Breast Rehab Program

Jul 2014

Edema Control

Lymphedema is a possible complication following breast surgery and mastectomy. It is partially caused by removal of underarm lymph nodes. Circulation of lymph fluid may be slowed, resulting in swelling of the arm on the affected side. As a patient, you need to know how to monitor and treat the swelling and take necessary precautions to prevent possible infection.

1. In the immediate post-operative period, elevate your arm on a pillow with your elbow positioned away from your body and your hand elevated above the elbow.
2. Avoid hanging your arm down except for brief periods to prevent accumulation of fluid in your lower hand and arm.
3. Follow the specific instructions for isometric exercises provided by your therapist twice daily until optimal results are achieved.
4. Within your physician's guidelines, you should use your arm as much as possible.
5. DO NOT permit injections, vaccinations, blood samples, or blood pressure to be taken on the affected arm.
6. DO NOT wear tight clothing, a wrist watch, or jewelry on the affected arm.
7. DO NOT carry heavy articles (over five pounds) with your affected arm for the first six weeks after surgery or as directed by your physician.
8. DO avoid all cuts, scratches, pinpricks, and hangnails. Any break in the skin may lead to infection and swelling.
9. DO protect your arm from sunburn and insect bites. Apply lotion to dry or chapped skin.
10. If edema persists, pressure garment or mechanical compression of the fluid may be recommended by your physician.

REMEMBER: A hot, reddened, or swollen arm may denote infection, and you should consult your physician immediately.

Exercise

GENERAL GUIDELINES

1. Check with your doctor about the exercises you can do at various stages after surgery. Your doctor may request consultation with an occupational or physical therapist while you are in the hospital to help outline the exercise program which is best for you.
2. When performing these exercises, pause when you begin to feel tension or pain. If pain eases, slowly continue the exercises. If the pain does not subside, rest and continue the exercises at a lower level until able to tolerate more.
3. DO NOT hold your breath during exercises. Remember to take deep breaths; it helps when the going gets tough.
4. Each exercise should be done slowly. The way to regain your motion is to work gradually, increasing in small steps each day. Begin with five repetitions and work to twenty.
5. The stiffness and tightness felt in the tissues of the chest and armpit (axilla) after surgery or radiation therapy will come and go for awhile. Continue to work to improve your motion at least three times per day until that feeling of tightness is no longer a problem.
6. Be persistent with your exercises. But get all the rest your body needs and do not get overtired.
7. Start on activities which will be helpful in your regular routine--reach into cabinets, wash and brush hair, put your arms behind your neck, fasten your bra.
8. Normal shoulder motion is achieved when you can reach across the top of your head and touch your opposite ear without feeling a stretch in your armpit of the arm on the side of the surgery. Another test to determine if you have achieved shoulder motion is to place your affected arm behind your back and touch your bra strap.
9. Your arm should recover its full motion and strength approximately two to three weeks following breast surgery. If you feel you are having difficulty regaining your shoulder motion, ask your doctor for specific instructions or for a referral to an occupational or physical therapist.

Exercise

Do the first two exercises the first week after surgery. Do the third exercise after your drain is removed. You may begin the other exercises (numbers four through twelve) at that time as well.

Isometric Exercises

1. a. Lying in bed, hold a rolled towel or sponge ball in your hand. b. Support the arm so that the elbow makes a ninety degree angle and so that the hand is above your heart. c. Alternately squeeze and relax your hand.