Surgery for breast cancer involves mastectomy ( removal of the breast ) or wide local excision removal of the part of the breast ) and Removal of Lymph nodes under your armpit ( Axillary clearance or Sentinel lymph node biopsy ). The main problem associated with breast cancer surgery is reduced shoulder movements and shoulder stiffness. When the stiffness lasts long enough, it leads to muscle wasting and loss of muscle strength.

To overcome this problem, exercise should be started as early as possible. Exercise reduces the formation of tight scarring under the armpit ( Cording ) and reduces lymphoedema risk(Permanent swelling of the hands due to the collection of fluid in tissues)

Regular exercise is beneficial for patients who have had breast surgery, Removal of lymph nodes and patients who are getting breast and axillary ( armpit ) radiotherapy.

When To start exercise after breast surgery

Exercise and light physiotherapy should be started as early as possible, usually the next day after the operation. However, if you had breast reconstruction your Surgeon may ask you to delay exercise for a few days. A full range of movement may not possible immediately after surgery this is normal and will improve over time. You should not feel pain during the exercises however; the pulling or dragging sensation is normal. You may take painkillers just before exercise to reduce discomfort.

How long should you continue exercising?

Exercise should be continued until you get the full range of arm movements. People who get radiotherapy may develop stiffness years after treatment, and exercise should be continued for a longer duration. If you are at higher risk of developing lymphoedema, you may be asked to continue exercise lifelong.

If you develop a wound infection, wound breakdown, seroma formation, or pain after exercise, you should temporarily stop exercise.

The type of exercises that you should do

The exercises should be done in three sessions per day, and each exercise is to be done ten times per session.The session starts with a warming-up exercise and ends with a cooling-down exercise.

During the first week after surgery, you should start with the basic exercise and from the second week onwards, more advanced exercises should be introduced.

Warming up and cooling down exercises

Shoulder Shrug

Keep your arms relaxed on either side of your body. Shrug it upwards towards your ear and lower it down slowly

2. Shoulder circling

Relaxed your arms, shrug them towards your ear and rotate them backwards and downwards

Basic exercises

Arm flexion (Moving arm forward)

Bent your arm at the elbow. touch your shoulder with your fingertips and move your elbow forward

Arm abduction ( Moving arms sideways )

Bent your arm at the elbow. touch your shoulder with your fingertips. Move your arms sideways and back towards your body

Back scratching

Bend your arm from the elbow and slowly reach under your shoulder blades

Winging movements

Place your hand on the back of your head. move your elbow forward similar to winging

Advanced exercises

Arm lifts

Lie down or stand up with your back straight. Hold your hands together. Slowly lift your hands above your head.

Wall climbing

Forward – stand facing a wall keep the palm of the hand on the wall. gradually walk it upwards and downwards

Sideways -Stand to the side of a wall and rest the palm of the hand on the wall. gradually walk it upwards and downwards

Beach poses

Lie down with your hands behind your head. gently push your shoulders towards the floor and hold for ten seconds

During the first week after the surgery, start with warm-up exercises ,then move to regular exercises and complete with cool-down exercises.