Exercise & Strength Training Post Mastectomy: What Do I Need To Know?

23 Aug 2021

Whether you’re keen to get back to your bench press PB, smash out some push ups in your Crossfit class, or get back to your favourite pump class at your local gym, it’s important to be aware of the impact breast surgery, such as a mastectomy, has on your functional strength and the time it may take to return to pre-surgery strength levels.

To discuss this topic further, Pink Hope Programs Manager, Sonya, sat down with Simone Paterson from Women in Focus Physiotherapy.

You can view the entire interview here

Simone is a Physiotherapist specialising in Lymphoedema and Cancer, with over 25 years experience.  She also worked closely with Prince of Wales Private Hospital on their Women’s Health Services programs and no works in collaboration with Genesis Care.

How soon should exercise be reintroduced following breast surgery and what exercise should you start with?
Simone explains that regardless of your pre-surgery level of strength, simple exercises should be introduced in the first few days immediately following surgery.

Most surgeons will have their own protocols that they will suggest a patient follow, so it is important to have honest and open conversations pre-surgery so expectations are established early about how quickly you will be able to return to ‘normal’. Simone also suggests that in order to manage these expectations, it would even be ideal to visit a Physiotherapist before surgery, or in those very early days post-surgery, to establish a base line for rebuilding strength.

Foundational exercises post-surgery should focus on postural exercises, such as focusing on pulling shoulders down and away from your ears and retracting your shoulder blades, back and down to open up the chest, moving onto a range of movement exercises and then stabilisation of the shoulder girdle.  These three components lay the foundation for being able to rebuild your strength while minimising the risk of injury, pain or dysfunction.

Who should you see to help you rebuild your strength?
For those who don’t receive a referral to an allied health professional, or who aren’t provided with an exercise protocol to follow post-surgery, it’s important to seek out a Physiotherapist or Exercise Physiologist who has experience with women’s health care.

Should you live regionally and not have direct access to a professional with this specialty, you can consider using a Telehealth consultation service with someone like Simone who will be able to go through an assessment with you, create the basis of a rehabilitation program and then liaise with the likes of a Personal Trainer, Pilates Instructor or whoever you may have that can support you as you work to rebuild.

Introducing your Serratus Anterior muscle and why it is so important you get to know it.
The Serratus Anterior muscle plays an incredibly important role in stabilising your scapula (shoulder blade) against your thoracic wall (rib cage). This muscle works in combination with many other muscles to coordinate and control movements that you do with your arms raised above your head, as well as movements that you do with your arms out in front of your body, for example, boxing or hanging out the washing.

Often during breast surgery, the muscle is interfered with leaving this complex combination of muscles compromised and weakened.  It is therefore important to have someone assess if this muscle is functioning correctly post-surgery, is it stabilising the shoulder blade, or does it need strengthening?

What can a woman who is an athlete or has a heavy focus on strength training expect post-surgery?
Most women will be able to return to their post-surgery exercise programs, but it can be more challenging and take a longer period of time for the elite or more athletic group of women. This is due to the damage that may be done to the Serratus Anterior during surgery, as mentioned above, or sometimes there is also damage to the Long Thoracic nerve which is the ‘motor nerve’ to the Serratus Anterior.

Whilst this damage will mostly heal over time, it may take several months, if not longer, making a return to full strength a process that requires a lot of patience, as you watch and wait to see how your body responds to increases in weight size and movement types.

Another factor that will influence a return to more athletic exercise is the placement of an implant during reconstructive surgery and the impact that has on the function of the pectoral muscles. Again, this requires patience, time and appropriate guidance to build strength slowly ensuring that you can achieve your ultimate long-term goals.

Will I be able to do a push up like I used to?
This will vary for every woman and is linked to the extent of damage caused to the Serratus Anterior and/or the Long Thoracic nerve during surgery and the time taken for this to heal.

Many women will return to being able to do a variation of push ups, with a progression starting from wall push ups, to knee push ups through to push ups off your toes.  For the smaller percentage of women who have trained at an athletic level, they may notice a discrepancy in their strength and may not return to their pre-surgery ability to punch out max rep push ups during training.

Why is strength training so important to women’s physical wellbeing?
There are many well-known benefits to incorporating strength training into your regular exercise routine; from maintaining strong healthy bones, improving mental health, assisting weight loss and maintaining a healthy weight. Plus, did you know there is increasing evidence showing a significant link between musculoskeletal strength and longevity?

There are also results from a large international study showing links between strength training and reduced risk of lymphoedema. The study revealed that the group of women who had never been diagnosed with lymphoedema reduced their risk by 70% and the group of women who had been diagnosed with lymphoedema, who then incorporated strength training regularly, reduced flare-ups by 50%. Another great reason to keep strength training!

Simone’s top tips for a woman preparing for breast surgery.
Women that are fit, active and athletic going into surgery are starting from a fantastic base, and research suggests that they will experience better recovery, so Simone’s first tip is – be positive!

Secondly, following your surgery make sure that you work through the postural, range of movement, and stabilising phases of rehabilitation, and finally, make sure you start low with your weights and increase gradually as your progress allows.