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Exercises after Surgery

This guide is for women who have had lymph nodes removed (axillary dissection) as part of their treatment for breast cancer.
​This information should not be used for self-diagnosis or in place of a qualified physician's care.​

Reviewed 2015

About the guide

What is axillary dissection?

The "axilla" is a medical term for the underarm area or armpit which contains about 30 – 60 lymph nodes. To determine whether breast cancer has spread to these lymph nodes, most women with breast cancer will have some lymph nodes (usually 10 – 15) removed from their axilla by their surgeon. After the nodes are removed, the surgeon usually leaves a drain in the axilla for about a week to drain excess lymph fluid. The presence or absence of cancer cells within the lymph nodes is an important predictor of whether the cancer will recur elsewhere in the body and determines whether or not you need chemotherapy or radiation.

What is upper extremity rehabilitation?

The "upper extremity" refers to the shoulder, arm, forearm, wrist, and hand. The surgeon must cut around and through skin, fat, muscles, and nerves to get to the axillary lymph nodes. This can lead to stiffness and loss of motion in the shoulder as well as lack of sensation on the inside surface of the upper arm. Rehabilitation, frequently under the direction of a physical therapist, can help to restore full movement of your shoulder and can minimize the shoulder stiffness that often follows axillary dissection.

What should I know about my upper extremity before surgery?

You should know whether the size, strength, active range of motion (full movement) and sensation (or feeling) in both your arms are identical. Your doctor or a physical therapist can provide these baseline measurements for you. The size or circumference of your arms should be measured with a tape measure at the knuckles, wrist, 10 cm. below and 15 cm. above your elbow (lateral epicondyle).

What should I know about my upper extremity after surgery?

Each of the measurements that was taken before surgery (range of motion, strength, sensation, and arm circumference) should be taken again in the weeks following surgery by either your doctor or a physical therapist. You can expect to have some loss of shoulder motion and strength in the affected arm and loss of feeling on the inside surface of the upper arm.

When the surgeon removes lymph nodes from the axilla, the lymphatic system in your underarm is disrupted, leaving you at risk for lymphedema as discussed below. Scarred lymphatic vessels which are thin, cord-like structures that look a bit like violin strings may also appear underneath the skin of your arm. Cording usually develops within a few weeks after surgery. These structures, although alarming, are essentially harmless and will disappear or actually "snap" on their own as you do your stretching exercises.

What types of exercises are worth doing after axillary dissection?

Even before the axillary drain has been removed, you can begin gentle movements of your shoulder. Once the axillary drain is out, it is important to start working on regaining full shoulder motion.
Just after surgery

1 to 6 days after surgery

Range of motion: Initial post-operative exercises

These exercises can be done as soon as your doctor gives permission.

Shoulder Shrugs and Circles 

Sitting or standing

a) Lift both shoulders up towards ears and then drop them down to a relaxed position.

b) Pull your shoulder blades together. Hold and then relax.

c) Gently rotate your shoulders forward and upwards and then backwards and downwards. Repeat in the opposite direction.

Shoulder Range of Motion Exercises

a) Arm Lift: With your hands clasped together and elbows extended, lift your arms upward toward your head until a gentle stretch is felt. Pause and slowly return to your starting position.

b) Sideways Stretches: With your elbows extended, make an"angel in the snow" pattern on the bed or floor with both arms.

c) Backward Stretches: In a standing position, gently extend your involved arm backward to the point of discomfort. Try to swing your arm a little while walking.

Gentle Isometrics 

Do these exercises sitting or lying down. These are muscle tightening exercises with no movement.

a) Place the hand of your affected arm on the opposite shoulder and press gently. Hold for 5 seconds.

b) Place the hand of your affected arm on the opposite flexed (bent) knee and press gently. Hold for 5 seconds.

These exercises should be continued for the first week post-surgery or until the drain has been removed, starting with 3 repetitions twice a day and gradually progressing to 10 repetitions twice daily. You will feel some incisional (scar tissue) pull and stretch with these exercises. A slow gentle stretch exercise is most effective when held for 15 to 20 seconds. Breathe deeply and often while exercising.

7 to 10 days after surgery

These exercises can be done as soon as your doctor gives permission.

Chicken winging 

(lying on your back and placing your hands behind your head):

a) Bring your elbows forward to try and touch them together in front of your nose. Hold for 15 seconds.

b) Stretch your elbows back to try and touch the floor or bed. Hold for 30 seconds.


a) While lying on your back, hold a cane or broomstick with both hands, shoulder width apart. Bend your knees and keep your feet flat on floor. Raise the cane evenly over your head and try to touch the floor. Then flex (bend) your elbows and try to bring the cane down behind your head.

b) While standing, hold the cane behind your hips and try to slide it up towards the upper thoracic area (mid-back).

Doorway stretch

a) Stand in a doorway and place each hand lightly on either side of the door frame, then slide your hands upward as far as possible.

Wall climbing

a) Stand facing the wall with your elbows flexed and your toes a few inches from the wall. Place your palms on the wall at shoulder level. Slide both hands up the wall until some pulling or discomfort is felt in the axillary incision. Make a pencil mark on the wall to measure progress. 

Bilateral arm swings 

Do these in front of a mirror. Try to match the movements of the unaffected arm.

a) Swing both arms forward and over your head as far as possible.

b) Swing both arms out to the side and over your head as far as possible..

c) Clasp both hands together and lift them over your head. Bend to the unaffected side to stretch the chest wall and axilla.

To assure balance and posture and to gauge normal range of motion, both arms should be exercised at the same time. Posture and movement can be monitored with a mirror. To maintain good posture, it is helpful to occasionally walk with your hands clasped behind the back while pulling the shoulder blades together.

These exercises should be continued until both arms have the same range of motion and are equally strong. This may take 2 to 3 months. Full shoulder motion is achieved when you can reach across the top of your head and touch your opposite ear without feeling a stretch in your underarm. 

Ongoing recovery

Ongoing recovery


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. 

Lymphedema Risk

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. Temporary (transient) 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 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.

Where can I learn more about upper extremity rehabilitation after breast cancer surgery?  There are a number of books, videos and websites available. Contact the Library to learn more.


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.

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