Breast cancer affects one in eight Australian women, and 40 per cent of those diagnosed undergo mastectomy for treatment. Further, half of the women in the mastectomy group will have major breast reconstructive surgery.

Physical recovery following breast cancer surgery – with or without reconstruction – is an intense rehabilitation process. And while physiotherapists play a critical role, those in private practice who advocate self-care pre-and post-operatively achieve the best possible outcome for patients – but it’s not without limitations.

Breast Research Australia physiotherapist Professor Deirdre McGhee conducted research that showed many women were unaware that exercise pre-and post-operatively significantly impacts recovery.

As a result, Professor McGhee created free online resources consisting of five videos, a podcast and a webinar to facilitate safe exercises and education on wound and drainage care, pain management, and acute post-operative care.

Physiotherapists, especially those in rural and remote areas with limited access to breast cancer-specific services, can use these resources to facilitate clinically suitable exercises and to promote self-care following surgery.

Physiotherapist Ronald Yip says breast cancer surgery clients are common in the private clinical setting. So, resources that provide education, raise awareness and engage health professionals in the life-changing journey that is breast cancer recovery are crucial – but there are barriers to self-care.  

“Recovery from breast reconstruction surgery can be a long, painful and tiring process.

“Most of the time, I have found that patients do not acknowledge the importance of physical recovery.

“Patients might be emotionally overwhelmed, and hence they do not have the additional time to perform appropriate exercises regularly,” says Mr Yip.

Another common barrier to self-care for women following breast cancer surgery is the fear of harming themselves through exercise.

“Patients can be unsure or afraid of performing regular exercises, thinking that exercises might cause damage to their joints and bodies.

“So, a progressive and guided prescribed exercise program is very important for these patients.”

The main benefits of a self-care resource for physiotherapists treating breast cancer patients is to help facilitate treatment plans and better understand post-treatment options for women.

“This resource is helpful for physiotherapists, as it increases the awareness of breast cancer physiotherapy management, especially targeting community-based or private clinic setting physiotherapists.

“Being physiotherapists in a private clinic setting, we are the first-contact practitioner.

“This resource will facilitate treatment and management planning, and, if need be, direct patients in the right direction for further community support.”

Preparations pre-operatively are also an important consideration for women to set the groundwork for optimum recovery following surgery. 

“Strengthening and maintaining shoulder or upper trunk range of motion is vital to preparing for reconstructive surgery.

“It normally takes at least six to 12 weeks to retrain muscle power - plus muscles and the body tend to fatigue easily after radiotherapy.

“So, preoperative physical and mental exercises are essential to achieve better outcomes.”

A preoperative exercise program designed by a physiotherapist (or other health professionals) is important to ensure exercises are specific and appropriate for individual patients, explains Mr Yip.

An ideal program includes a prescribed bilateral shoulder and upper trunk exercises performed two to three times per week and various strengthening exercises.

“Gentle and gradual strengthening can usually be self-managed with TheraBand or light dumbbell weights, which can be easily achieved at home.

“Another important aim of performing preoperative exercises is that it significantly reduces the risk of developing any lymphoedema or fluid accumulation around mastectomy site.

“Fluid accumulation is another leading factor of restricting upper limb movements and mobility, which is commonly seen in breast cancer patients.

“Active upper limb movements or exercises can hugely diminish the risk of fluid development around lymph nodes area.”

The barriers to physical recovery following breast cancer surgery are numerous, but common restrictions include limited range of motion, weakness and reduced sensation.

“Post-operative women typically experience limited shoulder range of motion, possible weakness in their arms and, at times, some altered or reduced sensation post-operation.”

Physiotherapists help to remove barriers to recovery by:

• Strengthening shoulder and arm muscles
• Reducing tension at the incision site
• Managing scar tissue
• Desensitising the incision site
• Reducing nerve irritation to overcome reduced sensation

Early interventions to manage physical side effects of reconstructive surgery

Early introduction of active assistant range of motion exercises, especially for the shoulders and upper trunk, is vital to combat incidence and severity of physical side effects of breast cancer surgery, advises Mr Yip.

• Gradual strengthening upper limb and trunk exercises (if it is tissue-based reconstructive surgery type

• Gentle stretches to maintain shoulder and upper limb range

• If the upper trunk/shoulder ranges are very limited by pain/other symptoms, a physiotherapist can reduce muscle tension and provide appropriate manual treatment to achieve a more optimal shoulder range.

• Advise on sleeping and sitting to avoid prolonged periods of shoulder internally rotated. Internal rotation of the shoulder is a common position that causes stiff shoulders

• If symptoms are still unresolved with manual treatment, hydrotherapy is a great option to help restore shoulder mobility.

• Encourage clients to attend supervised hydrotherapy sessions with a physiotherapist to establish a suitable hydrotherapy exercise program, which can be self-managed in the long term.

Breast reconstruction are major surgeries that require the expertise of physiotherapists to ensure safe rehabilitation, but self-care resources are also crucial to optimum recovery. Physiotherapists in private clinical practice can access free self-care resources to support their clients’ breast cancer recovery journey.