Strength Training after a Mastectomy

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:

Push-ups.

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.

What the…?!

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. 

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.

strength train after a mastectomy

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.

strength train after a mastectomy

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.

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Comments

  1. LOVE YOU!!!!!!!!!!!!!!!!!!

  2. Thanks for doing this. I have a new client is having her reconstruction in 3 months and wants to get fitter. This was very helpful

  3. Though I haven’t went through a mastectomy, I’m thankful you share this information, opinions and guidance. I do hope any woman, who has breast reconstruction surgery and bilateral prophylactic mastectomy would feel confident again. Mastectomy is not the end, it’s the beginning.

  4. I had a bilateral mastectomy on April 7. Friday will be 3 weeks. I have expanders and had my first fill today. I will be starting radiation in mid May. For then the reconstruction will be on hold for 6 weeks. I worked out leading up to my surgery, through 6 months of chemo. , Doing both cardio and weight training. I am anxious to get back to exercising and feeling strong again. I will be sharing your info from this article with the trainer from my gym. It’s hard to find people who train specifically for mastectomy patients. I will be talking with my doctor, but do you see the possibility of weight training, even light, while I have expanders. Will not have final reconstruction surgery until around December. Thanks for your information, definitely what I was looking for. Will read again when I feel a little better.

    • Anne, thank you for writing. Sending big hugs your way! You’ve gotten through the first big step of this process. You sound like a fighter – onward!
      I love hearing you want to stay fit through to the reconstruction process. Barring complications, I see no reason why you can’t lift light weights and do cardio before your reconstruction. My expanders were quite uncomfortable, and I avoided much lifting before reconstruction (but there was only 10 weeks between surgeries). One thing I’m adding to this post is the benefit of traction by hanging from a bar. Feels so good and very helpful in regaining mobility. (Obviously, you should wait until you’re cleared for exercise first.) I do hope you get the help of a trainer who can guide you in staying strong.It will be much easier coming back after the next surgery! xoxo

  5. I’m three weeks post bilateral mastectomy. One cancer, the other prophylactic. No reconstruction (didn’t want to go through all that since I’m 61 years old and lost a whopping total of barely 13.5 ounces of breast tissue!) Luckily I was in excellent shape going into this, which helped a lot with tolerating chemo and recovery so far, but I’m frustrated with this new lack of range of motion. Your excellent article has shown me that there is a light at the end of this tunnel and I CAN eventually get that barbell back over my head. You’re right…it is a traumatic surgery and we need to cut ourselves some slack and take needed time to recover. Thank you for sharing your experience. Can’t wait to nail some push ups of my own!

    • Hey Cindy! Congratulations on getting through your surgery. Also, for being in great shape prior! Your determination will help you get there. I couldn’t believe how long it took to get range of motion back, something the docs definitely didn’t prepare me for. Once you get back to the gym, something that will help move things along is to get on an assisted pull-up machine or under a bar with a chair and hang with partial bodyweight. Don’t use your full body weight at first, but work up to that. The traction feels amazing and does wonders :).

      • Thanks Suzanne, that sounds like an awesome stretch! Been back at the gym already working lower body and trying to get some intervals in on the treadmill. Did you find your skin to be super sensitive? I know I don’t need a bra any more but somehow feel a little more “protected” if I wear a tighter fitting sport bra.

        • Too cool! My skin was sensitive, yes. It still is where I had my complication, and sometimes I can’t bear to wear a bra. I occasionally wish I’d skipped saving the nipples so I could be bra-free forever! Ha!

          • What really has me leery of getting back to lifting is fear of lymphedema. They took one lymph node on the prophylactic side and five on the cancerous one (because they were all clustered together), and they were clear.I I understand that I’ll have to progress slowly, so will start with those isometric exercises for a week or two and progress to those heavy two-pounders from there. I was hoping that pre-surgery fitness would enable a quicker progression, but this is a whole new ball game!
            Finally got comfortable without the bra! A bit self-conscious, since I now have no breasts, but that will probably pass.
            Thank you again for sharing with us!

          • Wonderful you’ve adapted to your new no-bra lifestyle! Finding peace with the lifestyle and mindset challenges (or shall I say mind f*cks?!) are just as important as the physical ones.

            I hear you about the lymphedema, thanks for clarifying. I saw a study showing that “careful weightlifting” could possibly reduce the risk – now that would be awesome! “About 7% of high-risk women who lifted weights developed lymphedema compared to 22% of high-risk women who didn’t lift weights.” (http://www.breastcancer.org/research-news/20101208) Or more positively, 93% of women did NOT develop lymphedema :).

            I wonder if your doctor or physical therapist might know of a special lifting class. In any case you are right to go light and slow. And just as a frame of reference, don’t discount those light weights. When I came back to lifting after a whiplash injury, I used 2- and 3-lb weights for several months! I still benefited enormously just from moving my body and feeling the mental boost.

            xoxo

  6. Lol!!! You are so right about mind f*cks! Women feel so negative about our bodies. Men, not so much!
    My doctor did say that my lymphedema risk was very low, but other than that gave me no guidance. He didn’t know anyone who could work with me other than with physical therapy. I’m a trainer myself, and now am studying to be certified in exercise for cancer survivors. I got a hands-on education in screenings and treatments, and am now moving on to recovery. Not exactly how I would have chosen to be educated, but they say blessings come in strange packages!
    You’re absolutely right about the benefits of lifting weights and risks of recurrence or lymphedema.
    By the way, your arms look GREAT! You said that you lift lighter now to save your joints. I’ve been lifting lighter as well. Nice to see results like that!!!!! You are an inspiration!

    • It’s tremendous that you’ll be able to help women like yourself. There aren’t enough trainers out there who understand! And thank you, you’re so kind. I don’t train my arms as frequently as I used to. I’m more interested in joint health now ;). Keep in touch! Would love to hear about your progress. xoxo

  7. I had bilateral mastectomies with immediate reconstruction (tissue expander and implants) 8 years ago. After learning about Breast Implant Illness, chose to have implants removed and DIEP which is a fat transfer. In preparing for surgery, I learned I had Grade 3 Capsular Contracture, and during surgery, learned that my right pec muscle had attached to my skin-literally being detached and pushed away by the implants. ☹️ I did a fair amount of upper body work and can’t help but wonder if that contributed to this. Please be careful and consider looking into Breast Implant Illness- many feel it’s not a matter of “if” but “when” they (implants) cause illness.

    • I’m so sorry to hear of your troubles, Kathi. It seems as though no one escapes reconstruction unscathed. It could be a matter of time for any of us… or not. May I ask how your DIEP procedure went and if you’re happy with the results? Thanks so much for writing!

  8. Wow, I found you by accident. You are the first weight training personal trainer that I have found who has had mastectomy and knows something! I didn’t reconstruct, I began weight training as a result of diagnosis and I scour the web looking for sites like yours! I found it! Thank you!

  9. Thank you, I’ve been trying to figure out how this was going to work. I’m 3 weeks post op. This is actually my 2nd surgery, my first was a lumpectomy with lymph node removal 6 years ago. I never regained the full strength of my right arm; it took months to be able to raise my arm despite doing aqua therapy. I had to have the second surgery due to abnormal test, so I had bilateral with DIEP Flap reconstruction. I have been telling myself with 2 more surgeries in the next 9 months I have little hope of being physical. You have given me hope to walk and still be physical. I typically run, so walking is blahhhh. But I will do it if only to remain physical.

    • Hey there, thanks for writing. You’re right in the thick of recovery, yet here you are, thinking of how to come back strong. Do whatever you can between surgeries (and walking counts!). Bodyweight exercises at home, your physical therapy exercises, anything you can to maintain your strength and mobility. I sense that you will… I respect that!

  10. Thanks for these instructions. It is a little lonely feeling your own way after mastectomy and under muscle implant even if I am gym literate.

    • You’re right, it CAN be lonely at first. But once you’re back at it a little while, you’ll feel just like everyone else. Hugs!

  11. Hi Suzanne,
    I’m feeling heartened by your information! I am 3 years post mastectomy & reconstruction. I was told I could return to working out, originally, then told that my implants could drop if I did push ups, weights, etc. I then found multiple women post that this had happened to them… I would love to weight train again. What is your experience with implants dropping?
    Thank you for your information… & hope.

    • Laurie, thanks for writing! I’ve never heard of that concern or had any issues like that. There’s Alloderm supporting my implants from beneath, so I’m not sure how they would “drop.” They are quite secure :).

      I think forums can be an amazing source of support, but also of scary, completely inapplicable information. Maybe those women did have a some sort of issue, but they have different doctors, procedures, bodies, etc. Not once did my surgeon tell me of any dangers from lifting weights and after three years, I’m fine.

      Talk to your doctor and get reassurance from him/her that it’s ok. Then you’ll feel more confident. Let me know how it goes!
      xoxo

  12. LESLIE PIERCE says:

    My nipple sparing DMX was November 2018 and my reconstruction with implants was February 2018. I have refrained from doing any isolation chest exercises. This is hard for me as prior to the mastectomy I could do 50+ push-ups (from my toes) in a minute. I have been told by both my reconstructionist and my brother (cosmetic PS) to avoid isolation chest exercises as they could cause drift. I would like to hear what other women have experienced or other opinions. Thank you

    • Wow, 50 push-ups?! That’s insane!! Gosh, I think it’d be a shame to avoid chest exercises. That’s a muscle imbalance waiting to happen. Did you talk to your physical therapist? I don’t know about this drift people are afraid of. My implants have never moved and seem pretty dang stable. I plan on writing an e-book about recovering and fitness and maybe I will find the answers then.

  13. Leslie Pierce says:

    Thank you so much for your reply!!! I real appreciate it! My PT is okay with me easing into those types of exercises. I think it’s time to take the bull by the horns and go for it… thanks!

  14. Robin Auerbach says:

    Hi Suzanne! I was googling exercises I can do post mastectomy and cane across your article. I too had a prophylactic mastectomy due to years of benign breast disease and one small amount of dcis which was taken out two years ago. Just had mastectomy July 2 as more atypical cells had appeared in feb. I was negative for BRCA gene but was done with all the biopsies and stress. I’d love to hear your story! I worked out before surgery and I’m wondering if I can do ab exercises? I’ve been walking on treadmill.

    Best!

    Robin

  15. Sharon Fadale says:

    So thrilled that I stumbled across this article. I had my double mastectomy in February and your comment about an Iron Bra is so relatable. I’m finally in a place physically and mentally where I can start exercising and I had a total lack of direction! Thank you so much!!

  16. This is amazing and described a lot of EXACTLY what I’ve been feeling ! The ‘jumping’ of my pectoral muscles when I do certain movements . I can even sit at my desk and make them jump , I don’t understand why this happens but I’m learning to live with the implants. I was diagnosed with DCIS earlier this year and after 2 lumpectomies and testing, my doctor suggested a prophylatic bilateral mastectomy. I trust my doctors implicity and despite the emotional trauma decided to go through with it. It’s been 6 months. Phew. But I’m ready to get back to exercise which for me includes Ultimate Frisbee.

    • Ultimate Frisbee is hardcore, yow! Well, it does take awhile to get used to those things :). I don’t even notice mine jumping anymore (do they even? hmm). But for at least a year my chest felt like it was having spasms, especially if I got a chill – so uncomfortable and disconcerting! Weird how we adapt. You’ll get there!

  17. That’s a very detailed account of a superwoman! I’d recommend others following your courageous example to consult their own doctors because not everyone is allowed to train that hard

  18. Thank you for this really important post. I think it’s great to discuss the possibility of training and fitness post illness, operation or injury – especially with something like a mastectomy which, as you say, can be very traumatic. It’s important not to give up with your training goals but it’s also important to take it easy and listen to your body. There are experts and professionals out there who would be happy to give advice for your personal situation.

  19. Thank you so much for tackling this topic. I am 90 days post bilateral mastectomy and about to have my next surgery to swap out the expanders for implants. This is a lonely strange journey. I have always worked out and have been challenged by basic PT exercises to stretch. The expanders definitely feel like an iron bra- I was amazed at how accurate that description really is. I find myself so exhausted after working all day, I need to rest as soon as I get home. The tightness in the chest and strange feeling of the pectoral muscles is spot on. I thought I was just imagining all of this. I certainly hope to regain a new version of myself and my new body in time. Workouts have always been the way I relieve stress and maintain a positive mental health. Now holding my shoulders back for 20 seconds is a challenge! So thank again you for starting this dialogue- I think all of us on this journey need the hear and be reminded that fitness is possible again.

    • You’re welcome Steph! “Lonely and strange journey,” certainly the best description I’ve ever heard. Yes, it’s a ghostly feeling, that tightness. Very hard to articulate, yet an ongoing presence. Mine is worse with stress, lack of sleep, overdoing it in the gym. I’ve become so much more aware of the state of my body… is it expecting an emergency? Is it still clinched from an earlier interaction or stressor? We walk around in a clinched state so much of the time without even realizing it. Throughout the day we can make a conscious effort to release the fear and stress in our neck and shoulders. So that release becomes just as second nature as clinching.

      I feel hope and something positive in your words. I thank you for this, whether you intended it or not. Good luck to you on your journey! Soon your back muscles will cooperate again and you’ll slowly be back where you were <3.

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