Introduction
Breast Cancer – Facts and figures
Facts and figures for breast cancer in the UK (from breastcancernow, 2024):
- Around 55,000 women and 400 men are diagnosed with breast cancer every year
- 1 in 7 women will develop breast cancer in their lifetime
- 1 woman is diagnosed with breast cancer every 10 minutes
Surgery for breast cancer
Surgery is usually the first treatment for people with breast cancer. This may be:
- Breast-conserving surgery: removal of the cancer and a border of normal tissue around it
- Mastectomy: removal of all of the breast tissue
Surgery may be needed to remove lymph nodes in the armpit, if the cancer cells have spread to these, or some lymph nodes may be removed to test them.
Radiotherapy (the use of high-energy x-rays to destroy cancer cells) is often used after surgery, to destroy any cancer cells that may have been left behind, to reduce the risk of the cancer coming back.
More information about breast cancer and treatment is available here.
The role of Physiotherapy in breast cancer surgery
Physiotherapists give exercises and advice to help people recover from their surgery and prevent problems from developing. They also assess and treat problems that do develop with the shoulder movement, scars or cording (see further information section for more information).
What to expect from physiotherapy if you have been diagnosed with breast cancer
You may be invited to attend a pre-surgery class to go through the exercises and advice to help you recover from your surgery and prevent problems with your shoulder and scar. If you do not attend a class, you will be seen by a member of the physiotherapy team when you come into hospital for your surgery, who will go through the exercises with you then.
You should be given an exercise leaflet by your breast care nurse or physiotherapist – if you do not have one or need another, follow this link – you can download a copy for free.
Approximately 4 weeks after your surgery you will receive a telephone call from one of our team, who will check how you are getting on with the exercises and advice, how your shoulder is moving, and whether you are having any problems with your shoulder/ arm, scar or you think you may have cording. If you are having any problems, you will be offered an appointment to see a physiotherapist who will assess you and may give you treatments such as further exercises, soft-tissue massage, scar massage or manual therapy.
Contact us
If you have any problems before we contact you or after you have had your follow-up telephone call, please contact us on: Doncaster 01302 644207 or Bassetlaw 01909 50230. Alternatively, call your breast care nurse or the Jasmine Centre, who will contact us on your behalf if they need to.
Shoulder exercises after surgery
Exercises are very important to regain and maintain the movement in your shoulder following surgery for breast cancer. These exercises help to:
- Prevent shoulder and arm stiffness (shoulders stiffen up very quickly if they are not kept moving)
- Ensure there is enough shoulder movement to have radiotherapy treatment if you need it
- Improve symptoms caused by tight scars and cording (a tight band in the armpit or running down the arm)
- Aid circulation and help wound healing
- Reduce the risk of lymphoedema
How and when to do the exercises
Do the exercises 3 times daily (5 repetitions of each exercise), starting the day after your surgery:
- Always do the warm-up and cool-down exercises before and after the main exercises
- For the first week after surgery, stick to the warm-up, “basic exercises” and cool-down, and don’t raise your arms above shoulder level when doing these exercises
- From the second week after surgery, do the warm-up, the “basic exercises”, the “more advanced exercises” and the cool-down, and you can now lift the arms above shoulder level
- From the second week, try to increase the range of movement in your shoulder as you do these exercises over time, until the movement is back to normal, but do not force it
- You may feel a tight pulling/ stretching feeling when doing the exercises – this is normal and should get easier with time
- You may find it helps to do the exercises a short while after taking painkillers
- Continue the exercises until your shoulder movement has returned to your normal level
- If you have radiotherapy, you should continue the exercises until you no longer have tightness or stiffness after your treatment
Stop doing the exercises and seek advice if you notice:
- A new pain that gets worse during the exercises or doesn’t settle after doing them
- New swelling under the arm or the breast area
- New problems with the wound such as infection or problems healing
Scar massage
Once your scar has healed (usually around 2-3 weeks after surgery), regular massage is advised. Do not massage your scar if it still has scabs, or if there is any sign of infection (if the scar is red, hot or swollen).
The benefits of scar massage are:
- Helping the healing process by increasing circulation
- Preventing the scar from becoming tight or “stuck down” to the tissues underneath (which can cause restricted movement in your shoulder)
- Improving the appearance (look) of the scar by softening it and preventing it from becoming thick and lumpy
- Reducing itching and dryness in the scar
How often and how much?
- Aim to do scar massage 2-3 times a day, for 3-4 minutes each time (roughly the length of your favourite song!)
- You should continue scar massage for at least 2-3 months, but ideally until the scar is soft, flat and pale in colour: this can take up to 2 years!
- The longer you continue to do scar massage, the more flexible the scar will be and the better it will look
Should I use a cream when massaging?
- You don’t have to use a cream, but it helps to prevent the scar from becoming dry and cracked, and prevents scabs
- You can use a simple, un-perfumed moisturising cream such as aqueous cream to massage the scar
How should I massage my scar?
- Use the flat part of 2-3 fingertips or the palm of your hand
- Start on the skin around the scar and move then to the scar itself, working along the whole length of the scar
- Begin by gently stroking the skin over the scar: firstly, along the length of the scar, then across the scar
- Then press down gently (aim to apply enough pressure to make the scar go paler as you do it) and move your fingers in 3 directions, moving the skin over the tissues underneath:
- “Side to side” along the length of the scar
- “Up and down” across the scar
- In small circles around the scar and surrounding skin
Reducing the risk of lymphoedema
Lymphoedema is a condition in which fluid does not drain away properly, causing excess fluid to build up, which leads to swelling. Anyone who has surgery (especially involving the lymph nodes) or radiotherapy for breast cancer is at risk of developing lymphoedema. Lymphoedema can develop at any time after surgery – even years later.
To help reduce the risk of lymphoedema you can:
- Maintain a healthy weight and diet
- Use the arm on your affected side normally and do the shoulder exercises
- Exercise regularly
- Reduce the risk of infection and look after the skin on the affected arm
To protect the arm on the affected side, and reduce the risk of infection or damage:
- Avoid dry, cracked skin: keep the skin well moisturised
- Avoid sunburn: use a high factor sunscreen
- Avoid burns: e.g. use oven gloves when cooking
- Avoid bites and stings: use an insect repellent
- Avoid cuts and scrapes: wear protective gloves when gardening, take care when cutting nails, use a thimble when sewing
- Don’t wear tight fitting bras, sleeves, watches or rings
- Don’t have injections, blood samples or have your blood pressure taken on the affected arm if you can avoid it
- Take care when shaving under your arms: an electric shaver is the safest
- Keep cuts or grazes clean and use an antiseptic cream and see your GP if you think it shows signs of infection as you may need antibiotics (redness, heat, swelling, pain, or flu-like symptoms)
If you notice signs or symptoms of swelling in your affected arm, contact your breast care nurse, GP or treatment team as soon as possible (early diagnosis makes lymphoedema easier to manage):
- Swelling/ puffiness or feeling of fulness in the arm, hand, breast or chest area
- Rings, watches, bra straps etc feeling too tight
- Pain or discomfort, or altered sensations in the arm
Remember that the risk of lymphoedema is present for life, not just the first few weeks or months after surgery.
General advice for recovery after breast surgery
There are no set rules about when you can get back to your everyday activities as everybody is different. Be sensible and listen to your body, but the following points can be used as a guide:
Daily activities
- Try to do a little more activity each day – don’t set yourself large tasks, pace yourself and take regular breaks
- Get plenty of rest – having a lie down on your bed is more relaxing than sitting in a chair
- Use your affected arm normally for personal care such as eating and drinking, dressing (including back fastenings), washing your hair etc
- Light housework such as dusting, washing up and preparing a light meal can be good exercise, but avoid heavy housework for the first 2 weeks
- Avoid (or keep to very short periods only if you can’t avoid) heavy or repetitive tasks such as dusting, vacuuming, ironing, pushing a shopping trolley, hanging washing out for 4-6 weeks after surgery
- Avoid heavy lifting and carrying, especially above shoulder height, for 4- 6 weeks after surgery, or until your scars are healed – try to stick to lifting nothing heavier than a couple of bags of sugar for the first month or so, and use both hands to lift if it is easier
- By 8-12 weeks after surgery, if you have had no complications, you should be building up to your normal levels of activity
- Your shoulder may feel uncomfortable and stiff as you start to do more and move your arm more – this should improve naturally with time
- Remember, your body needs time and energy to recover – eating well will help your body to recover and your wound to heal
- When resting, in the early days, support your arm on a pillow, away from the side of the body and avoid holding your arm tight against your body
Emotions
- There are many emotions that you may feel: there is no right or wrong, and each day may be different
- You may feel tired, vulnerable and emotional when you first get home from hospital
- You may feel frustrated at the things you can’t do
- You may feel isolated
- You may struggle to come to terms with a cancer diagnosis
- You may be worried about the future
- Try to let your family and friends know how you are feeling
- Discuss how you are feeling with your breast care nurse – they can help signpost you to support services
- See the websites at the bottom of this page for more information about where you can get help and advice
Exercise
- General exercise has many physical and psychological benefits which will help your recovery
- Start gentle exercise such as walking straight after your surgery, but build up gradually
- Swimming should be avoided until scars are fully healed: usually around 4-6 weeks
- Ask for advice about swimming from the medical team if you are having radiotherapy or chemotherapy
- Most non-contact and non-racket sports (including gentle weights) can be started at 6-8 weeks after surgery – gradually increase the intensity and weights
- Higher intensity sports should be left until 12 weeks after surgery, and should be introduced gradually
- The general guidelines for exercise in adults can be found here
Driving
- You can resume driving when you feel ready to do so, if your wound is healed and you have good shoulder movement
- You must be confident that you can safely handle the car including in reverse (gears, handbrake, steering wheel) even in an emergency, and do an emergency stop
- This is usually 2-3 weeks depending on the type of surgery you had
- Check with your insurance policy, as some will not insure you for a certain number of weeks
- You are not exempt from wearing a seatbelt, so make sure that you can tolerate the seatbelt
- Start with small journeys (for example just practise driving “around the block”) and consider having someone with you at first
Sexual activity
- You can resume sexual activity as soon as you feel comfortable and ready to
- Your scar area may be sore, and you may feel vulnerable and insecure at first – try to talk to your partner to explain how you feel
- Emotional support is available – see further information section at the bottom of this page, or talk to your breast care nurse
Return to work
- How soon you can return to work will depend on the nature of your job, the type of surgery you had, and how well you recover – discuss this with someone in your medical team if you need to
- It is best to feel completely well before you go back to work
- Most people have between 4 and 8 weeks off work, but some have less time off, some more
- You may feel tired and struggle to concentrate when you first go back to work
What should I look out for?
Find out more about the after-effects of surgery and what to look for here
The following symptoms will usually be temporary and nothing to worry about, but if they do not go away or become more of a problem, then let your breast care nurse or anybody in your medical team know (especially if they restrict your arm movement)
- Seroma: a collection of swelling under the arm or in the breast or chest wall – these usually go down by themselves as the fluid is reabsorbed into the body
- Haematoma: a collection of blood around the wound which can cause swelling, hardness and discomfort – these usually get reabsorbed by the body over a few weeks
- Strange sensations/ numbness in the armpit or upper arm: this is due to the nerves being damaged during surgery. This could be temporary (but could take a year or more to recover), or it may be permanent
If you have any of the following symptoms, then let your GP, breast care nurse or anyone in your medical team know:
- Stiff shoulder: your arm and shoulder may feel stiff for some weeks, but the movement should gradually get back to normal as you use your arm and do your exercises – if the stiffness does not improve, then you should get this checked, especially if you are due to have radiotherapy
- Cording: a tight band or cord in the armpit or running down the arm – this can restrict your shoulder movement and can be painful – this is not harmful so keep doing your exercises
- Wound infection: if your wound becomes tender, red, hot or swollen, there is fluid leaking from the wound, or you feel unwell with a raised temperature, let your GP or breast care nurse know
- Lymphoedema: swelling in the arm, hand or breast area, due to a build-up of fluid in the tissues
Contact Physiotherapy
If you have any problems before we contact you or after you have had your call, please contact us on: Doncaster 01302 644207 or Bassetlaw 01909 502302. Alternatively, call your breast care nurse or the Jasmine Centre, who will contact us on your behalf if they need to.
Further Information
Breast Cancer Now website
This website has a great deal of information and a number of leaflets on all aspects of living with breast cancer. Some that are particularly relevant to physiotherapy are:
What to expect after breast surgery
Shoulder exercises after breast cancer
General exercise during and after treatment
Other sources of information
https://www.cancerresearchuk.org/
Cancer support services near you
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