Instructions for DIEP breast reconstruction

When can I return to work?

Most people are able to return to work in 6 to 8 weeks.

What activities are safe?

For the first 2 weeks after surgery:

• Only do light self-care activities such as showering, brushing your hair, walking and dressing.
• Only move your arms as high as your shoulders.

 

After 2 to 6 weeks:

• You can do more self-care activities. Do not push yourself. Always listen to your body.

From 6 to 12 weeks:

• You may slowly return to your usual everyday activities.
• No heavy lifting of more than 5 kilograms (10 pounds).
• You may slowly increase in weights.

After 12 weeks:

• You may begin to do abdominal (stomach) workouts.

Instructions for: latissimus dorsi flap with a tissue expander or implant based reconstruction; or two-stage implant based reconstruction using the tissue expander and/or implants

When can I return to work?

Most people are able to return to work 3 to 4 weeks after the latissimus dorsi flap and 2 to 3 weeks after the tissue expander/implant based reconstruction.

What activities are safe?

For the first 2 weeks after surgery:

• Only do light self-care activities such as showering, brushing your hair, walking and dressing.
• Only move your arms as high as your shoulders.

 

After 2 to 6 weeks:

• You can do more self-care activities. Do not push yourself. Always listen to your body.
• No heavy lifting of more than 5 kilograms (10 pounds) for 4 to 6 weeks.

After 6 weeks:

• You may slowly return to your usual everyday activities
• NO upper chest strengthening exercises during the recovery and expansion phase.

My tissue expander inflation appointments

You need to come into clinic for tissue expander inflations 2 to 3 weeks after having the tissue expander inserted. You will need to come once a week or once every 2 weeks for up to 6 to 8 weeks. During these appointments the doctor expands the pocket and skin.

Important: NO heavy lifting on the day of the expansion and 1 day after the expansion appointment.

Instructions for single stage implant based reconstruction using AlloDerm

When can I return to work?

Most people are able to return to work 2 to 4 weeks after their surgery.

What activities are safe?

For the first 2 weeks after surgery:

• Only do light self-care activities such as showering, brushing your hair, walking and dressing.
• Only move your arms as high as your shoulders.

 

After 2 to 6 weeks:

• You can do more self-care activities. Do not push yourself.Always listen to your body.
• No heavy lifting of more than 5 kilograms (10 pounds) for 4 to 6 weeks.

After 4 to 6 weeks:

• You may slowly return to your usual everyday activities

Exercises to do after your surgery

After breast reconstruction surgery it is normal to feel stiff in your back, chest, shoulders and arms.

Do the exercises in this pamphlet to help you get back to your everyday life. These exercises are part of your recovery and can help you:

• get back full movement of your shoulder
• ease stiffness
• lower swelling
• be more independent as you do more of your everyday activities

How to do the exercises

• Start the exercises slowly so that you don’t get tired or hurt yourself.
• Exercise 2 to 3 times every day.
• Do each exercise 5 to 10 times, unless you were given other instructions.
  • If it is too difficult to do the entire set of exercises, start by doing each exercise less than 5 to 10 times but exercise more than 2 to 3 times a day.
• Hold each stretch for 3 to 5 deep breaths.
• Avoid forcing any movements.
• Abdominal (stomach) exercises will start when your plastic surgeon feels you are ready. This is normally 12 weeks after your surgery.

You may have some swelling or puffiness in your hand or arm on the side(s) of your surgery. This is normal and will usually go away by itself.

Try these exercises to help lower swelling in your hand or arm:

• Raise your arm above your head several timesa day while you do hand pumps. Slowly open and close your fist 10 times. The raising and pumping actions of the muscles help gravity to drain the fluid out of the arm.
• You may also keep your arm raised a few times a day for about 20 minutes. To raise your arm while sitting, or while lying on your back or your side, rest your arm on a few pillows next to you. Your arm should be raised higher than your heart.

 

See the pictures below for how you can use pillows to support your arm.

 

 

 

 

 

Do these exercises starting the day of surgery and first day after surgery. They can be started when drains are in.

Deep breathing and coughing to keep lungs working properly

Deep breathing will help you with your exercises and make it easier to relax. Deep breathing exercises can help to keep your lungs clear, control pain and help you feel less stressed and worried. They take time and practice to get right.

1. Start this exercise as soon as you wake up from surgery.
2. Put your palms on your stomach.
3. Slowly, breathe deeply through your nose, allowing the stomach to get bigger.
4. Breathe out slowly through pursed lips (lips closed as though sucking a straw) to make your stomach flat. Then cough deeply.
5. If your incision (cut) is on your stomach, you may place a pillow on your stomach and press to make it more comfortable to cough.
6. Take a short rest or break.
7. Repeat 5 times with a short rest between each breath so you don’t get dizzy.

 

Leg exercises to get the blood moving in your legs

Ankle pumping

Move your ankles up and down. Rest. Then move them in circles. Repeat 10 times every hour.

 

Knee bends

Bring your knee to your chest. Repeat this exercise 10 times every hour.

 

Other exercises

Making a fist or ball squeeze

Open and close your fist 10 times every hour during the day. Try using a soft squeeze ball or sponge in your hand.

 

Shoulder rolls

1. Sit in a comfortable upright position.
2. Raise your shoulders up toward your ears. Bring your shoulder blades together at the back (roll shoulders backwards).
3. Lower your shoulders, and relax.
4. Repeat, rolling shoulders forward.

 

Head turning and tilting

1. Stretch your neck as tall as possible, keeping your chin in.
2. Turn your head slowly, looking over each shoulder as far as you comfortably can.
3. Tilt your head to one side and then the other. Bring your ear as close to your shoulder as you comfortably can.

 

 

 

External rotation

1. Sit or stand.
2. Keep your upper arms close to your sides and elbows at right angles.
3. Turn your forearms outwards so that your palms are facing forward while keeping elbows at your side.

 

Shoulder circles

1. Swing your arms from your shoulders in circles.
2. As your arm relaxes, make bigger circles, but don’t push yourself.
3. Do the same actions but in the opposite direction.
4. Swing your whole arm from left to right
5. Make sure that you are using your shoulder to swing your arm and not your elbow.

 

 

 

Wall exercises

1. Stand facing a wall.
2. Slide or walk your fingers up the wall. Hold the stretch.
3. Slide your fingers down the wall.
4. Do not arch your back or raise your shoulder just to get the arm to go higher.
5. Try to reach a little higher each time. As you get better, move your feet and body closer to the wall.
6. Now turn sideways with your affected side (the side with your incision) toward the wall.
7. Follow the same directions as for facing the wall. Make sure that your arm is moving straight out from your side.

The following exercises can be done with or without drains:

Back climb exercise

1. Place your hands behind your back.
2. Hold the hand of your affected arm and slide your hands up against the centre of your back.
3. Hold the stretch.
4. Lower your arms slowly.

 

Elbow push-back

1. Stand against a wall or lie on your back.
2. Place your fingers behind your neck.
3. Bring your elbows forward.

 

Forward lifting

1. Lie on your back and hold the stick (you can use a cane or metre stick) with both hands, with your palms down and arms shoulder width apart.
2. Keeping your elbows straight, raise the stick over your head until you feel a pulling feeling.
3. Hold the stretch for 3 to 5 deep breaths.

Lifting to side

1. Lie on your back and hold the stick with both hands, with your palms down and arms shoulder width apart.
2. Raise the stick up in front of you
3. Move the stick toward the side that you had your surgery.
4. When you begin to feel a pulling feeling, hold the stretch for 3 to 5 deep breaths.

Chest wall stretch

This exercise helps stretch your chest.

1. Stand facing a corner with your toes about 8 to 10 inches (about a foot’s length) from the corner.
2. Bend your elbows and put your arms and palms on the wall, one on each side of the corner. Your elbows should be as close to shoulder height as possible.
3. Keep your arms and feet in place and move your chest toward the corner. You will feel a stretch across your chest and shoulders.
4. Hold the stretch for 3 to 5 deep breaths.
5. Repeat this exercise with your arms raised higher than shoulder once you become more comfortable.

 

Scar massage

If your scar feels tight or itchy or the area is very sensitive, a scar massage may help. It softens and loosens the scar, and helps you to move your shoulder again.

You may begin massaging all your scars (breast and abdomen) 3 weeks after your surgery and after your incisions (cuts) are completely healed.

You might feel some firm areas on your breast after the DIEP breast reconstruction. Massaging the entire breast can help soften these areas.

To massage your scar:

1. Put a small amount of lotion of your choice or oil ointment (such as coconut oil, Bio-Oil, Vaseline or unscented lotion) on the scar.
2. Place 2 fingers or your thumb right on the scar.
3. With firm but gentle pressure move your fingers along the scar in an up and down zig-zag pattern. Move in one direction and then back in a circular motion.
4. Do this 2 to 3 times a day for 2 to 3 minutes.

Important: Do NOT put heat or ice packs on your surgical incisions (cuts). This may injure your skin.

Scar massage

What if I feel discomfort or pain?

Feeling some discomfort when you exercise is normal. You should feel pulling or stretching. You should not feel any strong pain that shoots down the arm or continues after you’ve done the exercises.

If the exercises are very painful or uncomfortable to do, take a break. Try not stop exercising completely. Start slowly again and build your ability to keep doing the exercises one step at a time.

What if I feel very tired?

For more information about relaxation classes:

• Pick up the “Patient Education & Survivorship Calendar of Events” from the Princess Margaret Patient & Family Library (main floor).
  
• Go to the Princess Margaret website. Click “Find Patient Education Classes” under the Patients, Caregivers and Visitors tab.
• Speak to a health care professional for information about relaxation sessions in the community.

Resources for more information

Find pamphlets on UHN Patient Education:

• How to Manage Your Fatigue CCO
• Relaxing Exercises to Relieve Stress
• Helpful Hints for Better Sleep
• Using Your Energy Wisely