After a breast cancer diagnosis, surgery is usually prescribed to find and remove cancerous lymph nodes (sentinel node biopsy), cancerous or abnormal breast tissue (lumpectomy) or for the removal of the entire breast (mastectomy). Today, physicians use less invasive surgical techniques, including breast conservation efforts that allow patients to recover more quickly. Still, patients can undergo side effects that affect arm or upper body mobility and quality of life.
Resie Collins, an occupational therapist and certified lymphedema therapist who specializes in breast cancer rehabilitation, says the inclusion of occupational therapy helps patients regain range of motion quickly and safely and return to normal activities of daily living.
Question: Who should receive breast cancer rehabilitation?
Answer: Male and female patients undergoing breast cancer surgery benefit from rehab as part of a comprehensive breast cancer treatment plan to proactively reduce the risk of developing side effects, such as muscle and joint tightness, decreased endurance, a swelling condition known as lymphedema, rigid scar tissue formation and cording or axillary web syndrome (AWS), often described as a visible cord that runs from the armpit down the arm.
There are patients who are afraid to move but the lack of physical activity can cause muscles to tighten up, making it more difficult to recover normal flexibility. Movement is a vital component to recovery after surgery. With simple exercises and normal activity, patients can regain range of motion and return to regular activities, which helps them recapture their independence.
Q: Why is it necessary?
A: When breast tissue is removed or cut during surgery, a person’s posture is affected and may create asymmetry in the upper body. Pain can cause a patient to use compensatory movements that change normal muscle action. It can also impact range of motion by making the person hesitant to move the afflicted arm. Any incision that creates scar tissue results in tightness along the skin and muscle. As occupational therapists, we guide a patient through exercises to help the person feel comfortable moving through pain.
Another aspect of our job is to educate a patient on how to reduce the risk of lymphedema, which can occur when lymph nodes are surgically removed or after radiation. If swelling does occur, we are trained in treating this condition with manual lymphatic draining massage techniques and compression bandaging. If cording or AWS occurs, we can perform manual stretching to reduce tightness and educate patients on appropriate exercises. Some patients say they wish they’d came in sooner when they see how much this can help the tightness that runs from the arm pit down the arm.
Q: When should I start?
A: At UC San Diego Health, patients who undergo breast cancer surgery are seen the day after surgery, as prescribed by their physician. We collaborate with our physicians to develop a therapy plan that suits each person’s needs. From the beginning, we encourage patients to use their arms to feed themselves, comb their hair and perform exercises while moving through a tolerable level of pain. The sooner patients begin rehab, whether in the hospital or at home, the sooner they can return to everyday activities and improve quality of life.
Q: What should I expect?
A: After surgery, we start with shoulder shrugs, shoulder rolls and start to move the arm in a forward motion and up above the head as much as can be tolerated. Another exercise might include placing the affected hand on top of the head while moving the elbow in and out.
Upon discharge from the hospital, patients are expected to do exercises at home at least three times per day. Approximately two weeks later, patients are referred to our outpatient clinic where we offer education on lymphedema and prescribe new exercises to do at home twice a day. Patients might visit us once or twice a week until they regain full range of motion that they had prior to surgery. It can be as much as 12 visits, depending on each individual, which is why each person’s therapy is personalized.
For more information, visit the
breast cancer rehabilitation website or call 858-657-6590.
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Breast Health Center
Breast Cancer Rehabilitation