Breast Rehab Program


   July 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. 1In 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 carryheavy 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 youx 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.

2.
a. While sitting, place hands on top of shoulder with elbows spread apart as far as possible.

b. Move hand to under arm position so that your hands touch your armpits making a half circle motion with your hands.

c. Pause briefly between each movement.

3.
a. Face the wall and place both hands on the wall straight ahead.

b. Slowly climb the wall with fingers.

a. With your side facing the wall, slowly climb the wall with fingers.

When performing these exercises, pause when you begin to feel tension or pain. Take several deep breaths and try to relax while maintaining your present position. if the pain or tension eases, slowly walk your fingers further up the wall stopping when you reach the next point of tension. If pain does not subside repeat the exercise only up to the same level on the wall until you are able to tolerate a higher position.

4.
a. Place palms of hands together with fingers extended.

b. Press firmly together for a count of three, then release and repeat.

5.
For the first few days following surgery, it is good for you to practice deep breathing frequently. Lying on your back, breathe in deeply, expanding your lower chest as much as possible. Then let your air out and relax. Concentrate on relaxing during the exhalation phase of breathing. Repeat this three or four times, breathing in deeply and then relaxing. This will help you to relax as well as to expand and gently move the chest wall and lungs on the side of your surgery.

6.
a. Fold arms in front (cradle position). Support the elbow of the involved shoulder,with the other hand.

b. Shrug both shoulders. Push elbow on the involved side up if necessary.

7.
a. Fold arms in front (cradle position).

b. Raise arms to shotdder height.

c
. Move arms side to side maintainin arms at shoulder height.

8.
Method #1

a. Fold arm (with arm closest to surgical site on top).

b. Raise arms as high as possible.

Method #2
a. lnterlock fingers.

b. Raise arms as high as possible, keeping elbows straight.

9.
a. Lie on your back.

b. Clasp both hands behind your head.

c. Spread elbows apart as far as possible.

d. Move elbows back close to your head.

10.
a. Sit forward in a chair with both feet flat on the floor.

b. Clasp your bands behind your waist.

c
. Slide hands up your back as far as possible.

d
. Hold to a count of three and slowly move arms back down.

11.
a. Sit forward in a chair with both feet flat on the floor.

b. Pull your shoulders back as far as possible.

c
. Hold to a count of three and relax.

12.
This is an advanced exercise that can assist to increase forward motion of the shoulder.

Equipment: A 6-foot rope or band; door.

Have someone drive a large nail into the top edge of a closet door or other door, about six inches from the out-side corner. If the door is hollow, use an expansion Lott. Be sure that the nail is driven in at least one inch. This will prevent the door from closing. The nail will not damage the door and it can be removed after you have mastered the exercise. The hole on the top cannot be seen.




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