Mastectomy Recovery: Six Factors That Influence How You Recover

Marian Barnick

Marian Barnick

Marian Barnick is a Registered Kinesiologist and Cancer Movement Therapist. She helps cancer patients build empowerment and return to activities with her Move Well techniques and training.

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The more patients I meet, the more it proves to me that each woman’s experience after their mastectomy is unique and no two roads to recovery are the same.  I know, I know.  Everyone’s unique.  But the healing process from breast cancer surgery brings up a whole new set of rules.

The Negative Emotional Impact

I’m not talking here about the impact of diagnosis, or the impact of surgery.  I’m talking about the emotional roller coaster that happens during recovery.

A very wise woman had a message for me last week.  We first chatted over the summer at a conference in San Diego.  I told her about my work with breast cancer patients and my plans to develop an online course.  I explained that after surgery, breast cancer patients have a lot of pain, tightness and really need movement therapy to help get mobility back in the shoulders and stretch out their chest muscles.  This really effects their physical recovery as well as their emotional well being.

Well fast forward a few months and this wise woman has been diagnosed, had a lumpectomy, and now undergone a double mastectomy.  She told me last week that if she hadn’t talked with me in San Diego she never would have known about how her surgery was going to effect her body and how hard it would be to try and move afterwards.

So if you don’t know what you’re in for, how can you prepare?

Do you know what happens between diagnosis and surgery?  You become best friends with Google.  For better or worse, this is your ‘Go To’ resource and you search, look, read, and compare.  Yes, I said compare.  And that’s the problem.

Remember I said that everyone’s unique?

There’s a lot of info out there in Google land.  And this is a good friend that can be some super helpful when you’re stuck at home, feeling like sh*t, and have no answers.  But when you start comparing yourself to the info you’re finding, that’s when the negative emotions can really take a turn.

The General Information Curse

As I said, there are great sites online.  Lots of fantastic information to get you through.  But it’s general information.  It’s meant for the ‘general breast cancer patient’.  And as we know, she just doesn’t exist.  Everyone’s story is different.  My point here is that when you start comparing yourself to the guidelines and the healing time frames, and the exercises you should be doing in the first week, second week…. you can find yourself getting frustrated, upset, and feeling like you’re not measuring up (or worse, that you’re doing too much and might get injured and delay your recovery!).

So let’s take a look at SIX Factors that effect your post mastectomy healing and effect your ability to move forward with your post mastectomy exercises.  Remember – I’m a Cancer Movement Therapist.  I am ALL about the exercise because I’ve seen the amazing physical and emotional benefits for my patients who stick with their program and start moving as soon as they’re allowed to after surgery.

My hope is that these factors keep you out of the comparison ‘rabbit hole’ and that you find your ‘best’ way to get back to your activities.  Do NOT feel disappointed with your progress.  If you think you’re falling behind – STOP.  This is the time to do the best for YOU.  Listen to your body, listen to your team of experts, and ask a lot of questions!

  1. Type of Surgery

Unless you’re in the know – and that usually means a patient, survivor, or someone who works with breast cancer patients – you probably think of ‘breast cancer surgery’ as a single type of treatment.  But that couldn’t be further from the truth.

You’ve got procedures for lumpectomy, mastectomy, lymph node biopsy, reconstruction, expanders….and there’s more and all with variations.

The point is that each of these types of surgeries impact how you feel after, how long you’re in the hospital, how long it takes to heal, and how soon you can start to move forward with activities.

What surgery does is disrupt the body – the skin, the muscles, the tissues.  And all of the disruption has to heal.  In addition, general anesthetic is no walk in the park for a lot of people.  Post surgery patients feel nauseous, certainly don’t feel like eating, and are on medications that have their own side effects.  All of these pieces are related to surgery.

While you can’t change the type of surgery that’s best for you, you can get ready for the side effects.

  1. Smokers will not heal as fast as non smokers. Enough said.
  2. Most pain meds post surgery will cause constipation so be prepared with remedies to help.
  3. You won’t feel like eating but good food, and even at the beginning, just calories, will help your body heal. A dairy free smoothie (dairy might upset your gut or react with meds), calorie dense food for energy, something you can easily digest.  Prepare a snack pack before your surgery and bring it to the hospital.  Or if you have a loved one visiting, ASK for something you think you might be able to tolerate.
  1. Medication

Oh ya, this is going to get you through the rough times but let’s face it, pain killers are not what you take to get you motivated to move.  And that’s for a reason.  Your body needs to heal.  And you’re not in a sprint – recovery is a marathon.

Your meds will give you a foggy head and you’re cognitive skills won’t be at their best.  So initially, you could have problems with things like remembering when you took your medications.

Medication side effects can also include things like a sore tummy, constipation, and headaches.  It’ll depend on what you’re prescribed and how you react.  But in any event – YUCK.

And some of your meds, including the anesthetic, can effect your appetite.  It may be hard to get any good food into you right after surgery.  So along with the grogginess from medication, your energy levels will be low because of not having a lot of food in you for your body to use.  Eat what you can, rest, and get in some ‘healthier’ food choices as your body is able to.

  1. Your Fitness Level

If you take care of yourself prior to surgery it will definitely be a benefit to healing after surgery.  You’ll recover faster compared to patients who have lower fitness levels.

You can look at fitness from these three basic levels.

  • cardio-vascular fitness
  • strength
  • flexibility

All of these are important after surgery and give you the benefit of already having a big ‘plus’ in your recuperation journey.

Cardiovascular fitness helps to ensure great flow through the body, lowers risk factors from anesthesia, helps you get rid of waste products within the body faster, and gives more oxygen and nutrients to the tissues that need to heal.

You’ll really rely on your strength after surgery as you try to get up and out of bed, move to the bathroom, and try to put on clothes.  If your core is strong, it will definitely help you.

The tendency after surgery is to be flexed forward, rounded, and you’ll be tight and sore.  This takes it toll on the back muscles.  It’s also difficult to find a comfortable position and you’ll most likely be sleeping on your back.  If you’re used to engaging your core to help with posture it’ll make a big difference as you move from lying to sitting, as you try to sit upright in a chair, and as you walk or climb stairs.

If you’re used to doing stretches and have good range of motion before surgery, it’ll be so much easier to complete your post surgical exercises.  After surgery the shoulders will be difficult to move and your pec muscles will be really tight.  Having flexible joints – wrists, elbows, shoulders, neck, upper back – ALL of these will be a benefit after surgery.

  1. Following Post Surgery Advise (not being Super Woman)

Are you allowed to shower?  Should you keep your dressing/bandages dry?  Are you keeping your drain sites clean?  Are you taking your meds?  Are you doing your post surgery exercises?  Are you talking to someone?  Are you allowing yourself to rest?

WOW!  What a list of things to do right after surgery?  But really, it’s just following the rules.  And since you probably haven’t been through this procedure before, there are others (doctors, nurses, hospital staff, your therapist, loved ones) that are looking out for your best interest.  So listen to them.

This is not the time to put on the Super Woman cape and think that you can bend the rules and push too hard, too fast, and too soon.  There’s no trophy for pain tolerance.  Take your meds and be honest with your ‘support staff’.

  1. Being Selfish

Whaaat?????

You heard me.  I know it sounds a little crazy but you gotta go there.  It carries over from the Super Woman syndrome mention in Factor 4 above.

A lot of women:

  • wanna do it on their own
  • are afraid to ask for help
  • suffer in silence
  • take care of everyone before themselves

This will not help you heal.  This will not help you get better.  This will not allow you to achieve your goals of independence, self care, or anything else on the immediate list.

You need your rest, you need your time, you need self care.

  1. Let someone brush your hair, help you bathe, help you get dressed.
  2. Get a Journal and write – doesn’t matter what – just write. Take the time for you.  Get out your thoughts, your feelings, anything… be expressive.
  3. Books, Netflix, Kindle…something to take your mind away the pain, static positioning, inability to sleep – YES, you have permission to mega batch on Netflix, read the books you haven’t had time for, and rest.

Express how you feel –rating your pain a 2 when it’s really a 9 doesn’t get you to the finish line any faster.  In fact, it’s going to slow down your healing process.  And if something doesn’t look right or feel right – let someone know.

DO NOT say to yourself “Oh, it’s nothing.  I don’t want to bother anyone.”  If you think something MIGHT be wrong, check it out and make sure.

  1. Neoadjuvant Treatment

If your Oncologist recommended that you have chemo before surgery, this can have an impact on your healing after surgery.  The time between the end of chemo and your surgery date will definitely play a role in the overlap of symptoms but you may be weaker and more fatigued before your surgery which can lengthen your healing time after.

You will have blood work done after chemo and before surgery to see how you’re progressing and the doctors may ask you to complete questionnaires about your fatigue, diet, energy levels, and activities.

It can be as little as 7 days and up to 8 weeks between the end of chemo and your surgery date.  Generally 3 to 6 weeks is the norm.

Remember: marathon, not a sprint.  Your chemo was prescribed to help you in your journey back to a healthy you.  So even if the recuperation after surgery may take a little longer, being healthy is the goal here.

MAT (Movement Action Tip)

I know, I know.  I just said rest, sleep, watch movies…BUT

You gotta do your post mastectomy exercises.  These will be based on your surgery, how long your drains are in, but there’s a whole lot of movement exercises you can do the first day after surgery.  These are so important in keeping down inflammation, getting rid of extra fluid and swelling, keeping your joints loose, and helping with the scar tissue from your surgery.

Your Post Surgery Exercises also help you be involved in your healing process – getting you proactive in your recovery.

So, do what you can, rest, and then do a little more.  Be your own guide with the help of your Cancer Team and Loved Ones.  And if you need to talk, send me an email.  We can setup a Zoom call and chat (even when you’re propped up in bed or on a recliner– that’s cool).

Remember though, right after surgery your surgeon makes the rules about what you should and shouldn’t be doing.

Megan E. Bowen, MD, Mary C. Mone, RN, BSE, Saundra S. Buys, MD, Xiaoming Sheng, PhD, and Edward W. Nelson, MD, FACS, Surgical Outcomes for Mastectomy Patients Receiving Neoadjuvant Chemotherapy, A Propensity-Matched Analysis. Ann Surg. 2017, Mar, 265(3).

Marian

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