Kettering Breast Service. Advice and Arm Exercises Following Breast Surgery. Information

Transcription

1 Kettering Breast Service Advice and Arm Exercises Following Breast Surgery Information

2 Exercises following breast surgery are an important part of post-operative care. The gentle exercises contained in this booklet should be started as soon as you are able after your operation. These exercises should not be painful. Please read through the complete booklet before starting any exercises. These exercises should feel comfortable and you should not push through the pain. Try to maintain a good posture whilst completing the exercises as this will help to strengthen muscles. The exercises should be carried out 3 times a day. Start with 4 or 5 repetitions of each exercise and gradually build up to 10 times each session. You should aim to have your full range of movement back by 6 weeks. 2

3 For Patients Undergoing Wide Local Excision or Mastectomy without Any Reconstruction Day One Gently pull your shoulders up towards your ears and then relax. Then roll your shoulders forwards and backwards in a circular motion. Place your fingers on your shoulders Move elbows forwards and backwards 3

4 Then move elbows out to the side Stand, and use the hand on the non-surgical side to lean on a table. Let your other arm on the side of surgery hang relaxed straight down. Swing your free arm forwards and backwards. Repeat 4-5 times, building up to 10 times. 4

5 Stand, and use the hand on the non-surgical side to lean on a table. Let your other arm on the surgical side hang relaxed straight down. Swing your arm to your left and then to your right. Repeat 4-5 times, building up to 10 times. Stand, and use the hand on the non-surgical side to lean on a table.. Let your other arm on the surgical side hang relaxed straight down. Swing your arm as if drawing a complete circle on the floor. Repeat drawing the circle in the other direction. Repeat 4-5 times, building up to 10 times. 5

6 Day Two Repeat exercises from day one. Add the following to your regime. Aim to take your hands to the back of your neck, as if brushing your hair. Gently aim to bring your hands to reach the small of your back 6

7 Day Two (continued ) Whilst still behind your back, bring your arms up as far as is comfortable. Raise your arms sideways as far as is comfortable 7

8 Day Two (continued ) Raise your arms forwards as far as is comfortable Stand or sit. Lift your arm sideways with thumb uppermost. Repeat 4-5 times building up to 10 times. 8

9 Day Two (continued ) Stand or sit. Lift arms forward and gradually increase the movement aiming to stretch your arms back as far as possible. Lying on your back with your hands behind your neck and elbows pointing towards the ceiling. Move elbows apart and down to touch the floor. Repeat 4-5 times, building up to 10 times. 9

10 For Patients Undergoing Breast Reconstruction Please follow instruction for day 1 exercises as for wide local excision or mastectomy. Continue these exercises 3 times daily until day 5. On day 5 please start adding in the additional exercises. Exercise 1 Aim to take your hands to the back of your neck, as if brushing your hair. Exercise 2 Gently aim to bring your hands to reach the small of your back 10

11 Exercise 3 Whilst still behind your back, bring your arms up as far as is comfortable. Your surgeon / breast care nurse will advise specifically when the remaining exercises can be undertaken. This may vary from patient to patient depending on the exact type of reconstructive / plastic surgery completed. Exercise 4 Raise your arms sideways as far as is comfortable 11

12 Exercise 5 Raise your arms forwards as far as is comfortable Exercise 6 Lying on your back with your hands behind your neck and elbows pointing towards the ceiling. Move elbows apart and down to touch the floor. Repeat 4-5 times, building up to 10 times. 12

13 Please Note: Patients who have a Becker expander / implant in position should not undertake any heavy lifting immediately after any episode of inflation as this stretches the pectoralis muscle. You should gradually return to your normal exercise levels to improve the strength of this muscle. General Advice Six weeks after your operation you should have gained full movement at the shoulder joint. If you have not achieved this, inform your breast care nurse as you may require further physiotherapy to regain your full movement. Patients with either a mastectomy or a wide local excision should avoid heavy lifting, pulling or pushing for at least 6 weeks after your operation. Patients who have had any level of breast reconstruction should avoid heavy lifting for at least 12 weeks after surgery. Try to use your arm and hand as normally as possible. Try to maintain a good posture. 13

14 General Advice Following Surgery Care of the wound You may be offered the opportunity to be discharged home with your drains in place, returning after a few days to have them checked or removed. You will be given some spare dressings to take home with full instructions on how to care for your wound. Your dressing will remain in position until your nurse or surgeon advises it can be removed. All sutures (stitches) are dissolvable. You will be up and about the day after surgery. It is important, if your breast is conserved, to wear a good supporting bra (without wires) as soon as possible. It may be helpful to wear a soft bra at night. It is quite normal for your breast or chest wall to tingle or feel tight. You may experience a few stabbing pains but this is not a cause for concern. Pain relief medicine, such as paracetamol may be taken as required. However, please follow the instructions on the packet. 14

15 Seek medical immediately advice if you have any of the symptoms listed below: Shortness of breath Pain when breathing in and out Pain and heaviness in your chest with or without other symptoms Pain, redness, swelling or heat in the lower legs (calf) You may feel more tired than usual. Rest is an important part of your recovery to allow healing to take place. Care of the arm It is important to inform your doctor or breast care nurse if you notice swelling of the arm or hand. This may be due to lymphoedema and may occur because of damage to the lymph drainage channels during surgery. There are simple methods that can be used to reduce the risk of lymphoedema developing. Avoid heavy lifting; use your non-surgical arm to carry heavy shopping etc. Protect your hands when gardening and use thick gardening gloves. 15

16 Use the non surgical arm for injections and blood pressure recordings Avoid tight clothing and jewellery on the surgical side Cuts and grazes should be thoroughly cleaned with antiseptic. If any signs of inflammation, heat or swelling occur, you should contact your GP or breast care nurse. Problems That May Occur Following Surgery You may not experience any problems after your surgery, but the following can occur: Wound infection This can occur at any time until the wound is healed. The following symptoms are an indication that an infection may be present: The wound feels tender, swollen or warm to the touch Redness around the wound Discharge from the wound Feeling generally unwell with a temperature. 16

17 If any of the above occur, please consult your GP or breast care nurse. Seroma Swelling is part of the healing process and common after an operation. Sometimes the swelling is due to a collection of fluid called a seroma. A seroma may need to be aspirated using a needle and syringe. If you develop a swelling with heat, significant pain, bruising or redness, please contact the breast care nurse for an appointment. It is not unusual for the fluid to reaccumulate and need several aspirations. Bruising A small amount of bruising is common following surgery and should gradually disappear. If you notice significant bruising please contact the breast service or your GP as soon as possible. Very occasionally, blood collects within the tissues causing swelling and hardness - this is known as a haematoma. If it is not reabsorbed, the fluid may need draining. 17

18 Loss/altered sensation If you have had your lymph glands removed you may experience a loss or change of sensation running down the inner side of your upper arm. This happens because the nerves running through your axilla (armpit) often have to be disturbed to reach the lymph glands. This causes trauma to the nerve which can lead to: Loss or reduced sensation/numbness Weakness in the arm Sensitivity to touch or pressure Burning or tingling sensation. Cording Occasionally you may develop a pain, which can feel like a tight cord running from your arm through to the back of your hand. This is called cording and this is thought to be due to hardened lymph or blood vessels and can appear 6-8 weeks after your operation. You may actually be able to feel raised cord-like structures that can significantly restrict your arm movement. 18

19 If this should occur, concentrate specifically on the following exercise and if you feel confident apply gentle massage to underarm area. If this condition occurs, physiotherapy is given to stretch the cords and it usually settles down. Contact information Breast Care Nurses Telephone: /3 9.00am 4.30pm Monday - Friday (excluding bank holidays) 19

20 If you need this information in another format or language, please telephone Further information about the Trust is available on the following websites: KGH - NHS Choices - Ref: PI 209 April 2016 Next review: January 2018