Exercises before and after breast reconstruction surgery

Breast reconstruction after a mastectomy is major surgery. Exercise is important to help you recover more quickly.

This exercise program – the Physical Preparation and Recovery After Breast Reconstruction program – is designed for people having a breast reconstruction.

Preparing physically helps you:

• build strength in the muscles you need while you recover
• keep or improve flexibility so you can return to normal activities.

You can do the exercises in your home, as long as your treating team is aware and can provide guidance.

Remember: there are different types of breast reconstruction surgeries. Work with your treating team to understand what exercises are best suited to you.

The resources in Prepare for breast reconstruction may also be helpful.

Exercise before surgery

If you can, start 6 weeks before surgery. Generally, you need at least 6 weeks to achieve significant changes in muscle strength and flexibility. This period is longer if you’ve had radiotherapy.

You can also practice the exercises that will help you after surgery.

If your surgery is less than 6 weeks away, don't worry. You can still focus on:

• preparing yourself emotionally
• making temporary changes to your home to make your recovery easier (See Prepare for breast reconstruction surgery).

Exercises for your shoulders and upper trunk 

Exercises to help prepare your shoulders and upper trunk for breast reconstruction surgery.

When:  Before surgery
Relevant for: Any type of breast reconstruction surgery
Contents:    

Strengthening exercises to help the surgery and help you recover your:  

• upper back muscles
• pecs (‘pectoral’ muscles)
• lat dorsi muscles (‘latissimus dorsi’ muscles such as lats)
• rhomboid muscles.  

Stretching exercises to help you prepare your:  

• major pecs (‘pectoral major’ muscles)
• minor pecs (‘pectoral minor’ muscles)
• lat dorsi muscles (‘latissimus dorsi’ muscles such as lats)
• serratus muscle in your chest. 

Length: 9 min 15 s

Exercises for your trunk and torso  

Exercises to help strengthen your trunk (pelvis, hips, lower back and abdominal areas).

When: Before and after surgery

Relevant for: Tissue-based breast reconstruction surgery

Contents:  Exercises to help you prepare for and recover from your breast reconstruction surgery:  

• glutes (‘gluteal muscles’)
• abs (‘abdominal muscles’) 
• hip stretch 
• squats. 

Length: 4 min 35 s

The role of physiotherapy before and after surgery

Physiotherapy plays an important role to help you physically prepare for and recover from breast cancer surgery and treatment.

When: Before and after breast surgery

Relevant for: Any type of breast surgery. Any type of breast reconstruction surgery

Contents: Physiotherapist Deirdre McGhee talks about the importance of exercise before and after breast surgery including. 

• how long it can take to return to your activities
• physio to reduce the impact of scarring and lymphoedema. 

Length:  6 min

Exercise after surgery

After surgery, the exercise program progresses to:

• improve your flexibility
• strengthen the muscles that may have been affected.

Shoulder exercises

Your surgery and your drains can affect the strength and flexibility of the muscles that move your shoulder, shoulder blade and upper trunk.

It is important to do these exercises to start moving again.

When: After surgery (but practice before surgery)

Relevant for: Any type of breast reconstruction surgery

Contents: Exercises to help you start moving again: 

• shoulder rotations 
• assisted shoulder raises 
• one-armed backward rows. 

Length:  3 min 10 s

Exercises to improve circulation 

In the first weeks after surgery, people are often not moving ‘normally’. To heal after surgery, you need good circulation of blood and lymphatic fluid throughout your body, especially in your chest and arm.

These exercises will ensure you have enough circulation and lymphatic drainage. The aim is to maximise healing and minimise any risk of lymphoedema.

When: After surgery (but practice before surgery)

Relevant for: Any type of breast reconstruction surgery

Contents: Exercises to improve circulation:  

• deep breathing 
• toe points/flexes (“calf pumping”) 
• head side tilts 
• head turns 
• head nods 
• shoulder shrugs 
• modified breast strokes 
• arm curls 
• repeat breathing and calf pumping 
• arm self-massage. 

Length: 5 min 10 s

Other resources

• Watch Preparing for the best possible recovery, with Associate Professor Deirdre McGhee, plastic surgeon Dr Dean Trotter, breast care nurse Monique Baldacchino and lymphoedema specialist Louise Koelmeyer.
• Learn when and how to keep active to help manage the side effects of breast cancer. 
• Connect with others online in our Online Network. The private group Choosing Breast Reconstruction is for people who have had, or are thinking about, breast reconstruction.
• Cancer Council has exercise videos as part of its resources to help with the emotional and practical effects of living with cancer.

About this research-based program

The Physical Preparation & Recovery After Breast Reconstruction program includes exercises developed by a physiotherapist.

Research shows that most people are not aware that exercise before and after a major surgery has a significant impact on recovery.

In 2018, Breast Cancer Network Australia and Breast Research Australia, University of Wollongong, in conjunction with clinicians and people who have undergone breast reconstruction, developed resources to help physical recovery after breast reconstruction surgery. 

Tell us what you think 

We would appreciate your feedback on this resource in an anonymous 10-minute survey. Your responses are confidential. This will help us improve and develop resources to help people recover from breast reconstruction surgery. 
The University of Wollongong’s Human Research Ethics Committee approved the survey.

Acknowledgements 

The Physical Preparation & Recovery After Breast Reconstruction program was made possible with support from BCNA and:

• Breast Research Australia
• Dry July Foundation.

We thank them for their contributions to this program.

Program author

This program was written by Deirdre McGhee, Associate Professor in the School of Medicine, Indigenous and Health Sciences at the University of Wollongong. She is also an APA Sports Physiotherapist, Director of Breast Research Australia (University of Wollongong) and Fellow of Sports Medicine Australia.

Program Advisory Committee 

An advisory committee consisting of a patient advocate, clinical experts and researchers reviewed the content of this program. The members were:

• Jodi Steel: Patient advocate - had a tissue-based breast reconstruction (TRAM) August 2017.
• Caroline Baker: Director of Breast Surgery, St Vincent’s Hospital, Melbourne, Australia.
• Dean Trotter: Head of Breast Plastics Unit & Breast Reconstruction Lead The Women’s Hospital and the Royal Melbourne Hospital, Melbourne, Australia.
• Professor Elisabeth Elder: Specialist Breast Surgeon, Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
• Professor Bruce Mann: Professor of Surgery, The Royal Women’s and Royal Melbourne Hospitals and Peter MacCallum Cancer Centre, Melbourne, Australia
• Damien Grinsell: Specialist Plastic and Reconstructive surgeon, St Vincent’s Private Hospital, Melbourne, Australia.
• Monique Baldacchino: Breast Care Nurse, The Royal Women's Hospital, Melbourne, Australia.
• Mary Anne Banting: Breast Care Nurse coordinator, St Vincent’s Hospital, Melbourne, Australia.
• Andrea Cannon: Breast Care Nurse Consultant, Think Pink Foundation, Melbourne, Australia.
• Janice Velasco: Nurse Unit Manager, Breast Cancer Institute, Westmead Hospital, Sydney, Australia
• Hildegard Reul-Hirche: Physiotherapist – Senior Consultant, Metro North Hospital & Health Service, Brisbane, Australia.
• Kate Rogers: Senior Physiotherapist women’s health, oncology and lymphoedema, Melbourne, Australia.
• Katherine Maka: Senior Physiotherapist, Westmead Hospital, Sydney, Australia.
• Rebecca Lee: Senior Physiotherapist, Westmead Hospital, Sydney, Australia
• Dragana Ceprnja: Senior Physiotherapist, Westmead Hospital, Sydney, Australia.
• Laura Burchhill: Physiotherapist, St Vincent’s Hospital, Melbourne, Australia.
• Andrea Jackson: Physiotherapist, St Vincent’s Hospital, Melbourne, Australia.
• Louise Koelmeyer: Lymphoedema Program Manager/Occupational Therapist, Australian Lymphoedema Education, Research & Treatment, Macquarie University, Sydney, Australia.
• Professor Sandi Hayes: Senior Research Fellow, Queensland University of Technology, Brisbane, Australia.
• Dr Sharon Czerniec: Physiotherapy Lecturer, Macquarie University, Sydney, Australia.
• Professor Kerry Sherman: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.