How can I expect to feel?

Pain or numbness

After your surgery, you may have sharp pains, feel pins and needles or be more sensitive on the side of your body where you had your surgery.

You may also feel numb (have no feeling) at or near the area where you had the surgery. This should get better as your nerves heal.

Some people may not get their full feeling back. If you feel numb, stay away from things that are very hot or very cold. For example, don’t put heating pads, hot water bottles, or ice packs on your arm or near your incision (cut from surgery).

It is important to keep moving, even if you have some pain or feel numb. Gently rub or tap any sensitive places to help reduce pain.

If you feel like your pain is keeping you from doing your daily activities, speak to your doctor, nurse, physiotherapist or occupational therapist. They can give you ideas for how to manage your pain.

Swelling

After your surgery, you may have some swelling or puffiness in your hand or arm on the surgery side. This is normal and usually gets better over time.

If you notice swelling in your hand or arm:

• Use 2 to 3 pillows to raise your arm higher than your heart. Do this a few times a day. You can raise your arm while you sit, lie on your back or lie on your side.
 
 
 
 
 
• Raise your arm and slowly open and close your fist 10 times. This acts like a pump and helps drain fluid out of your arm.

   

Some patients may develop cording and lymphedema

What is cording (also called axillary web syndrome)?

You may feel thick cords (like ropes) under your skin in your armpit that run down into your arm. This is sometimes a side effect after sentinel lymph node biopsy or axillary node dissection. The cords tend to be tight and painful. They can make it hard to lift your arm, straighten your elbow or reach for things over your head.

Cording usually goes away over time with regular stretching and exercise. Talk to your team if you have this side effect. You may benefit from a referral to the Cancer Rehabilitation and Survivorship Clinic.

What is lymphedema?

Lymphedema is a build up of fluid in a body part caused by damage to your lymphatic system. If your lymph nodes are damaged or removed, they can’t always properly drain an area of your body. This causes fluid build up and swelling in your tissues.

Your lymphatic system can become damaged if:

• lymph nodes were removed during your surgery
• you had radiation to an area where lymph nodes were removed

If you had treatment for breast cancer, lymphedema may happen in your hand, arm, shoulder, breast, chest, or middle of your body.

Attend a Lymphedema Awareness education class to learn more about ways to reduce your risk of lymphedema. Call 416 581 8620 to register for a class.

What activities can I do?

During the first week you are home from the hospital, try to get back to your usual activities. Use both your arms, if you can. For example:

• Use your arm (surgery side) to brush your teeth, comb your hair, dress yourself, make breakfast and lunch, eat and drink enough fluids.
• Ask for help with cleaning, heavier cooking and child care so that you have time to attend to your own self-care.
• Go for short leisurely walks.

Dressing

To help make dressing easier:

• Wear loose fitting tops that close at the front for the first few weeks.
• If you have trouble moving your shoulder, dress that side of your body first and undress that side last.
• To put on a bra with clasps, start by fastening the bra in front of you then turn it around. As your shoulder improves, try to reach behind your back to fasten it.

Driving

You must be able to turn and move without any sharp pains before it’s safe for you to drive. Wait until you no longer need to take prescription pain medicines before you drive. Always wear your seat belt, even if it causes some discomfort across your chest.

Work

Everyone recovers differently. You may need some time off work. Talk to your health care team about the best time to return to work.

Consider attending a “Prepare to return to work after cancer” class. Please refer to the Patient Education Calendar for more information.

Saving your energy

Recovering from surgery can take up a lot of your energy. This is normal, but it can be hard when you want to do things. Don’t try to do everything. Do the activities that are most important to you, and ask for help when you need it. For more information on using your energy wisely, see the pamphlet Using Your Energy Wisely .

Follow these tips to save energy while you recover:

• Pace yourself.
  Don’t schedule too many activities in a day. Spread them out during the day and week. Give yourself enough time to finish an activity without having to rush.
• Plan ahead.
  Gather all the things you will need before you start an activity. Keep things close to you, especially if you use them often. You won’t tire as easily if you are organized.
• Use aids.
  Use things to make it easier for you to do things, like appliances to chop or mix food or a long handled dust-pan to help clean.
• Rest often.
  Sit when you can. Don’t wait until you are tired before you rest. Plan rest times throughout the day, for example, 5 to 10 minutes each hour.
• Keep your back straight (good posture).
  Sit and stand straight. This balances your muscles and decreases stress. Bending your back forward makes it harder for you to breathe deeply.
  
• Use good body mechanics.
  Using good body mechanics means moving your body in a way that will make doing things easier and safer.
  For example, push or pull rather than lift. Slide things along a counter and stand close to something you want to move.

What exercises should I do after surgery?

Here is a list of exercises to do as part of your recovery. They can help reduce many of the side effects of your surgery and help you get back to doing your normal daily activities faster.

Deep breathing

Deep breathing is easy to learn, and you can practice it almost anywhere. It can help:

• with your exercises and make it easier to relax
• keep your lungs clear
• reduce your pain
• lower or control your stress or anxiety (worry)

How to do deep breathing:

1. Find a comfortable position. Sit in a chair or lie face up.
2. Take a slow deep breath in through your nose.
3. Let your chest and belly expand. Do not let your shoulders rise up toward your head as you breathe in.
4. Breathe out slowly through your mouth. Repeat this as many times as you like.

You may find the Yogic Breathing Exercises video to be helpful when practicing deep breathing. Visit the UHN Patient Education YouTube channel.

Relaxation exercises

Relaxation exercises can take time and practice to learn, but they can:

• reduce any anxiety you may have
• increase your energy
• improve your concentration
• increase your self-confidence
• prevent stress from building up

Relaxation exercises include things like:

• Progressive Muscle Relaxation. You tense or tighten and then relax different muscle groups in your body.
• Guided Imagery. You use your imagination to focus on calm and peaceful images in your mind.

For more information, check the Patient Education calendar for drop-in relaxation sessions at Princess Margaret Cancer Centre or in your community. You can also find more resources in the Patient Education Library or at the websites:

• Inner Health Studio
• Mental Health on HelpGuide.org
• An audio link for guided relaxation is posted on our YouTube channel

Walking

It is important to continue walking after surgery and during your recovery. Walking is a great way to improve your strength and endurance after surgery. It also improves your circulation (the blood flow) in your body. This helps with healing. Start slow and rest often until you are able to return to your normal level.

If you have some pain when walking, you can support your arm by keeping your hand in your pocket. As your pain decreases, return to swinging your arm by your side.

Exercises to improve your shoulder movement

It’s important to start moving your arm on the side you had breast surgery as soon as possible after surgery. This will help prevent scar tissue from forming. Too much scar tissue could reduce the movement in your shoulder. Moving your arm and doing exercises will also help you return to your daily activities sooner.

Get back the full range of motion in your shoulder

In the first 6 weeks after surgery, your goal is to get back the full range of motion in your shoulder. Full range of motion means being able to move your arm and shoulder the same way you did before your surgery.

If you get your full range of motion back before 6 weeks, include stretching exercises as part of your exercise routine. This is especially true if you feel a stretch in your chest or under your arm during certain exercises. The exercises will help prevent scar tissue from forming that can get in the way of your range of motion later.

Regain strength in your shoulder

After you get back the full range of motion in your shoulder, your goal is to make your arm stronger. Start with light weights (about 2 to 3 pounds) or a light resistance band. Progress slowly.

If movement in your shoulder does not improve after 4 weeks, contact your doctor. They may refer you to the Cancer Rehab and Survivorship Clinic at Princess Margaret Cancer Centre.

Manage your pain

Feeling sore or some pain when exercising is normal. For example, you may feel like something is pulling inside. This is normal. You are feeling your scar tissue stretching.

If it is very painful or uncomfortable, take a break. But, don’t stop exercising completely. Start slowly, and keep doing the exercises 1 step at a time. Be patient with yourself. You will slowly get stronger.

When you exercise:

• Begin exercises slowly, without tiring or straining yourself. Do not force any movements. This includes activities you do at work, at home, or during sports and hobbies.
• Start with whatever you are able to do and slowly add more until you are able to repeat each exercise 5 to 10 times, 3 times a day. Hold each stretch for 3 to 5 deep breaths. Continue with these exercises every day until you can use your arm the way you did before.
• If you can, do the exercises in front of a mirror so you can make sure you keep good posture.

First Set of Exercises

1. Making a fist – ball squeezes

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

 

2. Shoulder shrugs

1. Sit upright in a comfortable position.
2. Raise your shoulders up towards your ears, bring your shoulder blades together at the back.
3. Lower your shoulders, and relax.
4. Repeat 5 to 10 times.

 

3. Head turning and tilting

1. Stretch your neck as tall as possible, while 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, bringing your ear as close to your shoulder as you comfortably can.
4. Repeat 5 to 10 times.

 

 

 

4. Shoulder circles

1. Begin by making small, slow forward circles with your shoulder. Make sure you are moving your shoulder and not your elbow.
2. Slowly increase the size of the circles as you are able.
3. Reverse the direction of the circles and repeat steps A and B.

 

5. External arm rotation

1. Sit or stand.
2. Keep your upper arms and elbows close to your sides and elbows at right angles.
3. Turn your forearms outwards while keeping your elbows at your side.
4. Repeat 5 to 10 times.

 

6. Pendulum

1. Bend over and use your unaffected hand to support yourself on a table.
2. Swing your affected arm (like a pendulum) from left to right and back.
3. Then, swing your whole arm forward and back.
4. Repeat 5 to 10 times.

 

Second Set of Exercises

7. Elbow push-back

This exercise helps increase the movement in the front of your chest and shoulders. You can do this exercise standing up against a wall or lying down on your back on a bed or the floor.

1. Place your fingers behind your head or your upper neck.
2. Spread your elbows out to the side as far as possible.
3. When you get to the point where you feel a good stretch (but not pain), take 3 to 5 deep breaths and hold the stretch. Keep your neck straight and relaxed as you do this.
4. D. Repeat 5 to 10 times.

 

8. Shoulder flexion wall exercise

This exercise helps increase the forward movement of your shoulder. Try to reach a little higher each time. As you improve, move your feet and body closer to the wall.

1. Stand facing a wall.
2. Slide or walk your fingers up the wall as far as possible. When you get to the point where you feel a good stretch (but not pain), take 3 to 5 deep breaths and hold the stretch for 15 seconds.
3. Return to the starting position by walking your fingers back down the wall.
4. Repeat 5 to 10 times.

 

Keep track of how you are doing

For example, for the wall climbing exercises, reach as high as you can with your unaffected arm. Mark that point with a piece of tape. This will be the goal.

Every week, you can track how high you can reach for your surgery-side arm with a piece of tape to track your progress.

9. Shoulder side lifts wall exercise

1. Turn sideways with your affected side toward the wall.
2. Slide or walk your fingers up the wall as far as possible. When you get to the point where you feel a good stretch (but not pain), take 3 to 5 deep breaths and hold the stretch for 10 seconds.
3. Return to the starting position by walking your fingers back down the wall.
4. Repeat 5 to 10 times.
5. Try to reach a little higher each time. As you improve, move your feet and body closer to the wall.

 

10. Back climb exercise

This exercise helps you improve the movement behind your back. You need this for activities such as hooking your bra, buttoning up a blouse, or zipping up a dress. You can do this exercise sitting or standing.

1. Place your hands behind your back holding your surgery-side hand.
2. Slowly slide your hands up the centre of your back as far as possible. When you get to the point where you feel a good stretch (but not pain), take 3 to 5 deep breaths and hold the stretch for 15 seconds.
3. Lower your hands slowly.
4. Repeat 5 to 10 times.

 

11. Forward lifting

This exercise helps increase the forward movement of your shoulders.

1. Lie on your back and hold a stick with both hands, palms down and arms shoulder width apart.
2. Keeping your elbows straight, lift the stick over your head as far as you can. Use your unaffected arm to help lift the stick until you feel a stretch in your surgery-side arm.
3. Hold the stretch for 3 to 5 deep breaths.
4. Repeat 5 to 10 times.

 

12. Lifting to side

1. Lie on your back and hold the stick with both hands, palms down and arms shoulder width apart.
2. Lift 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 stretch in your surgery-side arm, hold the stretch for 3 to 5 deep breaths.
5. Repeat 5 to 10 times.

 

13. Chest wall stretch

1. Stand facing a corner with your toes about 8 to 10 inches from the corner.
2. Bend your elbows and put your forearms 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 5 to 10 times.

 

How can scar massage help?

Scar massage is another way to help your shoulder get back its full range of motion and function.

Begin scar massage after your incisions (cuts) are completely healed and your drains are removed. This is usually about 3 weeks after surgery.

You may find that your scar feels very sensitive, tight or itchy. Scar massage can help improve any sensitivity, tightness or itchiness you feel. It will help soften and loosen the scar and get the movement in your shoulder back more quickly.

To massage your scar:

1. Put a small amount of oil or lotion on your index and middle finger. If you are doing a scar massage while your are having radiation, please talk to your radiation oncologist about which oils or lotions to avoid (for example vitamin E).
2. Place 2 fingers or your thumb on the scar.
3. Press firmly but gently along your scar in an up and down zig-zag pattern. Move in 1 direction and then back in a circular motion.
4. Do this 2 to 3 times a day for about 10 minutes.

If you’re not sure you are doing it correctly, ask your surgery nurse, physical or occupational therapist.

Other helpful resources

Check YouTube for videos of these exercises:

• Exercises After Breast Cancer Surgery-First Set of Exercises
• Exercises After Breast Cancer Surgery-Second Set of Exercises

Princess Margaret Cancer Rehab and Survivorship Program

Call 416 946 4501 extension 2363 for more information about the following cancer-related concerns:

• reduced shoulder movement, cording
• swelling
• fatigue
• pain after surgery that is affecting your everyday activities
• wellness and exercise counselling
• return to work or school
• brain fog
• sexual health and intimacy

Have your cancer doctor refer you to the Cancer Rehab and Survivorship Clinic.

See the Patient Education Calendar for information about education sessions and exercise classes at Princess Margaret Cancer Centre.

Community resources

• Canadian Cancer Society
  Phone: 1 888 939 3333
• Gilda’s Club Greater Toronto
  (support group and other services)
  Phone: 416 214 9898
• Hearth Place
  Phone: 905 579 4833
• Lymphedema Association of Ontario
  Phone: 1 877 723 0033
• Nanny Angel Network
  Phone: 416 730 0025
• Willow
  Phone: 1 888 778 3100
• Wellspring
  Phone: 1 877 499 9904