There are many types of surgeries for the treatment of breast cancer or cancers involving axillary (underarm) lymph nodes:

• Lumpectomy, also known as Partial Mastectomy or Breast Conservation Surgery

• Mastectomy

• Breast Reconstruction, except for DIEP flap reconstructions (OT will go over exercises with you)

• Sentinel Lymph Node Biopsy

• Axillary Lymph Node Dissection

No matter what type of surgery, you will need to do certain exercises afterward to get your arm and shoulder moving again.

You may start the first exercise set (initial exercises) the day after surgery. You may begin the second exercise set (advanced exercises) about a week after surgery or when your drains have been removed.

Initial Exercises

When you start these exercises, avoid sharp pain, stretching the incisions, or pulling on your drains. Move into each stretch to the point of tension, but not sharp pain. You should easily be able to take a deep breath while stretching.

Do these exercises for about 1 week. Then progress to the advanced exercises. Exercise daily after surgery until you have full movement of your arm. Keep doing any of the initial exercises that provide a good stretch. Start with 3 repetitions of each exercise twice a day. Slowly increase to 10 repetitions each by the end of the first week. Exercise so you feel a good stretch under your arm and hold at that point for a slow count of 5-10.

Warm Up

Do these exercises with your arm raised above the heart on pillows (the first few days after surgery).

1. Fist squeeze, wrist circles, elbow bends 15-20 times each. This will help move lymph fluid out of your arm.

In a Seated Position

Move your arm as far as you comfortably can within each of these directions.

Forward arm lifts:

1. Start with your arm at your side.

2. Lift your arm forward and up, keeping your elbow straight, until you feel a stretch.

3. Return slowly to your side.

Sideways arm lifts:

1. Start with your arm at your side.

2. With your elbow straight and palm up, raise your arm sideways until you feel a stretch.

3. Return slowly to your side.

Windshield wipers:

1. Start with your arm straight out from your side (shoulder level).

2. Bend your elbow and point fingers toward the ceiling.

3. Roll your arm forward until your fingers are facing downward.

4. Roll your arm back until your fingers are facing toward the ceiling, at starting position.

Shoulder shrugs:

1. Sit up and straight.

2. Squeeze shoulders upward toward your ears.

3. Hold for a few seconds, and then relax.

Shoulder slide stretch:

1. Sit in a chair very close to a table with your back against the back of the chair. (You can also do this stretch standing at a kitchen counter or gliding on the arm of a chair at your side).

2. Place the affected arm on the table, palm down, with your elbow bent.

3. Without moving your trunk, slide the affected arm forward, across the table until you feel a stretch. You should feel your shoulder blade move as you do this.

4. Now bring your arm back to the starting position, squeezing your shoulder blade.

Shoulder blade squeeze (this exercise also helps to move your shoulder):

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

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

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

4. Return to the starting position.

Chest Wall Stretches

Deep breathing:

1. Sit up straight with your hands on your stomach.

2. Take a slow deep breath, inhaling through your nose.

3. Allow your stomach to rise and breath out through your mouth.

4. Try to expand your chest and rib cage as you inhale (exaggerate the motion).

Neck and shoulder stretch:

1. Turn your head to look over your shoulder.

2. Rotate your head and shoulders.

3. Complete on both sides.

Trunk side bend:

1. Stand with legs apart, hands resting at side.

2. Tighten belly muscles.

3. Slide hand along outside of thigh towards knee on affected side until you feel a stretch.

4. Return to stand up straight.

5. Repeat on other side.

Advanced Exercises

You can do these exercises one arm at a time. Progress to these exercises after about a week or after your drains are removed.

Apron strings:

1. Sit up straight.

2. Clasp your hands together behind your back as though you were tying apron strings.

3. Slowly lift your hands toward your shoulder blades.

4. Pull your shoulders back to feel chest stretch.

Forward arm lifts:

1. Sit up straight.

2. Raise your arm forward with your elbow straight while waving your wrist goodbye.

3. Lower your arms and relax them at your sides.

Sideways arm lifts:

1. Sit up straight.

2. Raise your arm to the side with your elbow straight while waving your wrist goodbye.

3. Keep your head and trunk straight.

4. Lower your arms and relax them at your sides.

Tree sway:

1. Stand up straight.

2. Clasp your hands in front of your body. Slowly raise your arms in front of you until you feel tension or a stretch. Hold for 10 seconds.

3. Once you can reach overhead, then progress to leaning towards your affected side, stretching your underarm area.

4. Repeat this exercise but lean towards the unaffected side.

Wall forward stretch (complete one arm at a time):

Part 1:

1. Facing the wall, stand with your feet a comfortable distance from the wall.

2. Place your palm on the wall at shoulder level.

3. Gently pushing into wall, slowly walk your hand up the wall until you feel a good stretch, hold for 10 seconds.

Part 2:

1. Then with your hand in place on the wall, turn your body away from the wall opening your chest into a stretch.

2. Only move until you feel a stretch, not pain.

Guidelines

Follow lifting instructions from your surgeon. Avoid heavy lifting. Do not vacuum or complete other pushing/pulling housework related tasks for several weeks after surgery. Lifting light objects in your daily routine can help you to regain strength.

When you have full movement of your shoulder, and you can do 10 repetitions of the advanced exercises easily, you may begin to add light resistance exercises.

• You may choose to keep doing the prescribed exercises, adding a one-pound weight. When you can easily complete 3 sets of 10 repetitions, you may increase the weight slowly.

• If you still have tightness in your chest wall or under arm area, you should do the shoulder and chest wall stretches to prevent further stiffness or tightening of your tissue.

If you will have radiation, keep stretching daily to maintain your range of motion for up to 18 months. Keeping your chest wall stretched out will help prevent tightness in your connective tissue and lymphatic system as you undergo radiation treatment.

Who to Call

If you need a referral, here is a list of clinics with therapists who are trained to help you after breast and/or underarm surgery:

UW Health
University Hospital
600 Highland Ave, E3/211
Madison, WI 53792
(608) 263-8060 Phone
(608) 262-7679 Fax

UW Health
Hand Clinic
1 South Park Street
Madison, WI 53715
(608) 890-6170 Phone
(608) 890-6718 Fax

UW Health
Yahara Rehabilitation Clinic
1050 East Broadway
Monona, WI 53716
(608) 890-6110 Clinic scheduler
(608) 221-6253 Voice mail
(608) 221-6250 Fax

UW Health
East Madison Hospital and Clinics
4602 Eastpark Blvd.
Madison, WI 53718
(608) 263-7540