• Relax your arm(s) and repeat 5-7 times.
• Remember to keep breathing throughout the stretch.

5. Ball Squeezing Exercise

A rubber ball or a crumpled newspaper is squeezed in the hand of the involved side.

• Hold the ball and squeeze it as hard as possible with thumb and fingers.
• Squeeze for 3 to 5 seconds and then release.
• Perform 10 repetitions before doing it with the other hand (if needed).

Stage 2 Exercises

These exercises are to be done after the drain(s) have been removed.

1. Wand Exercises (External Rotation)

This exercise helps increase your ability to move your shoulders forward.

To do this exercise, a wand (cane) is requited-try a broom handle, rod or stick.

• Lie on your back with knees bend. Hold the wand/rod in hands. The hands should be as wide apart as shoulders.
• Lift the wand over the head as far as you can until you feel a stretch. The unaffected arm can be used to lift the wand higher.
• Hold for five seconds, then gently lower arms.
• Repeat 5-10 times

2. Elbow Spread Exercise (Winging it Exercise)

This exercise helps to stretch the front of chest and shoulders. Do the exercise on a bed or floor.

• Lie on the back with the knees bend.
• With the fingers touch the ears with the elbows pointed to the ceiling.
• Move the elbows apart until a stretch is felt, but no pain.
• Hold this position for 5-10 seconds, and then slowly return to the start position.
• Remember to keep breathing throughout the stretch.

3. Wall Climbing (Wall Crawling)

This exercise help increase movements in shoulders. Try to reach a little higher on the wall each day. This exercise is done in two positions:

1. Facing the wall.

2. With the affected side to the wall (side wall stretch).

Facing the wall

• Stand facing the wall.
• Place the palm of the hand of affected arm flat on the wall.
• Slowly slide the hand up the wall as high as the patient can until she feels a
  stretch, but no pain.
• Hold for 5-10 seconds.
• Return to the start position.
• Repeat 5-10 times.

If surgery was done on both sides, repeat this exercise with the other arm.

Sidewall stretches

• Stand with your affected side to the wall.
• Place the palm of your hand flat against the wall.
• Slowly slide the hand up the wall, as high as the patient can go until she feels a stretch. Do not rotate the body toward the wall. Keep the body facing forward even if it means you cannot go up as high.
• Hold for 5-10 seconds.
• Return to start position.
• Repeat 5-10 times.

4. Side Bends

This exercise is more advanced and can be performed once a day when the patient feels ready.

• Sit on a chair and clasp both hands together in the lap.
• Slowly lift both arms above the head.
• Bend at the waist to move the body to the right. Use the right hand to gently pull the left arm a little further to the right.
• Keep sitting firmly on the chair.
• Hold this position for five seconds and then slowly return to the start position.
• Repeat this stretch to the left side using the left hand to pull the right arm further.
• Repeat 5-10 times.

5. Arm swinging Pendulum Exercise

Pendulum exercise is to prevent shoulder joint stiffness.

• Lean over with your arm supported in a table or chair.
• Relax the arm of the affected side, letting it hang straight down.
• Slowly begin to swing the relaxed arm by moving the body.
• Let gravity gently sway the arm.
• Move the arm in in circle, then reverse the direction. Next move the arm backward and forward.
• Do this exercise three times a day for 5-10 minutes.

6. Arm Circle Exercise

If you had surgery on both breasts do this exercise with both arms, one arm at a time.

• Stand with your feet slightly apart for balance. Raise your affected arm out to the side as much as you can.
• Start making slow backward circles in the air with your arm. Make sure you are moving your arm from your shoulder and not from elbow. Keep your elbow straight.
• Increase the size of circles until they are as big as you can comfortably make them. If you feel any aching or if your arm is tired, take a break. Start doing the exercise when you feel better.

7. Hands Behind Head Exercise

This exercise can be done while sitting or standing.

• Clasp your hands together on your lap if sitting, and at hip level, if standing.
• Slowly raise the hands over your head keeping the elbows together in front at the forehead level.
• Slide the hands over your head until you reach the back of head. Do not bend head and neck forward.
• When you get to this point, spread the elbows out to the sides. Hold in this position for one minute and breathe normally,
• After one minute slowly come out of the stretch by bringing the elbows together and slide your hands over the head to the front.
• Repeat the steps 4 times, making slower circles.

8. Figure “W Exercise

You can do this exercise while sitting or standing.

• Form a “W” with your arms out to the side and arms facing forwards. Try to bring your up so they are even with your face.
  Then bring them to the highest comfortable position.
• Pinch your shoulder blades together as if you are squeezing a pencil between them.
• Hold the farthest position that does not cause discomfort. Squeeze your shoulder blades together and downward for five seconds.
• Slowly bring your arms back down to the starting position. Repeat the movement 10 times.

Precautions to be Taken

• If any shortness of breath, pain or tight ness in the chest is felt, stop exercising immediately. Inform the doctor to develop a plan of movement right for the patient.
• If changes are noticed in the arm, hand, trunk or shoulder including swelling stop doing upper body exercises and inform doctor.

Special considerations

1. Proper assessment should be done before and after exercise to prevent complications.
2. Inform the treating physician for any untoward complications noted. Early detection can lessen the extent of damage that might happen.
3. It may take 6-8 weeks to regain full movement of arm (s). If difficulties in regaining full movement in arms after this time the surgeon may make a referral to physiotherapy.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
4. Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
5. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
6. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
7. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
8. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
9. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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