Physiotherapy advice and exercises following breast reconstruction using an abdominal flap - Northumbria Healthcare
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Northumbria Healthcare
NHS Foundation Trust
Physiotherapy advice
and exercises following
breast reconstruction
using an abdominal flap
Issued by the Physiotherapy Service
1
How can Physiotherapy help me after my operation?
You have had some surgery to reconstruct your breast using
some tissue from your abdomen.
Your stomach and chest will feel uncomfortable to move. It is very
important that your muscles are exercised correctly to prevent
stiffness and loss of function.
The exercises in this booklet are gentle and can be commenced
with your Physiotherapist during the days after your operation.
Once you are discharged home these can gradually be increased
to help you improve your posture and function.
You will be nursed in crook lying for several days after your
surgery with plenty of support from pillows. Over the course of the
2-3 weeks following your surgery you will be able to lie
progressively more flat and stand more upright.
You will be given an appointment with a specialist Physiotherapist
for 2-3 weeks after your operation to check your progress and
give you further advice and exercises.
2
Exercises to start in hospital
Breathing Exercises – to try to reduce the risk of chest infection
should be done 3 times each, 3-4 times daily.
1. Deep breathing Exercises
Take a deep breath in through your nose filling your lungs as fully
as possible. Hold it for a few seconds, take an extra breath in then
relax the breath out.
2. Diaphragmatic Breathing
Rest a hand on your stomach just under your rib cage. When you
take a breath in your stomach should rise, and as you breathe out
it should fall.
3. Huffing / coughing
To protect your abdominal wound when coughing, bend your
knees up a little and support your wound with your hand /arms. A
short forced breath out (huff) puts less stress on your abdomen
and may be sufficient to clear phlegm. If it is difficult to huff the
phlegm away, try a few huffs then a cough.
Circulatory Exercises – to maintain the circulation in the deep
veins of the legs, perform 5 repetitions of each exercise every
hour you are awake. Gentle active lower limb exercises are
important to enhance your circulation whilst your mobility is
limited.
l Pull your toes up towards you and push them away
l Gently bend and straighten your knees
l Tighten your thigh muscles by pushing your knee down onto
the bed, hold for a count of three and relax
l Clench your bottom muscles together
3
Practical issues
How do I get in and out of bed when I get home?
l Keep your knees together
l Roll onto your side
l Gently take your legs over the side of the bed
l Slowly ease your self up into a sitting position.
How do I improve my posture?
When standing and walking you may feel tightness across your
abdomen which will encourage you to stoop. This is normal.
Gradually it will ease and by about 2 weeks after your operation
you should be walking more normally.
Are there any movements I should avoid after my
surgery?
You will be advised by your surgeon / physiotherapist on any
movements you should avoid after your surgery depending on the
particular surgical technique that has been used. In general you
should not stretch your arm out to the side above shoulder height
with the elbow either bent or straight, for the first week after
surgery.
When can I start using my arm normally?
Unless you have specifically been told not to, you can start using
your arm more normally after the first week, gradually at first and
within a pain free range.
When can I start to lift and do housework?
Avoid lifting and any heavy push / pull actions for 6-8 weeks. This
is to protect your abdominal wound.
4
Which exercises should I start and when?
Shoulder exercises (week 1).
These can be started the first day after your operation. Continue
them for 1 week. Repeat each exercise 4 times daily 10
repetitions each time.
1. Shrug your shoulders up
towards your ears and then relax.
2. Shrug your shoulders up towards your ears,
and circle them backwards and down.
Then circle them forwards and down.
3. Rest your hands on your shoulders and
raise both arms forwards to shoulder height
and then slowly lower them down.
4. Rest your hands on your shoulders.
Gently take your elbows out to the side
to shoulder height and slowly lower them
down.
5
Abdominal Exercises
These can usually be started 2-3 days after your operation and
should be continued for at least 6 weeks afterwards. Build them
up gradually, practising them 5-10 times each, 3-4 times a day.
When you start them you will be in the crook lying
position
5. Pelvic tilt.
To ease backache and gently tone the muscles, pull in your
tummy, tilt your pelvis and flatten your lower back onto the bed,
hold, then release slowly. A gentle rocking motion can ease
backache.
6. Abdominal bracing.
You can do this gentle exercise for deep muscles in any
position. As you breathe out, draw in the lower part of your
tummy towards the spine. Keep breathing and hold for 10
seconds, then relax.
6
7. You can also do pelvic tilting sitting near the edge of the bed or
a chair. Sit up straight and gently arch your back. Then slump
down rounding your back and gently pulling your tummy in.
You can do pelvic tilting if your tummy is feeling tight, or your
back is sore.
8. Gentle knee rolling can be started within the first few days of
your surgery. Lie on your back with your knees bent and
together, so that your feet are flat on the bed. Slowly roll your
knees from side to side keeping your shoulders on the bed.
Progressed shoulder exercises to be started the
week after surgery (week 2)
These should be done to help mobilise the shoulder and maintain
range of movement. Repeat each exercise 4 times daily, 10
repetitions each time. These can be started from the second week
after surgery if your wounds are well healed and you have not
been told you have any restrictions.
9. With your arm straight, slowly
raise your arm forward as high as
you can comfortably and then
slowly lower it down.
7
10. With the arm straight take your arm
out to the side and then slowly lower it
down to your side.
11. Lie on your back with your elbows
straight. With your hands clasped
together or holding onto a stick, stretch
your arms above your head. Your
unaffected arm will be helping the
affected one. Slowly aim to stretch your arms back
towards the pillow. Start doing this with your knees bent and
feet flat on the bed. Gradually progress this exercise by
straightening your legs.
If there is any delayed healing do not progress your
exercises without advice from your Physiotherapist.
How long do I continue my exercises?
Continue your exercises four times a day
until your Physiotherapist gives you further advice.
Will I get full movement of my arm?
It is anticipated that you will regain full range of
movement unless you had restrictions before your surgery.
When can I drive?
You should not consider driving for 6-8 weeks and then only if
your wounds are well healed and you feel confident to handle the
car in an emergency situation.
8
When can I resume my hobbies / sports?
You can resume any sedentary hobbies (reading, knitting, sewing)
as soon as you feel able after your operation. You should be back
to all normal activities after 3 months including housework –
providing you have not had delayed wound healing.
Check with your Physiotherapist should you wish to resume an
activity prior to this.
You can resume pilates, yoga and swimming (wounds must be
well healed) from 6-8 weeks.
You can start to increase the sports activities such as keep fit,
weight training, tennis and golf from 3 months onwards.
When can I return to work?
If you have a sedentary job you, may be able to return to work
about 6-8 weeks after your surgery.
If you have an active job you will need to discuss this with your
Consultant or Physiotherapist. It is possible that you will be off
work for three months.
What about sexual activities?
You will be able to resume sexual activities once your wounds are
well healed and you feel comfortable.
What about care of my scars?
Once your abdominal wound has fully healed, moisturise your
scar and abdomen with moisturising cream. You will be advised
by your surgeon about moisturising your breast mound.
9How can I reduce my risk of developing
Lymphoedema?
By achieving a good range of movement at your shoulder,
keeping your skin in good condition, making sure that any cuts or
scratches to the arm do not become infected, avoiding injections
and blood pressure taking on the affected side, you can help to
reduce your risk of developing Lymphoedema.
For any further help or advice you can contact your
Physiotherapist
Name _______________________________
Tel Number __________________________
10Support Contact Numbers
Breast Care Physiotherapists
North Tyneside General Hospital 0191 2934064
Wansbeck General Hospital 01670 564010 / 564011
Hexham General Hospital 01434 655031
Breast Care Practitioners
Wansbeck General Hospital 01670 529391 / 529636
Breast Care Nurses
North Tyneside General Hospital 0191 2934183
Wansbeck General Hospital 01670 529319
Hexham General Hospital 01434 655386
Breast Cancer Care Helpline 0808 800 6000
Breast Cancer Care Website
www.breastcancercare.org.uk
Macmillan Cancer Relief Helpline 0845 601 6161
Macmillan Cancer Relief Website
www.macmillan.org.uk
Breast Cancer Campaign
www.breastcare.co.uk
11PIN 631/V2 Review date: June 2021
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