EXERCISE ADVICE FOLLOWING BREAST SURGERY

Arm movement and exercise after breast surgery.
Following your breast surgery, you may experience some discomfort in the arm/shoulder area. This is partly due to the position of your arm during the operation and partly to the effects of the surgery itself, particularly when the lymph glands from the armpit are removed.
It is important to resume some gentle movements using the affected arm the day after your operation. This will help prevent stiffness in the shoulder joint and will also help the flow of lymph.
In addition to encouraging you to use the affected arm for self care activities such as hair brushing, teeth brushing and eating; we recommend a series of exercises to help you regain your normal range of movement. These exercises should be performed slowly and regularly. You may feel a pulling discomfort from the wound or drain which is expected, but if you feel pain then stop, relax the shoulders and rest. You will be prescribed painkilling tablets to take at regular intervals and by performing your exercises about half an hour afterwards, discomfort should be lessened.

Exercises to do in hospital.
The physiotherapist will usually visit you during your stay in hospital to give advice and to assess your progress.
This set of exercises avoid over-stretching and so can be done with a drain in place. Start by doing each exercise 3 or 4 times, gradually increasing to 10 repetitions. These exercises should be carried out whilst sitting and be repeated at least three times a day.

1. Squeeze your hand into a fist and then open again and relax. Alternatively, a small rubber ball or similar item can be used.

2. Hand on shoulder - lift elbow out to side and down.

3. Hand on shoulder - lift elbow forwards and down.

4. Clasp hands behind neck, keeping head straight - stretch elbows to the side and back to the middle.

5. Put hand behind back - reach up back as far as possible.

Exercises to do at home.
Continue to carry out the above set of exercises as a 'warm up' and then carry on with the following exercises. The first 2 exercises may be done sitting down. It can be helpful to sit in front of a mirror and use both arms together to judge the quality of movement compared with the unaffected side.

1. Lift straight arms forwards above head.

2. Lift straight arms sideways and continue up towards head.

3. Standing up now, use the back of a chair to hold on to with the unaffected arm. Ensure that the chair is stable and then bend forwards to rest your forehead on that arm. Let your other arm hang loosely swinging backwards and forwards from the shoulder and then side to side. As the arm relaxes, swing in a circular motion, increasing the size of circles.

4. Lift straight arms sideways up as far as shoulders, then slowly drop arms from the elbow to reach behind your back to bra level.

5. Stand facing a wall with your feet apart. Stretch your arms forwards to allow the palms of your hands to touch the wall at shoulder level and slowly 'walk' your hands up the wall. Slide your hands back to shoulder level before repeating the exercise.

Daily activities.
You should to carry on with these exercises for at least 2 months or longer if you still have not regained your normal range of movements or if you are having radiotherapy.
It is important to use your arm as normally as possible but this may take some time. Introduce light house work gradually and then slowly progress to more strenuous activities such as hoovering, driving, hanging out washing or cleaning windows. However we advise that you continue to avoid heavy digging or carrying heavy items (see following section).
You will tire more easily at first so allow your self time to rest after activities.

Returning to work will vary from person to person so it is best to discuss your individual circumstances with your doctor or breast care nurse.

You may experience varying sensations in the skin around the scar lines and below the armpit, such as numbness, tingling, heaviness, aching or shooting type pains. These will gradually diminish, although occasionally there may be a small area of numbness that remains.

If you feel concerned about your progress or are experiencing any severe discomfort let us know.

Lymphoedema advice.
Following surgery to remove the lymph glands in the armpit, the lymphatic system will compensate but may be less efficient in the arm on the side of your treatment. There are small number of patients in whom the lymphatic system fails to compensate sufficiently and some swelling of the arm occurs. This is known as lymphoedema.

If you notice any swelling of your arm contact the breast care nurses or your doctor. Treatment and advice at an early stage is important in managing this condition.

It is possible for lymphoedema to occur even many years after surgery and it may also occur following radiotherapy to the breast and underarm area.

Exercise helps the lymphatic circulation so do carry out your exercise routines regularly and use your arm as normally as possible for daily activities. However, take care not to over exert; take things in moderation, particularly over the two months following surgery.

It is important to try and lessen the risk of any injury or infection on the side of your treatment to help prevent lymphoedema, and so we advise taking extra care in some situations.

Special care.
¨ Treat any insect bites, cuts, scratches or other breaks in the skin immediately. Clean the area well and apply an antiseptic such as Savlon or TCP according to the manufacturers instructions. Observe the area for any redness, swelling, pain or heat which indicate possible infection and a need to seek prompt medical advice.

¨ Avoid having injections, vaccinations, blood tests or blood pressure recordings on the arm of your treatment; always offer the unaffected arm.

¨ Raise your arm on pillows when resting

¨ Prevent chapping and cracking of the skin by drying well and using a bland moisturising cream or oil.

¨ Protect your arm against sun burn

¨ Use an emery board or nail clippers to trim finger nails and take care not to damage cuticles

¨ Use creams or electric shaver in preference to a razor for removing underarm hair

¨ Use a thimble when sewing

¨ Wear protective gloves for gardening and also for household chores such as washing up, oven cleaning etc., particularly if using strong detergents or abrasive cleaning pads.

¨ Do not carry heavy shopping, luggage etc. on the affected side and avoid any lifting of heavy, bulky items such as furniture.

If you require further advice or information please contact the
Macmillan Breast Care Nurses, Hazel Ricard and Hilary Rickwood on 020 8565 5885