Breast surgery can affect your arm

Women with breast cancer may have many different kinds of treatments. Many women with breast cancer have some kind of surgery. You may have had a:

• breast biopsy
• lymph node biopsy or removal
• breast conservation surgery (lumpectomy)
• mastectomy
• breast reconstruction

Any of these can affect how well you can move your shoulder and arm, take a deep breath, or do your daily activities, like dressing, bathing, and combing your hair.

Exercises can help

No matter what type of surgery you had, it is important to do exercises afterwards. Exercises help to decrease any side effects of your surgery and make you able to go back to your normal daily activities.

If you have radiation therapy, exercises are important to help keep your arm and shoulder flexible. Radiation therapy may affect your arm and shoulder for up to 6 to 9 months after it is finished.

It is very important to talk with your doctor before starting any exercises so that you can decide on a program that is right for you. Your doctor may suggest that you talk with a physical therapist or occupational therapist. This therapist has special training to help design an exercise program just for you. You may need this kind of help if you do not have full use of your arm within 3 to 4 weeks of surgery.

Some exercises should not be done until drains and sutures (stitches) are removed. But some exercises can be done soon after surgery. The exercises that increase shoulder and arm motion can usually be started in a few days. The exercises to help make your arm stronger are added later.

We will review some of the more common exercises that women do after breast surgery. Talk to your doctor or therapist about which of these are right for you and when you should start doing them. Do not start any of these exercises without talking to your doctor first.

The week after surgery

These tips and exercises listed below should be done for the first 3 to 7 days after surgery. Do not do them until you get the OK from your doctor.

• Use your affected arm (on the side where your surgery was) as you normally would when you comb your hair, bathe, get dressed, and eat.

• Lie down and raise your affected arm above the level of your heart for 45 minutes. Do this 2 or 3 times a day. Put your arm on pillows so that your hand is higher than your wrist and your elbow is a little higher than your shoulder. This will help decrease the swelling that may happen after surgery.

• Exercise your affected arm while it is raised above the level of your heart by opening and closing your hand 15 to 25 times. Next, bend and straighten your elbow. Repeat this 3 to 4 times a day. This exercise helps reduce swelling by pumping lymph fluid out of your arm.

• Practice deep breathing exercises (using your diaphragm) at least 6 times a day. Lie down on your back and take a slow, deep breath. Breathe in as much air as you can while trying to expand your chest and abdomen (push your belly button away from your spine). Relax and breathe out. Repeat this 4 or 5 times. This exercise will help maintain normal movement of your chest, making it easier for your lungs to work. Do deep breathing exercises often.

• Do not sleep on your affected arm or lie on that side.

Getting started -- general guidelines

The exercises described here can be done as soon as your doctor says it's OK. Be sure to talk to your doctor before trying any of them. Here are some things to keep in mind after breast surgery:

• You will feel some tightness in your chest and armpit after surgery. This is normal and the tightness will decrease as you do your exercises.

• Many women have burning, tingling, numbness, or soreness on the back of the arm and/or chest wall. This is because the surgery can irritate some of your nerves. These feelings may increase a few weeks after surgery. But keep doing your exercises unless you notice unusual swelling or tenderness. (If this happens, let your doctor know about it right away.) Sometimes rubbing or stroking the area with your hand or a soft cloth can help make the area less sensitive.

• It may be helpful to do exercises after a warm shower when muscles are warm and relaxed.

• Wear comfortable, loose clothing when doing the exercises.

• Do the exercises until you feel a slow stretch. Hold each stretch at the end of the motion and slowly count to 5. It is normal to feel some pulling as you stretch the skin and muscles that have been shortened because of the surgery. Do not bounce or make any jerky movements when doing any of the exercises. You should not feel pain as you do the exercises, only gentle stretching.

• Do each exercise 5 to 7 times. Try to do each exercise correctly. If you have trouble with the exercises, talk to your doctor. You may need to be referred to a physical or occupational therapist.

• Do the exercises twice a day until you get back your normal flexibility and strength.

• 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.

Exercises to do while lying down

These exercises should be done on a bed or the floor. Lie down on your back with your knees and hips bent and your feet flat.

Wand exercise (Figure 1)

	Figure 1

This exercise helps increase the forward motion of your shoulders. You will need a broom handle, yardstick, or other stick-like object to use as the wand in this exercise.

• Hold the wand in both hands with your palms facing up.

• Lift the wand up over your head as far as you can. Use your unaffected arm to help lift the wand until you feel a stretch in your affected arm.

• Hold for 5 seconds.

• Lower arms and repeat 5 to 7 times.

Elbow winging (Figure 2)

	Figure 2

This exercise helps increase the movement in the front of your chest and shoulder. It may take many weeks of regular exercise before your elbows will get close to the bed or floor.

• Clasp your hands behind your neck with your elbows pointing toward the ceiling.

• Move your elbows apart and down toward the bed or floor.

• Repeat 5 to 7 times.

Exercises to do while sitting up

Shoulder blade stretch (Figure 3)

This exercise helps increase your shoulder blade movement.

	Figure 3

• Sit in a chair very close to a table with your back against the back of the chair.

• Place the unaffected arm on the table with your elbow bent and palm down. Do not move this arm during the exercise.

• Place the affected arm on the table, palm down, with your elbow straight.

• Without moving your trunk, slide the affected arm forward, toward the opposite side of the table. You should feel your shoulder blade move as you do this.

• Relax your arm and repeat 5 to 7 times.

Shoulder blade squeeze (Figure 4)

This exercise also helps increase shoulder blade movement.

	Figure 4

• Facing straight ahead, sit in a chair in front of a mirror. Do not rest against the back of the chair.

• Your arms should be at your sides with your elbows bent.

• Squeeze your shoulder blades together, bringing your elbows behind you. Keep your shoulders level as you do this. Do not lift your shoulders up toward your ears.

• Return to the starting position and repeat 5 to 7 times.

Side bending (Figure 5)

This exercise helps increase movement of your trunk and body.

	Figure 5

• Sit in a chair and clasp your hands together in front of you. Lift your arms slowly over your head, straightening your arms.

• When your arms are over your head, bend your trunk to the right. Bend at your waist and keep your arms overhead.

• Return to the starting position and bend to the left.

• Repeat 5 to 7 times.

Exercises to do while standing

Chest wall stretch (Figure 6)

	Figure 6

This exercise helps stretch your chest.

• Stand facing a corner with your toes about 8 to 10 inches from the corner.

• Bend your elbows and put your forearms on the wall, one on each side of the corner. Your elbows should be as close to shoulder height as possible.

• Keep your arms and feet in place and move your chest toward the corner. You will feel a stretch across your chest and shoulders.

• Return to the starting position and repeat 5 to 7 times.

Shoulder stretch (Figure 7)

This exercise helps increase the mobility in your shoulder.

• Stand facing the wall with your toes about 8 to 10 inches from the wall.

• Put your hands on the wall. Use your fingers to "climb the wall," reaching as high as you can until you feel a stretch.

• Return to the starting position and repeat 5 to 7 times. 

Figure 7

Things to keep in mind

Start exercising slowly and increase it as you are able. Stop exercising and talk to your doctor if you:

• get weaker, start losing your balance, or start falling

• have pain that gets worse

• have new heaviness in your arm

• have unusual swelling or swelling gets worse

• have headaches, dizziness, blurred vision, new numbness, or tingling in your arms or chest

It is important to exercise to keep your muscles working as well as possible, but it is also important to be safe. Talk with your doctor about the right kind of exercises for your condition, and then set goals for increasing your level of physical activity.

This information was developed with assistance from the Oncology Section of the American Physical Therapy Association.

No matter who you are, we can help. Contact us anytime, day or night, for cancer-related information and support. Call us at 1-800-ACS-2345 (1-800-227-2345) or visit www.cancer.org.

Last Medical Review: 05/19/2009
Last Revised: 05/19/2009