Returning to Exercise After Mastectomy: Everything You Need to Know

Whether you’ve already had your mastectomy and are wondering when it’s safe to start exercising again, or are researching the procedure beforehand and want to know what to expect, the fact is, you’re going to need a little time after your surgery to recover before you hit the gym or your favourite running route again, but let’s start off saying that you will get moving again.

To ensure you do it safely though we asked the experts for their advice on returning to exercise after mastectomy – when to do it, what to expect and what new kit you might need to feel confident and comfortable as you workout. Read on to find out more…

The Most Important Advice

Before we get into specific details on how long after mastectomy before you can exercise again there’s one things we have to remind you of…

Every woman is different.

So, rule number one when rule when it comes to returning to any kind of exercising after mastectomy, is to ask your surgeon’s advice first.

Tell them what you want to do and ask them if you are ready to do it as every case is going to be different and it’s essential that whatever you do is appropriate for your level of healing.

Once they do give you the okay though, there’s unlikely to be any reason why you can’t go back to doing whatever type of workout you did before after surgery.

‘Modern mastectomy techniques shouldn’t impair any arm or shoulder movements as, except in very rare circumstances, surgery doesn’t include the chest wall muscle,’ explains Miss Caroline Payne, Head of Plastic Surgery and Clinical Lead in breast reconstruction at St Bartholomew’s and Royal London Hospitals and spokesperson for the British Association of Aesthetic Plastic Surgeons.

‘Scarring will be a straight line across the chest wall if you have a standard mastectomy, but again this shouldn’t limit movement once you are healed.’

Straight After Surgery

At first though, you will need to take things easy.

You’ll likely be given some gentle mobility exercises to do by your care team for the first weeks after your operation.

These might sound simple, especially if you were very fit before your surgery, you might literally just be asked to lift your arm or practise your breathing, but it’s essential you do them to start warming up the muscles that may have been involved in surgery and ‘to prevent complications like frozen shoulder from the joint not being moved,’ explains Miss Payne.

You’re going to feel weak for a while, but once you do feel strong enough, it’s good to start walking around as this will help get the circulation moving and lower risk of complications like blood clots.

Take it easy at first, it’s better to build up slowly than rush into things and overdo it.

Running After Mastectomy

Running is high impact cardio and classes as vigorous exercise (as do things like cross training, HIIT classes and many higher energy aerobic classes) and you’ll be asked to avoid more vigorous exercise for a while to give everything a chance to heal.

‘Exactly when you can resume things is likely to depend on the type of mastectomy you have had,’ says Miss Payne. ‘If you have had a mastectomy without reconstruction, you can start once you are healed. This could be as soon as four weeks after your surgery.’

When it comes to exercise after mastectomy with reconstruction things might take a little bit longer. Again, exactly how long will depend on what type of reconstruction you have.

If You Had: Reconstruction with Implants

‘If you have implants that are under the chest muscle these take a bit longer for recovery than under-breast (also known as sub-mammary) implants that sit on top of the muscle,’ says Ms Payne.

‘At the very least, you’ll be looking at at least 4-6 weeks with no running or other gym work. Those with under-breast implants will recover faster than those with under-muscle although it can be longer if you choose shaped implants.

Under-muscle implants require a longer absence of upper body exercise (and running uses the upper body) as the muscle will be painful and swollen.

Also, too much upper body exercise to the pec muscles can displace the implant and will be painful hence the recommended wait period after submuscular implants.’

If You Had: Non-implant Reconstruction

Not all reconstructions use implants, sometimes your own body tissue will be used.

If you have had a reconstruction using muscle you will need physio advice before you can start exercise using the upper body but expect to be out of action for about two months.

‘If a DIEP reconstruction has occurred (where tissue is used from the belly to reconstruct the breast) then you’ll be given a very specific exercise regime to do before you start regular exercise. This type of mastectomy takes a little longer to recover from and it will take you about three months after DIEP surgery before you can resume normal exercise,’ says Ms Payne.

If You Had: Tissue Expanders

If you choose not to have your reconstructive surgery at the same time as your mastectomy, you will need to use tissue expanders in between operations.

These are inflatable implants that you wear to gently stretch the skin and muscles to make room for the implants. They have a valve on the side and you gently increase their size with regular addictions of saline. Think of it like filling a balloon with water.

You can exercise with tissue expanders in, once your wounds have healed and you’ve been given the okay (there’s a good timeline here as to what’s generally okay when – although again always check with your doctor).

Some women report that exercising with the expanders in can feel a bit uncomfortable, others say it’s no big deal with a good sports bra.

Buying a Sports Bra After Mastectomy

The type of support you need during exercise after mastectomy might also change and so we asked expert bra fitter Michelle Duncan from lingerie and sports bra company Anita for her advice.

‘There’s a number of things you should look for in a sports bra if you have had a mastectomy – including…

• A soft comfortable under band that won’t rub, dig in or roll over,

• A higher cut under the arm, to reduce to risk of rubbing on any scar tissue or putting pressure on the lymph area,

• Cups that have flat seams or are moulded fabric without seams are ideal so that there is a less risk of aggravating any tender areas.

• Avoid low-cut cups that may not provide enough coverage for any areas on the chest that may be shallow after surgery, or may not fit a breast prosthesis in. Cups need to have good and firm coverage to help minimise any bounce from the breast or prosthesis.

• Fabrics need to be smooth, breathable and ideally offer moisture management (to transport moisture from the inside to the outside of the garment) to keep the wearer cool and dry.

• Sports bras should be wire-free to avoid any rubbing or digging in to any scar tissue or tender areas.

• Padded and ergonomically shaped straps offer a high level of comfort and prevent straps from slipping down from the shoulder.

• A front-fastening sports bra can be an asset for ladies with reduced mobility in the shoulders or wrists, but can also be a help for those who have had lymph node surgery, or lattimus dorsi flap reconstruction (in which skin, fat, muscles and blood vessels from the upper back are used to reconstruct the breast).  It means that the bra can be easily fastened at the front and thereby avoiding any unnecessary twisting or reaching round.

For ladies that have had reconstructions, the bra requirements are generally the same as for ladies that have had mastectomies, fit and comfort are still the priority – the only difference is that they will not need a pocket in their bras for a prosthesis.’

What About Yoga and Strength Training?

You might be wondering about yoga after mastectomy. Or Pilates, or strength training.

When exactly can you go back to non-cardio workouts like weight lifting after mastectomy?

Because they are low impact exercises they might seem more gentle and low-risk but Miss Payne says you shouldn’t get complacent.

Once you get back to moving again, the main concern from a surgical point of view is anything using the upper body, as while mastectomy removes breast tissue and, sometimes lymph nodes in the area, muscles in the surrounding area – like the one that helps you lift your arms out in front of you or above your head – can be affected by surgery and they need to heal before you start using them.

This is also why you’re not supposed to lift anything over a couple of pounds in weight for about 4-6 weeks after surgery!

‘Yoga, pilates and anything else requiring upper body strength should be restarted with caution and after doing other strengthening exercises suggested by your doctor or physiotherapist,’ says Miss Payne. The time lines are pretty much the same as we suggest above.

Then when you can go back to your practice, start slow.

Unless you’re very experienced this is also probably not the time to be doing online classes. Until you get used to moving in your new body, go to classes with a teacher or trainer who can help spot moves that might not be the best idea for you and modify them while you build your strength and range of motion back up.

And How About Swimming?

When you have a sports injury swimming is normally suggested as a great exercise while you recover, so you might think it’s okay to start swimming after mastectomy. It is – but not too soon after.

As with yoga and Pilates, swimming uses the upper body to propel you through the water and as such you need to make sure you’ve done your physio and everything is healed before you enter the water.

But there are also a couple of other issues you need to be aware of.

If you’re having chemotherapy post-mastectomy you also should avoid swimming for a little while. Chemotherapy affects the immune system and, while pools should be clean, it’s best to avoid potential exposure to germs in the water.

Radiotherapy doesn’t affect immunity but it can affect the skin and chlorine can irritate this further so check with your radiotherapy team if it’s okay for you to start swimming.

Buying Swimwear Post-Mastectomy

If swimming is your exercise of choice, you might also be a bit worried about buying swimwear, but Michelle has some tips for you too.

‘There are a wide variety of stylish swimwear styles available for ladies that have had breast surgery – one-pieces, bikinis and tankinis.

• Post-mastectomy swimwear tends to have a higher neckline which helps to cover any scarring or shallow areas on the chest.

• Adjustable straps help to optimise the fit and wires should be avoided that could dig in or rub the skin.

• Pocketed swimwear styles allow for a swim prosthesis to be easily inserted and remain in place. They provide a balanced appearance and therefore comfort and confidence.’

What to Expect When You Do Start Moving

Your fitness could be down a little – even if you were exercising right up to the day before your surgery, you’re going to have time off and your fitness will take a small knock. Don’t panic, your body will remember what it used to and you’ll recover quickly.

When you do start moving you might notice a few changes in the way the muscles move – they might feel tighter. This might also cause some tightness when you’re breathing which can take some getting used to at first.

Some muscles may feel weaker than they were before, partly because you’ve had a bit of a break but also because they were involved with your surgery and need time to build back to full strength. Be patient with yourself.

You might also find you get a few issues like pins and needles or shock-like sensations which are related to nerve regeneration. If anything worries you, make sure you mention it to your doctor just to check it’s all okay.

Lastly, there’s one slightly strange side effect you might experience if you choose to have an implant-based reconstruction. According to one runner, because implants don’t warm up as much as natural body tissue, they can be a bit cooler after your workout than the rest of your chest.

Feeling Comfortable With a Prosthesis

If you choose not to have a reconstruction, you might choose to wear a prosthesis to give the appearance of breast under your clothing.

Cancer Research UK define a prosthesis as ‘an artificial breast shape that sits inside your bra to replace all, or part, of your breast.’

There are a few different types of prosthesis. The full prosthesis is used if the whole breast has been removed – ie through mastectomy, while a part prosthesis can be used after surgery where a small area has been removed like lumpectomy.

Within the world of the full prosthesis, you’ll probably first use a temporary breast prosthesis. This is a pocket full of soft material and it’s good to use when the area is healing or while you wait for a longer term solution.

A permanent prosthesis is made from silicone and it aims to match the shape and weight of your original breast.

You can also buy special swimming prosthesis like these ones from Anita.

A first, you might be worried about exercising with your prosthesis in place but Michelle told us not to be concerned – the right sports bra can really boost your confidence about this.

‘If you are planning to wear a prosthesis (for full mastectomy) or partial breast form (for lumpectomy) then it is preferable to wear a pocketed sports bra to keep it safe and secure during exercise.

A pocketed bra has a separate layer of fabric on the inside of the cup with an opening in which a breast from can be slotted with ease between the two layers.  

The pocket of the bra will prevent the prosthesis from “travelling” around, keeping it in the correct position which is important for comfort and the optimum fit of the bra.

Wearing a prosthesis inside a sports bra or indeed any bra, provides a more balanced aesthetic and helps to increase confidence following such an invasive medical procedure.

There are breast forms available that are specifically designed for exercise. Look for those with a ribbed or ridged back that allow for more breathability to keep the skin cooler, and enable water to drip away more easily if used for swimming. Exercise / swim breast forms are also usually a lighter weight than standard prostheses that are used for everyday wear.’

Why You Should Keep Up Your Exercise

For starters it’s a brilliant way to help cope with your feelings after surgery. But most importantly, it’s been shown that exercise can actually help reduce risk of breast cancer recurrence.

In one study, it was determined that 30 minutes of moderate exercise – which can just mean brisk walking – five times a week helped reduce the risk of breast cancer recurrence by 40 per cent. Note – all the people in the trial also had all their suggested medical treatment for their case.

Talking of medical treatment, if you do have chemotherapy, radiotherapy or hormone therapy after your mastectomy, exercise has been shown to help reduce fatigue-related to treatment.

It’s also a good way to help reduce stress and raise mood which considering you’ve gone through a tough time is not a benefit to be sniffed at.

If you’re not ready to run, yet, it might also be a good time to try a walking technique called gratitude walking which can help you shift your focus to all the good things going on around you.

So there you have it. Hopefully everything that you need to know about returning to exercise after a mastectomy.

If you do have any further questions though, please drop a line in the comments and I’ll see if we can get one of our experts to answer them.

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