Exercise and Advice Following a Sub-pectoral Reconstruction Therapy Services Macclesfield District General Hospital 01625 661481 @EastCheshireNHS Leaflet Ref:11578 Published: Jan 2019 Review: 31/12/2021 Page 1
The Operation The operation you are having is an implant-only reconstruction, which involves making a space between your ribcage and pectoral muscles and inserting an implant into this space (sub-pectoral implant reconstruction). The overlying skin is then sutured together to close the wound. The implants are either expandable implants, which are slowly enlarged over a period of time to give the desired shape and size, or a definitive implant that is not expandable. This will have been discussed with you by your consultant. The advantages of having this type of reconstruction are that there is a shorter operation time and a quicker recovery time. There will be a number of things that you will be unable to do for a few weeks following the operation. This is to ensure that over-stretching of the pectoral muscle is limited to ensure the implant settles. Exercises to start in Hospital following your Operation Breathing Exercises The following exercises should be performed hourly, whilst you are awake. These exercises are going to help prevent any respiratory problems after your operation. 1) Deep Breathing Place your hands on your lower ribs. Take a deep breath in through your nose and fill your lungs as much as possible, feeling your chest move outwards under your hands. Hold for a few seconds and breathe out through your mouth. Repeat 5 times. 2) Huffing and Coughing Open your mouth widely and force the air out as if you were steaming up a mirror or your glasses. This sharp breath out helps to bring any phlegm to the back of your throat. Then cough to clear it. Remember: one big cough is more effective than lots of little coughs. Circulatory Exercises 1. Pull your toes up towards you and then point them away from you. Repeat 20 times. 2. Make fists with your hands then open your hands. Repeat 20 times. Mobility The nursing staff will help you to get out of bed the day after your operation. When getting out of bed, you should avoid pushing or pulling with the affected arm. This is so you don t overwork and stretch the pectoral muscle. Leaflet Ref:11578 Published: Jan 2019 Review: 31/12/2021 Page 2
Shoulder Movement To ensure that your operation and recovery goes to plan, it is important to avoid any movements or activities that can overstretch the pectoral muscle. For the next 2-3 weeks DO NOT Reach behind your back or attempt to fasten your bra with the bra clasps at the back Carry anything heavier than a bag of sugar Vacuum / do heavy housework with the affected arm Take your elbow above shoulder height. Guide to daily activities in the first few weeks Useful Advice Work - You may be off work between 4-8 weeks, depending on the type of job you have. If you are involved in manual work or heavy lifting you are advised to be on light duties for 6-8 weeks. Driving: We recommend that you do not drive for 3-4 weeks after your operation. You may find using a piece of foam useful to limit compression from the seatbelt on your new breast. Dressing: Wear loose clothing, either with front fastening or that you can slip over your head. For ease also remember to dress your operated arm first and undress your operated arm last. Household tasks/cooking: Do not use your operated arm for activities involving weight (e.g. lifting a full kettle or pans, ironing) for 3-6 weeks. Do use your affected arm for light activities such as hair brushing, washing up or drinking a cup of tea. Leaflet Ref:11578 Published: Jan 2019 Review: 31/12/2021 Page 3
Shoulder Exercises Basic Exercises Complete these exercises 4-5 times a day for the first 2-3 weeks after your operation. Stand up. Lean over onto a support (e.g. a table) with your unoperated arm. Let your operated arm hang down relaxed. Gently swing your arm: 1. Forwards and backwards 30 times 2. Side to side 30 times 3. Round in circles 30 times in each direction Leaflet Ref:11578 Published: Jan 2019 Review: 31/12/2021 Page 4
Basic Exercises (continued) Gently squeeze your shoulder blades together (a small movement). Hold for 30 seconds and, if able, perform gentle tasks in this position e.g. eating, writing. Repeat throughout the day. Lift your affected arm forward to 90 degrees assisting the movement with your other hand. Repeat 10 times. Lift your arm to the side to 90 degrees, assisting the movement with your other hand. Repeat 10 times. Leaflet Ref:11578 Published: Jan 2019 Review: 31/12/2021 Page 5
Advanced Exercises Complete these exercises 10 times each, 4-5 times a day. Start 2-3 weeks after your operation. Lie on your back. Use your unoperated arm to lift the operated arm up as far as you can within your pain limits. Stand, sit or lie on your back with hands behind your head. Gently move your elbows out to the side to feel a stretch at the front of your chest. Stand with arms behind your back and hold one hand. Gently slide your hand up along your back. Leaflet Ref:11578 Published: Jan 2019 Review: 31/12/2021 Page 6
Stand facing a wall. 'Walk' your fingers up the wall as high as possible. Reverse down in the same way. Repeat standing side on to the wall. Scar Massage Once your wound has healed you can start using moisturising cream and massage this into the scar with a small circular motion. Scars will naturally fade between 6 and 12 months after your operation, but scar massage will help further reduce the appearance of your scars. If you have any further questions that have not been answered in this leaflet, please ask your physiotherapist, consultant or breast care nurse. Your notes. Leaflet Ref:11578 Published: Jan 2019 Review: 31/12/2021 Page 7
Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: 0800 1613997 Phone: 01625 661449 Textphone: 01625 663723 Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation, contact Communications and Engagement on 0800 195 4194. East Cheshire NHS Trust operates a smoke-free policy (including e-cigarettes) For advice on stopping smoking please contact the KICKSTART Stop Smoking service on 0800 085 8818. East Cheshire NHS Trust does not tolerate any form of discrimination, harassment, bullying or abuse and is committed to ensuring that patients, staff and the public are treated fairly, with dignity and respect. If you have any comments about how we can improve our services please inform a member of staff in the department or complete a comment card available throughout the hospital. Macclesfield District General Hospital, Victoria Rd, Macclesfield SK10 3BL Leaflet Ref:11578 Published: Jan 2019 Review: 31/12/2021 Page 8