Revised March 2007

Strengthening

Within 4-6 weeks after the axillary dissection, you can begin doing exercises using light weights (1-2 pounds). (You can make your own 1-pound weight by filling a plastic detergent bottle with pebbles or sand). Some physical therapists have suggested that you can lift as much as 5-10 pounds within 6 weeks after surgery. Start out with biceps curls, i.e. holding a 2 lb. weight in your extended arm (palm forward) by your side and bending the arm up so that your hand is brought up to your shoulder. To strengthen your triceps muscle, lower the weight slowly as your arm returns to your side. Do one set of 8-12 repetitions at least twice a week.

Other types of "strengthening activities" include resuming home and yard duties, child care, and recreational activities gradually over 6 weeks. Beginning on the first day after surgery, try to use your arm as normally as possible, within the limits of pain and incisional pulling, for activities of daily living (ADL) such as washing, grooming, and eating. However, avoid using your arm to push or pull yourself into or out of bed or a chair. Elevate and support the arm on several pillows when sitting or lying down. Avoid sudden, unexpected movements until the incision has healed and the drain has been removed.

Whenever doing heavy weight-training (more than 10 lbs.) or strenuous upper body recreational activities (such as cross-country skiing, canoeing, kayaking, tennis, or bowling), it's a good idea to wear a compression sleeve on your involved arm. This is an elastic garment that can be purchased at medical equipment stores or pharmacies specializing in lymphedema care. Physical therapists or trained personnel at the stores selling the sleeves can ensure that you get a properly fitted sleeve. 

A compression sleeve fits properly when it can be worn without causing your hand or fingers to swell.  A hand glove or gauntlet should not be required if you have had no hand swelling prior to purchasing a compression sleeve.  If your hand or fingers begin to swell after you purchase a compression sleeve, please contact the medical store where you purchased the sleeve.

Aerobic or General Conditioning Exercises:

Regular aerobic exercise can improve your cardiovascular fitness as well as maintain your ideal weight and enhance your sense of well-being as you face the many challenges associated with cancer treatments. 

In a study published in 2005 (1), women who exercised 3-5 hours per week (at an aerobic level equivalent to walking a 20-30 minute mile) significantly reduced their risk of recurrence as well as their risk of dying from breast cancer when compared to women who exercised less than 3 hours per week.

What else should I be doing to enhance my recovery from surgery?

Scar Tissue Massage: Within a month or so after surgery, when your axillary and mastectomy scars have healed and are not too tender, you should begin massaging the scar tissue daily with the tips of your fingers. Use aloe vera lotion or some other favorite body lotion to make deep, circular motions with the pads of your fingers along the length of the scar to "loosen up" the scar tissue. A massage therapist or a physical therapist can instruct you in scar tissue massage. It's a good idea to continue scar massage for the first year or two after surgery to prevent tethering of muscles underneath the scar. 

What about the risk of developing lymphedema? Axillary dissection can lead to lymphedema. Lymphedema is swelling in the arm or hand that is caused by a build-up of excess lymph fluid. Transient or temporary lymphedema is quite common in the arm shortly after surgery and radiation therapy and usually responds to elevation. Permanent or irreversible lymphedema may occur at any time after treatment for breast cancer but most commonly will occur within the first 3 - 4 years. 

To minimize the risk of developing irreversible lymphedema, try to: 

• Maintain an ideal body weight. (Obesity is a risk factor for developing lymphedema and also for making pre-existing lymphedema worse). 
• Avoid having blood pressure taken or receiving injections or vaccinations in the affected upper extremity. 
• Keep the skin clean and avoid injury, burns, or infection to the involved arm. 
• Wear a compression sleeve when lifting heavy weights or engaging in vigorous, upper body exercise, such as cross-country skiing, rowing, or tennis. 

How do I find a physiotherapist and what are the costs?
To locate a physical therapist in your area who has special expertise in working with women facing breast cancer surgery or recovering from surgery, ask your doctors or women who had breast cancer, or go to www.bcphysio.org.  You do not need a doctor's referral to access physical therapy private clinics.  The Medical Services Plan of B.C. no longer covers the cost of private physiotherapy treatments unless you meet low-income criteria.  Prior to scheduling your first appointment, discuss the costs for the initial assessment, follow-up appointments and cancellation policy.

Lymphedema treatments at hospital-based outpatient physiotherapy departments are at no cost to the patient but do require a doctor's referral.  Costs vary for compression garment(s) and may be covered by Pharmacare or extended medical insurers.  Click here to find a list of hospital-based physiotherapy programs for lymphedema.

Where can I learn more about upper extremity rehabilitation after breast cancer surgery?   The book by Diana Stumm, entitled "Recovering from Breast Surgery: Exercises to Strengthen Your Body and Relieve Pain", is particularly helpful. You can also see a list of Illustrated Resources here (you can obtain these resources from a library or bookstore). 

References

Harris SR, Hugi M, Olivotto IA. Levine M. Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema. Can Med Assoc J. 2001;154:191-199.

Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005;293:2479-2486.

McTiernan A, Gralow J, Talbott J. Breast Fitness: An Optimal Exercise and Health Plan for Reducing Your Risk of Breast Cancer. St. Martin’s Press: New York, NY, 2000.