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. 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. 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 bilateral mastectomy.
Disclaimer: Please check with your doctor before starting a strength training or fitness program. I am not a medical professional and am sharing this information based on 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 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, recovery can be a double whammy of tough emotions and physical struggles.
That’s where strength training comes in.
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Who is this information for?
These tips can be used by women who have had a mastectomy and are cleared to lift weights by their 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 and regaining mobility.
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 can be a mistake. That’s why upper-body training is the focus on this article.
Concerns about Training Pectoral Muscles after a Mastectomy
Women who undergo a mastectomy usually have physical therapy 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, your upper back and shoulders may acquire symptoms of overuse, which could lead to chronic issues.
The good news is that strength training will help you bounce back from surgery more quickly, as long as you are consistent.
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 feel that my pectorals were “jumping around” 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.)
- Uncertainty about whether 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 and sometimes still do. Everyone’s different, but I’ve found that being active, stretching, and keeping my stress level in check decreases 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.
- Fear of lymphedema or implants shifting.
If you’ve had your lymph nodes removed, you should get guidance from your doctor or PT about preventing lymphedema. Some doctors tell patients not to strength train because it could cause movement of their implants. I cannot speak to this, as I’m not a doctor, obviously, but I have not had this issue.
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. I was able to return to heavy lifting, but it was a process that took time.
Training Back and Shoulders after a Mastectomy
A hunched, rounded posture is very common after a mastectomy, as it is with anyone who works at a computer. But this position contributes to chest tightness, too. To counteract this posture you can strengthen your back and shoulders. Physical therapy helps you regain shoulder, lat, and pectoral mobility and some strength. To continue after you’re released, you need to slowly increase the weight 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 physical therapist or doctor to assess your mobility.
Strengthening your 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 light weights and higher reps (15-25) for a period of weeks, slowly increasing the weight. 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 your lats after strength training.
Training Pectoral Muscles after a Mastectomy
Body weight isometric exercises are a great way to ease into chest training and 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
Ask your doctor and physical therapist if you can do these beginner chest exercises:
- 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.
Stretching Your Upper Body after a Mastectomy
Stretching and mobility is a critical piece 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.
You can use the stretches you learned in physical therapy to stretch your lats, pectorals, and shoulders after lifting weights.
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.
Go slowly. I know I keep saying it over and over, but get your doctor’s approval and work with your physical therapist before starting any plan. We’re all different, and what worked for me may not be right for you.
Got something to share? Leave me a comment below! I’d love to hear from you.
This article originally appeared on www.workoutnirvana.com.