Athletics,exercise and rehab after Masctectomy
Hi All!
I am recently diagnosed and I am struggling with how to treat this diagnosis. I have met with an MO (medical oncologist) and last week a Plastic surgeon. The MO recommended a lumpectomy with radiation but I told her that I would rather have a BMx for peace of mind and to avoid radiation. She said it's a big surgery but that she would respect my decision and sent me to a P.S.. I had my appointment with that P.S. last week. She was cold and clinical but didn't really answer my questions! It was my first day at the cancer hospital and i was feeling umprepared, emotional and overwhlemed. She said she thought that a BMx was too extreme and went on to tell me how i wouldnt be able to resume my activities. FYI-I explained to her that I was a massage therapist, surfer, yoga instructor and VERY active. She said after the surgery I wouldnt be able to do a push up. I asked her for how long and she said, "the rest of your life". I left that appointment completely demoralized and upset. My question to those of you that have had a double mastectomy is: Can you do a push up? Are you able to exercise and resume your before surgery activities? I have spoken to a client that has gone through the process and she said that she still does yoga and is able to do push ups. BTW she had the implant put on top of the muscle and my P.S. said that the implant would go under. I am reading much better things about over the pec as opposed to under. I am quite afraid and want to make the right decision i.e. not affect my quality of life and active liestyle for years to come. I was diagnosed with IDC no.2 Est + and pro +. I am going for another biopsy on Thursday to determine whether it's a her2+ cancer (also nervous about that as i was reading about cell seeding and spreading). I'm being pushed by family to do what the Doctors tell me but it just doesn't feel right. I know that this is a major surgery but please, If you could share your experiences, particularly getting back into your fitness routine, I would greatly appreciate it! (sorry such a long message).
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I believe the old school was no push ups and no weights, but all this is changing. It does depend on the type of reconstruction though. If the chest muscles are disturbed, it may be different situation.
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Gracem1,
I do push-ups like a champ! I can do them for a full minute and several sets. I did a set of ten from my toes two months out from surgery. Pure joy! I was VERY concerned about this prior to surgery. I love push-ups. The first one I did after I was cleared to return to full activity felt like my chest was ripping apart. I can see why a person wouldn't do them! I took it slow and started from my knees, after trying them on the wall or table. I have to get quite fatigued to feel anything remotely like that pulling apart feeling now. I had implants placed under the muscle as I didn't have a choice.
I am in better shape now than ever. Stronger and fitter. I keep it up with Beachbody home fitness and love Shaun T's crazy workouts. It didn't take too long to get back in it.
Best of luck with your decision-making. It's the worst part!
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Wow. Find a different surgeon. Either she plans to do something unusual and mutilating, or she's not aware of the past 10 years of lymphedema research, either of which would be really bad for a breast surgeon. And if it's because she's dead- set on putting implants under the muscle so that's all she is all she is offering, she's got to explain why.
Years ago, women were told never to do anything forceful with the arm on the side of a mastectomy. They were given lifting restrictions, told all sorts of things they couldn't do. This was because it was thought that exercise or physical work could cause lymphedema. When it was actually studied - and this was an article in a really major journal, I think the NEJM, maybe 10-12 years ago - it was found that exercise, if begun at a low challenge level and gradually increased, actually led to a LOWER risk of lymphedema. Since then, that recommendation has become standard. There are definitely lots of women out there who are doing fine and who do things as challenging as a pushup. I have had a bilateral mastectomy, and while I do have lymphedema, by starting gradually and building up, I was able to get up to doing really anything I ever did without causing flares. I'm 7 years out from ending treatment, and the only "exercise" that has ever caused swelling has been hiking with my arms just dangling. Even that isn't a problem anymore. I have played soccer, basketball and soccer, I have swum, rock-climbed, and done lots of yoga, and I've messed around on playgrounds doing things like the monkey bars. I have done hundreds, or possibly thousands, of pushups since treatment.
The other thing is, if she's talking about no-pushups because she's going to put implants under muscle and that's just how it's going to be, and she didn't give you a good explanation why she wants to put the implants under the muscle, then you need to find out why she is seeing doing a particular type of surgery that she thinks will cause you to have new limitations as the best choice. Some women do fine with implants under muscles, some definitely have problems (pull up Gran's posts). If she can't or won't explain why, you have to wonder if it's just because it's her bread and butter, and anything else is a newer technique that she does not yet know how to do, or even an older one she never got good at. Surgeons don't like to talk about it, but that happens a lot - they just don't know how to do something new yet, or they're not good at something so they don't see good results in their own patients. There are a lot of options for reconstruction, and plastic surgeon A is not going to be exactly the same as plastic surgeons B and C - I recommend you get more opinions before making a decision that the surgeon thinks will have this kind of impact on your body.
Not answering questions is always a bad sign. Someone can be technically brilliant - the best hand/eye coordination ever - but if they haven't paid attention to you and know your priorities, they are likely to make decisions that aren't in your best interest. I
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I had a BMX with implants under the muscle. I now lift weights 4-5x/week and push myself to increase weight every week. I do all sorts of chest/shoulder exercises - bench press, military press, incline bench, overhead press, side lateral, etc.
Time to find a new PS!
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I will write more later but no I will never be able to do a push up again. I have serious problems with my upper body strength and my arms and hands. I would never tell someone with your lifestyle to do implants under the muscle based on my experience. Diep is probably not an option for you but you could do a dbl mastectomy now and reconstruction after you finish treatment. This might allow you to travel and find a plastic surgeon that could give you more options.
It definitely is not like a Hollywood boob job. Also did she say you could have nipple sparing? That's a whole other issue to face.
These decisions are tough. It is like ordering off a menu where you hate everything the restaurant is serving.
All of this is playing the odds and the cards you are dealt. Some women can do pushups etc with implants under the muscle but odds are probably not in favor of it. In my case the odds were not on my side and I have a lot of exercise issues post bmx even with physical therapy.
I think it is worth finding out more about your risk profile. Many women have a lumpectomy and go on with their lives just fine. I was high risk stacked on top of DBL breast cancer so my decision was made for me. In hindsight I think I would have not gone the immediate reconstruction route but I am still not sure.
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I get had left side mx and a DIEP reconstruction. I can do anything. I am thinking about skiing again but worried about falling. Never heard of can't do push ups or any limitations. None of my surgery involved muscle just tissue.
Where are you at?
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I was very active before my surgery and am still active after. HOWEVER, I did give up push ups. (I have under-the-muscle implants.) My PS said I could do them but I found that the push ups (and bench presses) were forcing the implants out towards my armpits. At first I just ignored it and figured they would go back into place. They didn't, so I stopped doing them as I didn't want to need a corrective surgery. I do more small muscle group exercises now instead.
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I think this is very specific to the person. I have had issues with push ups/planks since my exchange surgery. My surgeon recommended I try to avoid these. I am still able to be very active and yoga, Pilates, etc are all fine, it is just very uncomfortable for me and seems to shift implants when I do extended planking, push ups, etc. Rather than calling your surgeon out as unqualified, its possible the surgeon may be trying to prepare you for the worst case. It also might be fine for you, but it is a risk. I for one wish I had known more about this issue before surgery. My implants are also under the muscle since I had radiation and my skin support over the muscle. Even if you can do pushups, there may be some discomfort and your muscle development and implant location may be impacted. Certainly get a second opinion, I am always in favor of that. But I do want to be realistic that after this type of surgery some pectoral restrictions may be a side effect, and may be permanent.
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I had a PBMX in April 2017 with silicon implants (under the pec) with nipple sparing. By early June I was skiing again. I was taking it very easy, not using my poles and having someone to carry my skis at the end of the day. By early July I was back to full on skiing, black runs, carrying my skis etc. however, this is the problem, I had a nasty fall (nothing to do with the mastectomy) broke my leg in multiple places and ended up in hospital for 8 days. The mastectomy made everything more difficult. From worrying about LE every time they wanted to take my blood pressure, to not being able to use the crutches because they pushed on the scar line under my arms, to not being able to push the wheelchair because it was aggravating the pec muscle.
Inevitably I ended up hobbling around on crutches and using the wheelchair for 3 months. My pec muscles got a complete workout, got much bigger and even got bruised from the exercise as it rubbed against the implant and I could feel (and see) the implants moving out under my armpits.
Once I got off the crutches things got much better. I am back to doing Pilates, yoga, swimming, working out with a trainer. I can do almost every exercise he throws at me - lat pull downs, rows, bench press, planks etc. However, the one exercise I hate doing is the push up. I can do it, it is just the feeling that it is pushing my boob out to the side under my arm pit that I don’t like. I also don’t like the feeling of lying on my stomach. The implant doesn’t squish like breast tissue used to, so it is just a bit uncomfortable.
Meow13 my recommendation about skiing is... don’t fall! In hindsight I should have waited a bit longer before going back to skiing to let the implant fully settle before attempting it. I was only 2 months out from implant and it was definitely too soon.
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as stated above, you may not be a candidate for a DIEP flap recon, but you might be for SGAP or stacked flap. All of these are natural tissue recon so no implants. That makes a big difference. A great resource and group of docs who do these types of recon are the center for restorative breast surgery. Hundreds of women travel to them every year to have them do their recon either in combination with MX or delayed recon well after MX (including me).
I agree it’s strange the PS only discussed under muscle implants, however I found that if a doc doesn’t do a particular procedure they will not offer it and will even go so far as to tell you you’re not a candidate for it (even though they have no personal experience doing the procedure or determining candidacy) so that you just assume their way is your only option and you don’t take your business somewhere else. Sad but true. Second and even third opinions are good ideas.
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gracem1, I hope you see I reworded my first post because I hadn't really absorbed the bit about the surgeon being set on placing implants under the muscles. That, more so than lymphedema risk, is likely why she said no pushups, but a surgeon who will not answer questions about why they are making a specific recommendation is simply behaving suspiciously. It's not the recommendation that is the red flag, it's the refusal to answer questions. Not all surgeons have great "bedside" manners, but even in cold, abrupt, or awkward ways they should be able to answer questions.
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Wow, your PS was the opposite of mine who was all hearts and flowers. I specifically asked whether i would have loss of strength and she said she had weight lifters with implants. I asked how long the extra recovery was from the plastic surgery and she said 2 weeks. I asked if there was any reason not to have silicon implants and she said no. I have silicon implants under the pecs (down a size, 500 cc.). So far, it sucks. 2 1/2 long months of the dreaded expanders (feel like you are wearing an internal brass bra), and now its 4 1/2 months out with the silicon. The pecs are so traumatized by the new positioning that they contract and if feels like you are wearing tupperware under your skin. I've been in physical therapy for 2 months. Finally progressed from range of motion to strength training. Every new advance means we are back to contracted pecs again. That said, some folks have said it gets better after 6 months, others say they will always get cold and contract. I don't think about them much during the day but sleeping is always a trial. I'm still on my journey and it feels like a long road though I am very lucky. My advice, talk to another plastic surgeon - or two - they are only concerned with aesthetics and not with function. And also maybe talk to someone who went flat. Its not an option the doctors typically give you because they feel like they have failed if you aren't back to "normal", but I expect going flat is alot more "normal" than this and you can wear whatever bra you are comfortable with. Weigh your risk factors, I have a friend who was like swiss cheese from successive lumpectomies year after year and finally had them off and is very happy about it. Others who had one lumpectomy and walked away and were fine. I wish I had a crystal ball for you (an MRI might give you some better data to deal with - mine did). I just wanted it all over with, but in hindsight I wish I had really known what to expect.
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My diep even though I have an incision from hip to hip hasn't given me trouble. My SIL however really regrets getting under the muscle tissue expanders with a DIEP preparation. Wow it would drive my crazy to have a foreign object under my skin. She lives in Hawaii and had her surgery in Honolulu. My plastic surgeon in Seattle, if you can get passed his massive ego, was the best. No troubles at all. Looks great.
My SIL was supposed to go to Boston to have her DIEP but after hrr suffering from bmx with under muscle implants she cancelled it.
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What? No one told me I wasn't supposed to do push-ups! I hate push-ups, so if a surgeon told me that, I'd probably go along willingly :-) But seriously, I am 2 months out from a single sided mastectomy with simultaneous DIEP flap reconstruction and I just shoveled some wet, heavy snow. I have been given the all-clear to cross-country ski, which involves a lot of arm movement (if we only had some non-soggy snow!) I have been doing yoga daily for the last two weeks, and have noticed a huge change in my arm mobility on the surgical side. I did not have a lot of dissection of lymph nodes (only one sentinel node needed examination) so I think I lucked out there. The lymph node removal probably has caused the most discomfort and tightness of anything, more than the belly incision by far.
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me too, lymph node removal seems to have impacted me more than the DIEP.
After 6 years still tight, I get relief from swimming and yoga but it is short lived relief.
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I had BMX with direct to implant above the muscle - skin and nipple sparing. My incisions were under the breasts and I had two drains in place for six days.
I have recently joined a fitness and nutrition class for survivors. I was not super active before all of this and, while I did do PT after surgery, I felt like I wanted someone to help me figure out what to do. There is a growing body of evidence that supports doing exercise after BMX with minimal restrictions.
My second opinion BS was the one that recommended my PS - because she knew he did the kind of reconstruction that I wanted. I'm a big fan of multiple opinions. You need to hear the info from multiple sources and you need to feel good about your doctors.
My MO and the first BS totally tried to talk me out of the BMX. I had multiple reasons for choosing it. It's a huge decision and there are ramifications with any decision you make. Best of luck to you with this.
PS - Why can't they test the HER2 status on the original biopsy tissue?
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I have bilateral sub-pec implants. I am an athlete and was able to work back to doing everything after surgery over time, including one arm pushups and muscle ups on the bar and rings. I was not a candidate for pre-pec (over the muscle) implants, because of my ultra low body fat. With under the muscle implants, you will experience dynamic distortion when you use your pecs, and if I were a massage therapist (or any job requiring extensive use of pec muscles), I'm not sure I could endure that for several hours a day without it driving me nuts. Please consult 1 or 2 other PSs to do your research and inform yourself of your options and determine whether no recon, delayed recon, autologous recon or implants are the right decision for you. I would suggest you consult a PS experienced with pre-pec implant recon. Check out this thread, which lists PSs who do pre-pec recon and consider DMing andraxo - she is a PT who chose pre-pec because of her profession and also leads an active lifestyle. Best wishes.
https://community.breastcancer.org/forum/44/topics/835911?page=1
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I have sub-pec implants. Have taken it easy getting back into workouts but did plank and push-ups (not a ton) on Friday. It felt fine. Plank I think I even did with TEs. Caveat that I have small implants (I'm petite) so perhaps this makes some difference. Downward facing dog fine, too. I mean, I'm not saying everything is perfect or the same as it was -- but overall I'm happy with results.
The thing that bothers me the most, which is silly actually, is that I can't do a full body stretch. Like extended arms and legs. Legs fine of course but arms just bend a little now and don't go straight out. I have tightness along IMF incision line that I'm not sure will ever go away. (Idk)
I had nipple/skin sparing as well, FYI.
Good luck with making decisions! It's a very personal choice but has to be what you can live with. YOU. I agree on looking into PSs who do pre-pec if you want to go that route.
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Hi gracem1
I don't know if you've decided on your treatment yet. I have IDC, 1cm, stage 1a, grade 1-2. I had breast cancer 14 years ago, in the same breast. It was DCIS and Ihad a lumpectomy and brachytherapy radiation.
This time I thought about it, waited for my HER2 results, and when they came back negative decided I never want to wait for that test again. So I decided on a bmx removing also the left breast. My doctor was not thrilled about taking the left breast, and gave the usual talk about how it doesn't improve survival rates. I said, it's not only survival I care about. It's about doing everything I can to avoid ever having chemo.
I am lucky that I met with a great PS who told me he works with my surgeon nearly every week, and that she will be fine with my decision. He was right. The next time I talked to her she seemed to have accepted it.But stay informed. For example, I also found out that the skin-sparing mastectomy can be a bit tricky if you've had radiation, and that once you have radiation they don't normally do it for a second breast cancer. I wish someone had told me about the long-term possible affects of radiation BEFORE I agreed to do it the first time.
PUSH for what YOU want and don't let anyone push you to follow a treatment plan that you are uncomfortable with or unsure of. If you can't find a PS that you like, you can consider traveling to find one. For example, I am having a TUG flap surgery, and people come from all over to see my PS. You might look into the flap reconstruction. TUG is inner thigh (I didn't have enough tummy tissue for a DIEP).
Good luck!
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Hi! I hope you're still here and reading all our replies. :-) I had BMX with immediate reconstruction (implants under the muscles) on November 27, 2017. I sought physical therapy for stretches to help me work out some kinks, but I'm happy to report that I am mostly back to my active lifestyle. I'm back to running trails, road cycling, using resistance machines and the row machine at the gym, and even rock scrambling. I haven't specifically focused on doing push-ups, but on Sunday while rock scrambling, I had to push myself up with one hand and I felt a little twinge in the pectoral, but I did it and none worse for it. The only thing I don't tolerate in the muscles now is getting cold. OMG, cold chills in my pectorals is crazy...it's like they seize up or something. LOL Still doesn't hurt, just weird.
Like you, I asked my reconstruction surgeon and breast cancer surgeon point blank: will I still be able to run, rock climb, swim, paddle board, etc., etc., with implants because if not, then no way! They assured me I would be able to. Three months out and they were right.
Good luck! We all -- you included! - make tough decisions in this process and all we can really do is inform ourselves as much as possible, seek out help and don't hesitate to get a second opinion and then make the best decision we can.
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Hi gracem1,
I am a long-distance triathlete and was diagnosed on my 41st birthday. I immediately requested a BMX because I wanted to do everything possible to only go through this once. I ended up also needing a lymph node dissection, and 25 rads, so they threw everything at me.
I went flat after my surgery, and was back in the pool swimming at 3 weeks. I waited until after chemo and rads to start running again, but did much weight training starting about 2 months post BMX (including pushups and pull-ups). Aside from some lingering tightness, I did not notice any issues.
I had delayed diep reconstruction 11 days ago, and asked so many questions about returning to my activity after surgery, and long term deficits. I was assured I would have none. I follow up with my surgeon next week, where he plans to allow me back in the pool and to resume what I am comfortable with. I didn’t think diep would be an option for me because I was thin with not much extra belly fat, but I am thrilled with my small A cup breasts and they fit my lifestyle
If your surgeon does not feel confident that you will resume your activities, they may not be the best surgeon for you. I made it clear from the very start, that I was not willing to lose who I am, and all my doctors have been on board. Good lick
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I don't do push-ups or lift weights, but I do long distance biking, swimming, running, and snowshoeing. I had a umx 3 years ago with an implant under the pec. I was also very worried about resuming my activity and seriously considered going flat. I am happy with how I feel. Have gotten used to the weird feeling of the pecs moving when you life something. Overall, I have to say that I am much more active and fit than any other 61 year olds that I know.
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Thanks to all the lovely ladies that answered! After waiting over 1 1/2 for a surgery date and over two months since my diagnosis, I am finally having my DMX on Tuesday! I am relieved but mostly terrified. It still kinda feels like a bad dream. I am still very worried about being able to return to my old life. I a, a massage therapist, surf and teach yoga (I need to be able to do poses to demonstrate correctly). Both my jobs are very physical so you can understand my concern. There is no turning back now! I just have to jump in with both feet and faith and pray for the best possible outcome. I went from the first plastic surgeon saying i would never do another push up to the other saying i can resume my regular life after 6 weeks. I am sure the truth is somewhere in the middle...? How long did it take most of you to be back to normal activities? Wish me luck sisters ...and please any advice for recovery would be greatly appreciated. I am grateful for the health care here in Canada but the system is flawed for sure. Info is not forthcoming and both the surgeon and PS didn't explain the procedures or outcomes. I thought I would be seeing them again but it was impossible to get an appointment before the surgery! Unacceptable but I can't go through the referral process and wait again. I had to settle for talking with a nurse at the teachimg class to prep for surgery with 20+ other women! God grant me strength! xxx
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Good luck as well klowey! Please do keep in touch .... x
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How are you doing GraceM? I found that physical therapy was essential. It took about 7 months for me to get back to normal-ish activites. That doesn't mean the girls feel normal. At best it feels like an uncomfortable bra, at worst, painful. Generally the pecs stay sore to the touch (such a bad dream that they only feel pain and discomfort), especially after using them (I drive a horse, garden, lift a wheelbarrow). You do get good at ignoring the discomfort however. I am grateful that I am back to my life. The implants look good under a shirt, but functionally they stink. Nobody tells you that in the US either.
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Notthrilled, I am with you. Looks good under my clothes, still feels like crap 8 months later. And the PS says wait, some women feel better x number of months later, a year, even several years later.
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At this point if I can just get through the AI treatment pain and stiffness I can ignore the breast area discomfort!
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I have been able to exercise and I am resuming my before surgery activities.
I had my year post-op visit today with PS and I specifically asked about the push ups and chest/arm strength. PS said that the muscles are weakened from the surgeries, but will come back as I build back my strength. PS suggested started push ups from the knees at first, then continue working on strength.
PS expects me to return to pre-surgery strength,
Best wishes,
Madelyn
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I had a bilateral mastectomy, TE and then exchange for implants. Although I now only have one implant due to a postop infection...I was able to do pushups with both my tissue expanders in place after some time had passed, and also my implant. Although I was definitely weak after each surgery, in time once I was given the green light to resume activities I was able to run, swim, lift some weights and yes do push ups. I felt at one point my range of motion was limited due to scarring from some surgical debridements due to infection. However, after some PT I was surprised how much I regained. Hope this helps!
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