In this guest blog, physiotherapist Rebecca Heath explains some of the physical issues you might face following breast cancer surgery and how exercise can help you. It’s based on a talk she gave at Future Dreams House in October 2021.
Going through breast cancer surgery is difficult for many reasons and can have an impact on both your mental and physical health. In this article I focus on how exercise and movement can help you manage the physical side effects following surgery. I’ll take you through what can happen physically, why these issues might arise and how you can deal with them. I’ll also share some post-op advice.
The physical side-effects you experience following breast cancer surgery might include:
These side-effects are all perfectly normal though. Many will either resolve themselves on their own or with some help from physiotherapy. Completing your prescribed exercises and following your post-surgery guidance is integral to your recovery, particularly in preventing side-effects from happening.
It’s also very important to listen to your body throughout any recovery journey. A gentle stretch through any exercise is positive and beneficial but pushing the body into or through pain can prolong the healing process.
A good rule to live by in the initial stages is: if you’re asking ‘Should I be doing this?’, the answer is probably no. Taking this into consideration will help to stop you doing too much to soon.
During any surgery, the moment the scalpel touches the skin the body kick starts an inflammatory response. This is the very start of the healing process. and leads to what’s known as the proliferative stage. This is when the body starts to heal the wound by creating scar tissue to repair the area of trauma.
When scar tissue is formed it impacts all the surrounding tissues not just the point where the incision was made. The tissue affected will depend on the type of breast cancer surgery you’ve had. Changes to the surrounding tissues can also cause pain, restriction in movement, cording and a seroma.
One of the most important aspects to your post-surgical journey is to complete the exercises given to you by your breast care nurse or physiotherapist. These exercises will help you to recover and manage any post-surgical issues.
The Breast Cancer Now: ‘Exercises after breast cancer surgery’ booklet is frequently recommended. It will guide you through the early post-surgery stages. The exercises are designed to help you safely progress your movement from the day after surgery until you have full movement back and on through any radiotherapy treatment you may need.
They will help you to increase your range of movement and ultimately enable you to return to previous levels of activity. The exercises will also be useful before, during and after radiotherapy to ensure your shoulder doesn’t become restricted and painful.
A gentle stretch can be very beneficial but forcing movement through pain isn’t recommended. It can lead to complications such as pain, bruising and worsening of cording.
The type of surgery you have will determine how quickly you progress through the exercises. For example, you may progress at a slower rate if you’ve had a breast reconstruction. The important thing is that you are guided by your consultant, breast care nurse or physiotherapist.
There will also be some precautions to follow to help with your recovery. This might include restricting movement of the arm: not lifting your arm higher than 90 degrees for 1-2 weeks (depending on the type of surgery) and not lifting anything heavier than half a kettle of water (approx. 2-3 kg).
In simple terms lymphoedema isa build-up of lymphatic fluid within in the body’s tissues. Symptoms can include an aching or a heaviness in the arm, difficulty with movement and swelling in the arm. It happens when there is damage or an alteration to the lymphatic system, for example after a Sentinel Lymph Node Biopsy (SLNBx) or an Axillary Node Clearance (ANC).
Lymphoedema is preventable and even following a diagnosis there are various treatments available. One of these is Manual Lymphatic Drainage (MLD). This is a light massage that helps to promote the movement of lymphatic fluid out of swollen limbs by directing it towards functioning lymph nodes. Following a treatment session, you may notice a reduction in the swelling in your hand or arm. For further information on MLD please visit the the Macmillan page on lymphoedema.
There are a number of steps you can take to manage and treat lymphoedema yourself. This can include wearing a compression garment, regular exercise and having a healthy lifestyle. A referral can also be made to either a specialist physiotherapist or MLD (Manual Lymphatic Drainage) therapist.
You can help to prevent lymphoedema by protecting your skin from infection by doing things like:
Other things to be mindful of are avoiding heavy lifting and having your blood pressure taken on the effected side.
A seroma is a build-up of fluid which can form after surgery. It tends to fill a space where tissue has been removed. They can be painful and feel like a ball of fluid to the touch. Seromas can resolve themselves but occasionally may need some intervention. If you’re concerned or have noticed any signs of a seroma, please speak to one of your medical team.
Cording is found commonly in the axilla (armpit) although it can occur in other areas and extend into the arm. This is often due to lymph node removal and again is part of the inflammatory response to surgery. Cording mostly causes a restriction in movement and can feel like a pulling or tight sensation in the arm; you may also notice cords in the axilla/arm, and these tend to feel like guitar strings. Just to reassure you this is quite common and can be treated by a specialist physiotherapist.
If you find you’re struggling with side effects or have any questions, mention it to a member of your medical team. A referral can be made to a physiotherapist who will carry out an assessment and tailor a treatment plan to suit your individual needs. Treatments might include myofascial release (a form of massage to relieve tightness in the connective tissues), a strengthening and stretching program, postural advice, MLD, education, cord release and exercise advice.
I qualified as a physiotherapist 10 years ago and throughout this time I have always had a keen interest in oncology. I currently practice at The LOC on Harley Street and The Wellington Hospital in St John’s Wood (North London).
What I love most about my job is being able to help and make a difference in people’s lives, particularly when they are going through one of the hardest times in their life. Seeing people able to return to their activities and hobbies like they did before their diagnosis really makes the job so fulfilling and I feel so lucky to treat such amazing and inspiring people.
My main goal is to make as many people aware as possible that life after cancer doesn’t mean physical restrictions and pain, it’s all about being active and doing all the things you love.
The information and content provided on this page is intended for informational and educational purposes only and is not intended to substitute for professional medical advice.
Published 23 November 2021
Sylvie and Danielle began Future Dreams with just £100. Since then we have raised over £6.5m. We couldn’t do any of this without you. Please donate, if we all act now we believe that by 2050 everyone who develops breast cancer will live.