This information describes how to do arm and shoulder exercises, a breathing exercise, and scar massage after your mastectomy (breast surgery).
Your physical therapist will tell you when it’s safe for you to start doing these exercises. Many people can start the exercises on the first day after their surgery.Back to top
Deep Breathing Exercise
Deep breathing can help you relax and ease discomfort and tightness around your incision (surgical cut). It’s also a very good way to relieve stress during the day.
- Sit comfortably in a chair.
- Take a slow, deep breath through your nose. Let your chest and belly expand.
- Breathe out slowly through your mouth.
Repeat as many times as needed.Back to top
Arm and Shoulder Exercises
Doing arm and shoulder exercises will help you get back your full range of motion on your affected side (the side where you had your surgery). With a full range of motion, you’ll be able to:
- Move your arm over your head and out to the side
- Move your arm behind your neck
- Move your arm to the middle of your back
Do each of the exercises below 5 times a day. Keep doing this until you have a full range of motion again and can use your arm as you did before surgery in all your normal activities. This includes activities at work, at home, and in recreation or sports. If you had limited movement in your arm before surgery, your goal will be to get back as much movement as you had before.
If you get your full range of motion back quickly, keep doing these exercises once a day instead of 5 times a day. This is especially true if you feel any tightness in your chest, shoulder, or under your affected arm. These exercises can help keep scar tissue from forming in your armpit and shoulder. Scar tissue can limit your arm movements later.
If you still have trouble moving your shoulder 4 weeks after your surgery, tell your surgeon. They will tell you if you need more rehabilitation, such as physical or occupational therapy.
Before you start, gather the following supplies:
- 4 pieces of dark tape (to mark your progress with some exercises)
- A stopwatch, timer, or watch with a second hand (to time some exercises)
The shoulder roll is a good exercise to start with because it gently stretches your chest and shoulder muscles.
- Stand or sit comfortably with your arms relaxed at your sides.
- Start with backward shoulder rolls. In a circular motion, bring your shoulders forward, up, backward, and down (see Figure 1). Do this 10 times.
- Switch directions and do 10 forward shoulder rolls. Bring your shoulders backward, up, forward, and down. Do this 10 times.
Try to make the circle as big as you can and move both shoulders at the same time. If you have some tightness across your incision or chest, start with smaller circles and make them bigger as the tightness decreases. The backward direction might feel little tighter across your chest than the forward direction. This will get better with practice.
The shoulder wings exercise will help you get back outward movement of your shoulder. You can do this exercise while sitting or standing.
- Place your hands on your chest or collarbone.
- Raise your elbows out to the side (see Figure 2), limiting your range of motion as instructed by your healthcare team.
- Slowly lower your elbows.
- Do this 10 times. Then, slowly lower your hands.
If you feel discomfort while doing this exercise, hold your position and do the deep breathing exercise. If the discomfort passes, raise your elbows a little higher. If it doesn’t pass, don’t raise your elbows any higher. Finish the exercise raising your elbows only high enough to feel a gentle stretch and no discomfort.
If you had surgery on both breasts, do this exercise with both arms, 1 arm at a time. Don’t do this exercise with both arms at the same time. This will put too much pressure on your chest.
- Stand with your feet slightly apart for balance. Raise your affected arm out to the side as high as you can, limiting your range of movement as instructed by your healthcare team (see Figure 3).
- Start making slow, backward circles in the air with your arm. Make sure you’re moving your arm from your shoulder, not your elbow. Keep your elbow straight.
- Increase the size of the circles until they’re as big as you can comfortably make them, limiting your range of motion as instructed by your healthcare team.
- If you feel any aching or if your arm is tired, take a break. Keep doing the exercise when you feel better.
- Do 10 full backward circles. Then, slowly lower your arm to your side. Rest your arm for a moment.
- Follow steps 1 to 4 again, but this time make slow, forward circles.
You can do the W exercise while sitting or standing.
- Form a “W” with your arms out to the side and palms facing forward (see Figure 4). Try to bring your hands up so they’re even with your face. If you can’t raise your arms that high, bring them to the highest comfortable position. Make sure to limit your range of motion as instructed by your healthcare team.
- Pinch your shoulder blades together and downward, as if you’re squeezing a pencil between them.
- If you feel discomfort, stop at that position and do the deep breathing exercise. If the discomfort passes, try to bring your arms back a little further. If it doesn’t pass, don’t reach any further.
- Hold the furthest position that doesn’t cause discomfort. Squeeze your shoulder blades together and downward for 5 seconds.
- Slowly bring your arms back down to the starting position. Repeat this movement 10 times.
You can do the back climb stretch while sitting or standing. You’ll need a timer or stopwatch.
- Place your hands behind your back. Hold the hand on your affected side with your other hand (see Figure 5). If you had surgery on both breasts, use the arm that moves most easily to hold the other.
- Slowly slide your hands up the center of your back as far as possible.
- If you feel tightness near your incision, stop at that position and do the deep breathing exercise. If the tightness decreases, try to slide your hands up a little further. If it doesn’t decrease, don’t slide your hands up any further.
- Hold the highest position you can for 1 minute. Use your stopwatch or timer to keep track. You should feel a gentle stretch in your shoulder area.
- After 1 minute, slowly lower your hands.
Hands behind neck
You can do the hands behind neck stretch while sitting or standing. You’ll need a timer or stopwatch.
- Clasp your hands together on your lap or in front of you.
- Slowly raise your hands toward your head, keeping your elbows together in front of you, not out to the sides (see Figure 6). Keep your head level. Don’t bend your neck or head forward.
- Slide your hands over your head until you reach the back of your neck. When you get to this point, spread your elbows out to the sides. Hold this position for 1 minute. Use your stopwatch or timer to keep track.
- Breathe normally. Don’t hold your breath as you stretch your body.
- If you have some tightness across your incision or chest, hold your position and do the deep breathing exercise. If the tightness decreases, continue with the movement. If the tightness stays the same, reach up and stretch your elbows back as best as you can without causing discomfort. Hold the position you’re most comfortable in for 1 minute.
- Slowly come out of the stretch by bringing your elbows together and sliding your hands over your head. Then, slowly lower your arms.
Forward wall crawls
You’ll need 2 pieces of tape for the forward wall crawl exercise.
- Stand facing a wall. Your toes should be about 6 inches (15 centimeters) from the wall.
- Reach as high as you can with your unaffected arm. Mark that point with a piece of tape. This will be the goal for your affected arm. If you had surgery on both breasts, set your goal using the arm that moves most comfortably.
- Place both hands against the wall at a level that’s comfortable. Crawl your fingers up the wall as far as you can, keeping them even with each other (see Figure 7). Try not to look up toward your hands or arch your back.
- When you get to the point where you feel a good stretch, but not pain, do the deep breathing exercise.
- Return to the starting position by crawling your fingers back down the wall.
- Repeat the wall crawl 10 times. Each time you raise your hands, try to crawl a little bit higher
- On the 10th crawl, use the other piece of tape to mark the highest point you reached with your affected arm. This will let you to see your progress each time you do this exercise.
As you become more flexible, you may need to take a step closer to the wall so you can reach a little higher.
Side wall crawls
You’ll also need 2 pieces of tape for the side wall crawl exercise.
You shouldn’t feel pain while doing this exercise. It’s normal to feel some tightness or pulling across the side of your chest. Focus on your breathing until the tightness decreases. Breathe normally throughout this exercise. Don’t hold your breath.
Be careful not to turn your body toward the wall while doing this exercise. Make sure only the side of your body faces the wall.
If you had surgery on both breasts, start with step 3.
- Stand with your unaffected side closest to the wall, about 1 foot (30.5 centimeters) away from the wall.
- Reach as high as you can with your unaffected arm. Mark that point with a piece of tape (see Figure 8). This will be the goal for your affected arm.
- Turn your body so your affected side is now closest to the wall. If you had surgery on both breasts, start with either side closest to the wall. Crawl your fingers up the wall as far as you can. When you get to the point where you feel a good stretch, but not pain, do the deep breathing exercise. Return to the starting position by crawling your fingers back down the wall.
- Repeat this exercise 10 times.
- On your 10th crawl, use a piece of tape to mark the highest point you reached with your affected arm. This will let you to see your progress each time you do the exercise.
- If you had surgery on both breasts, repeat the exercise with your other arm.
You may feel uncomfortable touching your skin in the area of the scar. It’s very important that you become comfortable moving the skin over this area. Moving the skin will help improve the circulation and soften the tissue.
Don’t start doing scar massage until your incision has fully healed and your nurse tells you it’s safe. There should be no open wounds or scabbed areas. The area of the scar may be numb or extra sensitive at first. Both of these feelings are normal after surgery.
To do the massage, place 2 or 3 fingers over the scar and gently move the skin in all directions. Then, pick up your fingers and move them 1 or 2 inches (2.5 to 5 centimeters) in each direction in the area of the scar and repeat the massage. Don’t squeeze your breast tissue.
Do this massage once a day for 5 to 10 minutes.Back to top
After your surgery, you may have some swelling or puffiness in your hand or arm on your affected side. This is normal and usually goes away on its own.
If you notice swelling in your hand or arm, follow the tips below to help the swelling go away.
- Raise your arm above the level of your heart and do hand pumps several times a day. If you’re following any range of motion restrictions, make sure to stay within your range of motion.
- To do hand pumps, slowly open and close your fist 10 times. This will help drain the fluid out of your arm.
- Don’t hold your arm over your head for more than a few minutes. This can cause your arm muscles to get tired.
- Raise your arm to the side a few times a day for about 20 minutes at a time. To do this, sit or lie down on your back. Rest your arm on a few pillows next to you so it’s raised above the level of your heart.
- If you’re able to sleep on your unaffected side, you can place 1 or 2 pillows in front of you and rest your unaffected arm on them while you sleep.
If the swelling doesn’t go down within 4 to 6 weeks, call your surgeon or nurse.Back to top
If you have any questions, call the Rehabilitation Service at 212-639-7833.Back to top