It had been about six months since my breast reconstruction surgery and bilateral prophylactic mastectomy. I was at the gym, following an old training program I wrote. Back to training for months, I’d mostly avoided chest training until recently. I glanced down to see which exercise was up next:
I felt a little flutter in my stomach and made a spur-of-the-moment decision: I would try push-ups this time instead of skipping them.
Since it would suck to lower myself down and choke at the bottom (which had happened a few months ago), I quickly assessed whether there was anyone nearby who looked particularly judgmental. All clear, I got down on the floor.
One, two, three, four, five full push-ups.
Shocked, astounded, amazed – whatever it was, I was happy as hell. In fact, it took self-control not to do a little dance right there. Unsure what would happen, I did two more sets of five push-ups.
Well, look at that. I could actually do push-ups after having a double mastectomy.
*Disclaimer* Please check with your doctor before starting a strength training or fitness program. I am not a medical professional and am simply sharing these ideas as a certified personal trainer and from personal experience.
A Mastectomy Is Traumatic
It may not seem like such a big deal to do push-ups after a mastectomy, but it is.
A mastectomy is massively invasive and usually includes follow-up surgeries and a long recovery period. Most women lose all feeling in their breasts, yet may suffer from pain or discomfort from cut nerve endings, complications, and/or tissue expanders.
It’s been two years since my preventative mastectomies, which I underwent due to years of escalating breast disease. I’ve rebuilt most of my muscle and strength and feel great for a woman in her 50’s. I’ll never be the same physically as I was before, but I feel very comfortable with strength training and happy with my progress. In fact, I even have a little pectoral muscle definition! (See my Instagram to follow my journey.)
Maybe you’re not there quite yet or you’re still recovering from surgery. Regardless, you’re beyond wise to be researching how to strength train after a mastectomy. Several months after my surgery, my doctor told me I was “miles ahead” in my recovery, probably due to my fitness level prior to and after surgery.
It can be a lonely road trying to regain your pre-surgery self. Most people can never fully understand what we’ve felt and gone through, including pain, discomfort, fear, lost self-confidence, and frustration. And since many women are also in menopause around the time of their surgery (due to age or also having a hysterectomy), recovery can be a double whammy of tough emotions and physical struggles.
That’s where strength training comes in.
Who is this information for?
These tips can be used by any woman who has had a mastectomy and has been cleared to lift weights by her doctor. Whether you’ve had a mastectomy with reconstruction or not, and whether it was due to breast cancer or done preventatively, your focus should be on getting stronger. (If you’ve had your lymph nodes removed, you should get guidance from your doctor or PT about preventing lymphedema via exercise.)
Several influential studies have confirmed that lifting weights after breast surgery is highly beneficial for strength and mobility improvements (see this article for more). Whether you were active and fit prior to surgery or not, learning how to strength train after a mastectomy can help you feel confident about your body again.
I’ve found that most women are comfortable doing cardio and lower-body workouts after recovering from a mastectomy. It’s the upper-body workouts women avoid, but that’s a big mistake. That’s why upper-body training is the focus on this article.
Concerns About Training Pectoral Muscles After A Mastectomy
Every woman who undergoes a mastectomy needs physical therapy first to regain range of motion and upper back strength. Once you’re cleared for exercise, you should continue to strengthen your chest, back, core, shoulders, and lower body. Yet many women avoid training their chest out of fear and confusion.
The truth is that you will never truly have a strong upper body without strong pectoral muscles. Your chest muscles are not just required for pushing, but for pulling movements too. Weak, atrophied pectorals can lead to muscle imbalances, injury, and poor posture. Imagine what happens when your shoulders take on more than they should because your chest muscles are too weak. Over time, you may acquire overuse injuries in your shoulders/upper back.
The good news is that strength training will help you bounce back from surgery more quickly, as long as you are consistent and follow a good plan.
Common concerns about chest training after a mastectomy:
- Using your chest muscles feels uncomfortable and unnatural.
If you have implants that lie beneath the pectoralis major muscles, the muscle contractions may feel exaggerated. You might even feel your implants shifting aggressively and wonder if it’s normal.
While it feels disconcerting at first, you’ll get used to more pronounced muscle contractions. For most women, the muscles are just under the skin now, so no wonder you can both see and feel the contractions so strongly! I used to say my pectorals were “jumping around” (convulsing, almost) when I lifted something heavy or even tried cutting food. But either my muscles learned to calm down or I learned to control them better – maybe a bit of each. (Of course, if you feel pain, stop immediately and check with your doctor.)
- You’re afraid that lifting weights will cause or worsen chest tightness or discomfort/pain.
A lot of women report a feeling of wearing an “iron bra” after a mastectomy. I certainly did, particularly during the tissue expander phase of my breast reconstruction. Everyone’s different, but I’ve found that being active and stretching regularly decrease my muscle tightness.
Lifting weights does cause tension in the muscles – this is one mechanism of muscle growth. I cannot say how it will feel for you, but my best advice is to stretch often and not push too hard, as I talk about below.
Get used to the sensation of your pectorals assisting other muscles before direct chest work. If you haven’t done any direct chest training beyond PT, start with isometric chest exercises (more below). Of course, for a well-rounded exercise program, you’ll also train your legs and strengthen your heart with aerobic exercise.
Start where you are. After my mastectomies, I couldn’t open a jar, shut a window, or cut my own meat, much less do bench presses. But here I am, doing 50-pound dumbbell bench presses and 75-pound barbell bench presses. (I’m probably capable of doing much more, but I keep my workouts moderate these days to protect my joints.)
Training Back and Shoulders After A Mastectomy
A hunched, rounded posture is very common after a mastectomy, so it’s important to strengthen your back and shoulders to counteract this. Physical therapy helps you regain shoulder, lat, and pectoral mobility and some strength. But up until now, you may have only used light dumbbells and resistance bands.
To gain strength and muscle, you can’t just continue using light weights. You need to progressively challenge your muscles. It’s time to start increasing the weight slowly with pristine form (see my strength training articles for more on this).
Be sure you have full shoulder mobility before starting a new training plan! Ask your PT to assess your mobility.
Exercises for back, shoulders, and core
- Lat pull-downs
- Cable rows, either seated or standing
- Straight-arm pull-downs
- Face pulls
- Band pull-aparts
- Rear-delt flyes
- Dumbbell overhead presses
- Lateral and front shoulder raises
- Any arm work you want to do (bicep curls, tricep extensions/pushdowns)
- Planks and anti-rotational core work
Start with lighter weights and higher reps (15-25) for a period of weeks, slowly increasing the weight when you can do more than that. Always practice beautiful form that would cause people to stop and admire!
Focus on a healthy shoulder position that is relaxed and down, not rounded forward. However, don’t go overboard with the common shoulder cue, “down and back.” Forcing your shoulders to stay stationary during rows is not a good idea. (See this for more about letting your shoulder blade breathe.)
–> Tight lats can contribute to chest tightness, so be sure to stretch and foam roll your lats frequently (more on stretching below).
Training Pectoral Muscles After A Mastectomy
Isometric exercises are a great way to ease into chest training. Isometric exercises put your muscles under tension without changing their length. In other words, you’ll simply hold the position instead of doing repetitions. Be sure to warm up first and don’t hold your breath during these exercises.
Isometric exercises for chest
- Chest squeeze. Stand or sit (with your back upright). Clasp your hands together and push them together as hard as you can for at least 10-15 seconds, focusing on completely flexing your pectoral muscles the entire time. Relax and repeat 5-10 times.
- Doorway flye. Standing in a doorway, place your hands at about chest level against either side of the door frame. Exert outward pressure as if you’re trying to push the sides of the door frame farther apart. Use the pressure to pull your chest slightly forward into the doorway. Hold for 15 seconds then gently release. Rest for 30 seconds and repeat. Aim for five reps.
- Pillar plank. Get into a top push-up position on your toes and hands. Hold for 15-60 seconds without pushing up your butt or letting your torso sag.
- Wall push-ups. Place your hands against a wall at shoulder height with your body leaning inward at a slight hang. Your feet should be firmly planted into the floor. Gripping shoe soles may be necessary to avoid sliding. Apply pressure through your arms, chest, and hands as if you are trying to push the wall away, pulling your shoulder blades down as you press. To make the exercise more challenging, lower your hands to near waist level.
Other exercises for chest
After 2-3 weeks of isometric exercises, start doing resistance exercises with high reps (15-25) and light weight. Always focus on keeping your shoulders down and relaxed and not overdoing the range of motion. Start using these go-to chest exercises:
- Dumbbell floor or bench press
- Dumbbell incline press
- Standing cable or resistance band chest press
- Dumbbell or cable flye
- Wall or incline push-ups (hands higher = easier)
When it feels too easy, increase the weight in small increments. And don’t forget to stretch both your chest and your lats after training.
Stretching Your Upper Body After A Mastectomy
Stretching is a critical part of strength training, whether you’ve had a mastectomy or not. Get in the habit of stretching after every session, but also daily to keep your chest and lats relaxed. If you ever feel too tight after training, back off the weight a bit.
Be careful with your shoulder joints when stretching your pecs, as Eric Cressey talks about here. Hold each stretch for 20-30 seconds without overstretching.
You can use the stretches you learned in PT, my suggestions below, or both. But always be sure to stretch your lats, pectorals, and shoulders after lifting weights. If you feel tight at home, stretch.
I’m also a huge proponent of foam rolling – applying your own bodyweight to muscles to release tight, painful areas and increase range of motion. Foam roll your lats and upper back along with these stretches:
- One-arm doorway stretch
- Dynamic oscillatory pec stretch
- Kneeling lat stretch
- Foam rolling for the entire body
You Can – And Should – Strength Train After A Mastectomy
The way I see it, my early experiences after surgery – both the unsuccessful and successful – were the best of my recovery. Being able to do push-ups showed me that I was stronger and more capable than I knew. It showed me that even though my upper body changed in a major way, with dedicated work I can have a new normal that is seriously badass. So can you!
Be sure to check out my first post on how to strength train after a mastectomy and more about my personal journey, too. And here’s a great article on proper push-up form (notice that your elbows do not flare out to 90 degrees.)
Got something to share? Leave me a comment below! I’d love to hear from you.
This article originally appeared on www.workoutnirvana.com.