Shoulder Rehabilitation After Mastectomy – What Breast Surgery Patients Should Know

After mastectomy many women experience chest tightness, numbness or tingling in their arm or hand on the surgical side, or decreased shoulder mobility and/or strength.  These changes can be due to the surgery itself, scar tissue from the incision, or from decreased movement after surgery due to pain or fear of moving the shoulder.  The pain and stiffness after surgery can lead to shoulder weakness and frozen shoulder.  It is important that post-mastectomy patients start gentle shoulder mobility and activity shortly after surgery, and once activity has been approved by their physician.

When is PT Needed Following Mastectomy?

The American Cancer Association recommends asking for a referral for post-mastectomy physical therapy if you are having decreased strength, mobility or continued pain 4 weeks after surgery.  You may have shoulder changes with any breast surgery including:

• breast biopsies
• lymph node biopsies
• lumpectomies
• mastectomy
• breast reconstruction

What are the Symptoms of Shoulder Deficits Following Mastectomy?

Symptoms of continued shoulder deficits can include decreased ability to lift your arm over shoulder height, difficulty taking a deep breath or feeling rib cage tightness, completing daily activities such as washing your hair, dressing, or hooking your bra.

The therapist who assesses you should look at your shoulder range of motion, strength, rib mobility, and surgical scar.  You should also have an assessment of any swelling surrounding your shoulder, shoulder blade and upper arm to get a baseline and to watch for signs of lymphedema.  Learning basic lymphatic massage can also help you to manage any swelling from the surgery itself.

What Happens In Relation to Mastectomy Scars?

Often the scar from mastectomy will get bound down to the ribs or to the connective tissue in the chest wall.  This can significantly decrease your ability to move your shoulder and cause discomfort when the shoulder is stretched beyond the limits of the scar.  Because of this, it is very important that your therapist look and touch your scar so that they can start increasing the mobility of the scar and teaching you how to do scar massage at home.

Post-Mastectomy Shoulder Exercises

Below are some basic shoulder exercises to help you get moving following mastectomy or any breast surgery.  Remember, if you are continuing to have a decrease in shoulder mobility or you feel that you can’t move your shoulder to complete your daily routine, please seek help from a physical or occupational therapist who specializes in post-mastectomy care.  Also, please watch for any change in swelling or heaviness in your upper arm.  If you notice swelling, contact your physician about lymphedema therapy.

-Jennifer Cumming PT, MSPT, CLT, WCS

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed, you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you. If you enjoyed this blog, check out our website at foundationalconcepts.com for more blog entries and to learn more about our specialty PT practice, Foundational Concepts. Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook/Foundational Concepts for updates.