Further information
Pharmacy Medicines Helpline
If you have any questions or concerns about your
medicines, please speak to the staff caring for you or
call our helpline.
t: 020 7188 8748 9am to 5pm, Monday to Friday
Patient Advice and Liaison Service (PALS) – To make
comments or raise concerns about the Trust’s services,
please contact PALS. Ask a member of staff to direct you
to the PALS office or:
t: 020 7188 8801 at St Thomas’ t: 020 7188 8803 at
Guy’s e: pals@gstt.nhs.uk
Language support services – If you need an interpreter
or information about your care in a different language or
format, please get in touch using the following contact
details.
t: 020 7188 8815 fax: 020 7188 5953
NHS Choices – Provides online information and guidance
on all aspects of health and healthcare, to help you make
choices about your health.
w: www.nhs.uk
Physiotherapy Department
Physiotherapy advice
after breast
reconstruction surgery
using a latissimus
dorsi flap with or
without implant
Leaflet number: 2579/VER3
Date published: November 2014
Review date: November 2017
© 2014 Guy’s and St Thomas’ NHS Foundation Trust
20 Notes
Contents
p.3
Why do I need to exercise after my
reconstructive breast surgery?
p.4
Your exercise plan – stage 1
p.6
Your exercise plan – stage 2
p.11 What can I do to aid my recovery?
p.15 Can I still exercise after a seroma?
p.15 How do I know if I need further
physiotherapy?
p.16 How do I arrange further physiotherapy?
p.17 Contact details
p.18 Notes
p.20 Further information
2 19 This leaflet explains more about returning to your
everyday activities after your operation, and
provides you with some exercises to follow. If you
have any further questions or concerns, please
speak to your doctor or physiotherapist.
Notes
Why do I need to exercise after my
reconstructive breast surgery?
It is important that you follow the exercise plan in
this leaflet because it will:

prevent shoulder stiffness

help you regain and maintain full movement in
your shoulder

encourage your circulation and healing of your
scar tissue

prevent or ease any back pain caused by the
operation

encourage back movement and increase your
abdominal (stomach) muscle strength.
If needed, these exercises will also help you to get into
the required position for radiotherapy within a short
period of time – see picture below for the radiotherapy
position.
18 3 There are two stages to your exercise plan:
Appointments at King's
Stage 1
Start these exercises one to two days
after your operation and continue to do
them for four weeks (unless you have
been advised otherwise by your doctor or
physiotherapist).
Stage 2
Start these exercises in the fifth week
after your operation (unless you have been
advised otherwise by your doctor or
physiotherapist).
We recommend that you continue with these exercises
every day, even after you have regained full shoulder
movement.
We have teamed up with King’s College Hospital in a
partnership known as King’s Health Partners Academic
Health Sciences Centre. We are working together to
give our patients the best possible care, so you might
find we invite you for appointments at King’s. To make
sure everyone you meet always has the most up-to-date
information about your health, we may share information
about you between the hospitals.
Contact details
If you have any questions or concerns about your
exercise plan, please contact the Physiotherapy
Department on 020 7188 5106 (Monday to Friday,
8.30am to 4.45pm).
For more information leaflets on conditions, procedures,
treatments and services offered at our hospitals, please
visit www.guysandstthomas.nhs.uk/leaflets
Link the exercises with something you do every day
(such as mealtimes) and they will soon become part of
your routine.
Your exercise plan – stage 1
Do these exercises for the first four weeks after your
operation (unless advised otherwise by your doctor or
physiotherapist).
Frequency: Four times a day, five repetitions each. If
you develop a seroma (a collection of fluid which
can develop in the area where tissue has been
removed from your breast), reduce the exercises to
two times a day only.
4 17 How do I arrange further physiotherapy?
 Ask your breast care nurse to refer you to the
outpatient physiotherapy department.
 Call the oncology physiotherapy team at Guy’s
Hospital on 020 7188 5103 between 9am and
4.30pm, Monday to Friday. If your call is answered by
our answerphone, please leave a message and we
will call you back.
 Call the hospital switchboard on 020 7188 7188 and
1. Place your hands at the
back of your neck and raise
your elbows out in front of
you to 90 degrees
(shoulder height). Then
lower your elbows to your
sides.
Repeat five times.
2. Place your hands on
your shoulders and raise
your elbows outwards,
away from your body, to 90
degrees (shoulder height).
Then lower your elbows to
your sides.
ask for the bleep desk. Ask for bleep 2744 and wait
for a response. This will connect you to the senior
oncology physiotherapist directly.
 You can email the oncology physiotherapist for any
questions or to self-refer at
breastoncologyphysio@gstt.nhs.uk
Repeat five times.
3. Place your hand on your
lower back.
Repeat five times.
4. Keeping your arms by
your side, push your
shoulder blades forwards
and then pull your shoulder
blades back – squeezing
your shoulder blades
together.
16 Repeat five times. 5 Your exercise plan – stage 2
Can I still exercise after a seroma?
Start these exercises in the fifth week after your
operation. It is fine to feel a stretch while you do these
exercises but they should not be painful.
If you develop a seroma, you should stop overhead
exercises and contact your breast care nurse. A seroma
is a normal part of the healing process, but if it is severe,
it will need to be drained by your surgeon.
Frequency: Four times a day, five repetitions each.
These replace stage 1 exercises. If you develop a
seroma, reduce the exercises to one to two times a day
only and go back to your stage 1 exercises (see page 9
for more information).
1. With your elbows straight, move your arms out in front
of you. Raise your arms until your fingers point to the
ceiling. Finally lower your arms to the sides.
If you develop a seroma having progressed to stage 2
exercises, you should go back to stage 1. Once your
seroma has been treated or is minimal, you can gently
start your stage 2 exercises again. You should also
reduce the frequency of your exercises to once or twice
a day while you have a seroma or while it is being
treated.
How do I know if I need further
physiotherapy?
Repeat five times.
You may need further physiotherapy if:
 you cannot reach the radiotherapy position due to
cording, scar tightness or a painful shoulder
 your shoulder restriction is causing you problems in
your daily activities.
6 15 exercise and you can start building it up with
breaststroke and side-stroke. You should avoid
freestyle (crawl), butterfly and backstroke until eight
weeks after surgery. Please note that you should not
go swimming during radiotherapy or if you have any
open wounds. This is because of the drying effects it
has on your skin. Speak to your radiographer for
more information.
2. With your elbows straight, raise your arms outwards
from your sides, with your palms facing up. Continue
raising your arms until your fingers point to the ceiling.
Finally lower your arms to your sides.
Repeat five times on the operated side.
Driving
We advise you not to drive for six to eight weeks after
your operation. Before you start driving again:
 Check with your doctor that it is all right to do so. You
can do this at your first outpatient clinic appointment.
 Check with your insurance provider to make sure you
are covered.
 Ensure you are confident that you can perform an
emergency stop and handle the car in an emergency
situation.
Returning to work
When you return to work depends on what your job
involves. Your doctor or nurse can discuss your work
with you and give you more specific advice.
If you notice sudden changes in the colour, texture,
temperature or size of your affected arm or breast
after leaving hospital, you should contact your
breast care nurse or GP.
14 3. Stand with your side to a wall.
Raise your arm straight out and
place your hand on the wall. Gently
‘walk’ your hand upwards, moving
closer to the wall the higher you get.
You can mark the wall as a
reference point, to see how you
progress.
Repeat five times.
7 Lifting and housework
 Avoid heavy activities and heavy lifting for the
first eight weeks after your operation – your
physiotherapist can advise you on this. Also avoid
activities that will strain the abdominal muscles, such
as carrying heavy loads or any contact sports.
4. Repeat previous exercise, but
stand facing the wall.  Think about any activities that you do during the
day which might cause your seroma to develop
and try to reduce them. These may include:
- static exercises or repetitive movements, such as
working on a computer
- knitting or writing, which you do for periods of time
without moving around
- small and fast movements, such as dusting and
light housework.
5. With your arms up in front of
you, push your shoulder blades
forwards bringing your arms across
in front of you, and take a deep
breath in. Then pull your shoulder
blades back with your elbows
pushing back horizontally out to
the side – squeezing your shoulder
blades together.
Sport and leisure
 Begin some form of gentle exercise, such as
walking – this can help maintain a good level of
fitness. It is normal to feel tired after surgery and/or
treatment such as chemotherapy or radiotherapy, so
a sensible regime is recommended. It is difficult to put
a time on how long you might feel tired – this will
depend on the type of treatments you have had. Ask
your doctor or physiotherapist for advice.
Repeat five times on each arm.
6. Move your affected arm behind
your back towards your opposite
shoulder, then change arms (aim
for the same amount of movement
on each arm).
 After eight weeks you can start building up to
more advanced upper body and abdominal
exercises – generally you can start doing more
active walking and using an exercise bike. Build up
your exercise tolerance step-by-step. Your
physiotherapist can advise you further about how to
do this. For example, swimming is a great form of
Repeat five times on each arm.
8 13 will help reduce shoulder stiffness and prevent scar
tissue from tightening up more.
7. Reach your hand behind head and
down your neck.
Repeat five times.
Massage
 Massage your scar to increase skin suppleness –
once your scar has healed, massage it using your
fingers or the palm of your hand. Move the top layer
of skin on the underlying layers in a circular motion or
away from the scar. The aim is to make your skin
supple. This will help you to move your arm as well as
you could before your operation. After your massage
you can use a non-perfumed and lanoline-free cream.
We recommend using aqueous cream (your local
chemist will stock this).
 Gentle stroking and tapping can ease discomfort
– following breast surgery you may experience
changes in sensation over your breast and inner arm
(for example numbness, tingling or extra-sensitivity).
These sensations are quite normal and often pass a
few months after your surgery. Sometimes gentle
stroking or tapping of the affected area may ease the
discomfort. However, you may be left with some
numbness.
8. Touch your neck with
your finger tips and raise
your elbows to 90 degrees
(shoulder height). Move
your elbows out to the side
and then back to the
middle. Feeling a gentle
stretch is ok.
Repeat five times.
12 9 9. Lying on your back or standing,
push your shoulder blades forward,
and reach finger your tips up
towards the ceiling and back again,
squeezing your shoulder blades
together.
What can I do to aid my recovery?
Your exercise programme
 Complete your exercises slowly and gently.
 Do not do any painful stretches – you should feel a
gentle stretch when exercising but not pain. If
exercising feels painful, take painkillers 30 minutes
beforehand. It is important that you follow the
instructions that come with the painkillers and do not
take more than the recommended dose. If you have
any questions, speak to your doctor or
physiotherapist.
Repeat five times.
 Reduce ‘cording’ – after your operation, tight bands
10. Sit or stand, take your
affected arm up and out to the
side, and back again.
or cords may develop in your armpit, sometimes
stretching down your arm. This is often called
‘cording’. You may experience a sharp pulling
sensation, or pain, when you try to stretch your arm.
Exercise will help stretch and relieve these cords,
allowing you to move your arm freely again. Although
they will gradually get better, please speak to your
physiotherapist if you have any questions or concerns
about cording, especially if you are unable to reach
the radiotherapy position (see picture on page 2), or
you find daily tasks difficult.
Repeat five times.
 Be aware of your posture – aim to keep your
shoulders levelled and try not to slouch.
 Move your operated arm as naturally as possible
– this will help with the healing process.
11. Add in stretching your trunk to
the side for a bigger stretch.
Repeat five times.
10  Continue with your exercises until you are able to
use your arm as well as before your operation –
you might have days where your arm feels stiff and
days when it will not. Keeping up with the exercises
11 9. Lying on your back or standing,
push your shoulder blades forward,
and reach finger your tips up
towards the ceiling and back again,
squeezing your shoulder blades
together.
What can I do to aid my recovery?
Your exercise programme
 Complete your exercises slowly and gently.
 Do not do any painful stretches – you should feel a
gentle stretch when exercising but not pain. If
exercising feels painful, take painkillers 30 minutes
beforehand. It is important that you follow the
instructions that come with the painkillers and do not
take more than the recommended dose. If you have
any questions, speak to your doctor or
physiotherapist.
Repeat five times.
 Reduce ‘cording’ – after your operation, tight bands
10. Sit or stand, take your
affected arm up and out to the
side, and back again.
or cords may develop in your armpit, sometimes
stretching down your arm. This is often called
‘cording’. You may experience a sharp pulling
sensation, or pain, when you try to stretch your arm.
Exercise will help stretch and relieve these cords,
allowing you to move your arm freely again. Although
they will gradually get better, please speak to your
physiotherapist if you have any questions or concerns
about cording, especially if you are unable to reach
the radiotherapy position (see picture on page 2), or
you find daily tasks difficult.
Repeat five times.
 Be aware of your posture – aim to keep your
shoulders levelled and try not to slouch.
 Move your operated arm as naturally as possible
– this will help with the healing process.
11. Add in stretching your trunk to
the side for a bigger stretch.
Repeat five times.
10  Continue with your exercises until you are able to
use your arm as well as before your operation –
you might have days where your arm feels stiff and
days when it will not. Keeping up with the exercises
11 will help reduce shoulder stiffness and prevent scar
tissue from tightening up more.
7. Reach your hand behind head and
down your neck.
Repeat five times.
Massage
 Massage your scar to increase skin suppleness –
once your scar has healed, massage it using your
fingers or the palm of your hand. Move the top layer
of skin on the underlying layers in a circular motion or
away from the scar. The aim is to make your skin
supple. This will help you to move your arm as well as
you could before your operation. After your massage
you can use a non-perfumed and lanoline-free cream.
We recommend using aqueous cream (your local
chemist will stock this).
 Gentle stroking and tapping can ease discomfort
– following breast surgery you may experience
changes in sensation over your breast and inner arm
(for example numbness, tingling or extra-sensitivity).
These sensations are quite normal and often pass a
few months after your surgery. Sometimes gentle
stroking or tapping of the affected area may ease the
discomfort. However, you may be left with some
numbness.
8. Touch your neck with
your finger tips and raise
your elbows to 90 degrees
(shoulder height). Move
your elbows out to the side
and then back to the
middle. Feeling a gentle
stretch is ok.
Repeat five times.
12 9 Lifting and housework
 Avoid heavy activities and heavy lifting for the
first eight weeks after your operation – your
physiotherapist can advise you on this. Also avoid
activities that will strain the abdominal muscles, such
as carrying heavy loads or any contact sports.
4. Repeat previous exercise, but
stand facing the wall.  Think about any activities that you do during the
day which might cause your seroma to develop
and try to reduce them. These may include:
- static exercises or repetitive movements, such as
working on a computer
- knitting or writing, which you do for periods of time
without moving around
- small and fast movements, such as dusting and
light housework.
5. With your arms up in front of
you, push your shoulder blades
forwards bringing your arms across
in front of you, and take a deep
breath in. Then pull your shoulder
blades back with your elbows
pushing back horizontally out to
the side – squeezing your shoulder
blades together.
Sport and leisure
 Begin some form of gentle exercise, such as
walking – this can help maintain a good level of
fitness. It is normal to feel tired after surgery and/or
treatment such as chemotherapy or radiotherapy, so
a sensible regime is recommended. It is difficult to put
a time on how long you might feel tired – this will
depend on the type of treatments you have had. Ask
your doctor or physiotherapist for advice.
Repeat five times on each arm.
6. Move your affected arm behind
your back towards your opposite
shoulder, then change arms (aim
for the same amount of movement
on each arm).
 After eight weeks you can start building up to
more advanced upper body and abdominal
exercises – generally you can start doing more
active walking and using an exercise bike. Build up
your exercise tolerance step-by-step. Your
physiotherapist can advise you further about how to
do this. For example, swimming is a great form of
Repeat five times on each arm.
8 13 exercise and you can start building it up with
breaststroke and side-stroke. You should avoid
freestyle (crawl), butterfly and backstroke until eight
weeks after surgery. Please note that you should not
go swimming during radiotherapy or if you have any
open wounds. This is because of the drying effects it
has on your skin. Speak to your radiographer for
more information.
2. With your elbows straight, raise your arms outwards
from your sides, with your palms facing up. Continue
raising your arms until your fingers point to the ceiling.
Finally lower your arms to your sides.
Repeat five times on the operated side.
Driving
We advise you not to drive for six to eight weeks after
your operation. Before you start driving again:
 Check with your doctor that it is all right to do so. You
can do this at your first outpatient clinic appointment.
 Check with your insurance provider to make sure you
are covered.
 Ensure you are confident that you can perform an
emergency stop and handle the car in an emergency
situation.
Returning to work
When you return to work depends on what your job
involves. Your doctor or nurse can discuss your work
with you and give you more specific advice.
If you notice sudden changes in the colour, texture,
temperature or size of your affected arm or breast
after leaving hospital, you should contact your
breast care nurse or GP.
14 3. Stand with your side to a wall.
Raise your arm straight out and
place your hand on the wall. Gently
‘walk’ your hand upwards, moving
closer to the wall the higher you get.
You can mark the wall as a
reference point, to see how you
progress.
Repeat five times.
7 Your exercise plan – stage 2
Can I still exercise after a seroma?
Start these exercises in the fifth week after your
operation. It is fine to feel a stretch while you do these
exercises but they should not be painful.
If you develop a seroma, you should stop overhead
exercises and contact your breast care nurse. A seroma
is a normal part of the healing process, but if it is severe,
it will need to be drained by your surgeon.
Frequency: Four times a day, five repetitions each.
These replace stage 1 exercises. If you develop a
seroma, reduce the exercises to one to two times a day
only and go back to your stage 1 exercises (see page 9
for more information).
1. With your elbows straight, move your arms out in front
of you. Raise your arms until your fingers point to the
ceiling. Finally lower your arms to the sides.
If you develop a seroma having progressed to stage 2
exercises, you should go back to stage 1. Once your
seroma has been treated or is minimal, you can gently
start your stage 2 exercises again. You should also
reduce the frequency of your exercises to once or twice
a day while you have a seroma or while it is being
treated.
How do I know if I need further
physiotherapy?
Repeat five times.
You may need further physiotherapy if:
 you cannot reach the radiotherapy position due to
cording, scar tightness or a painful shoulder
 your shoulder restriction is causing you problems in
your daily activities.
6 15 How do I arrange further physiotherapy?
 Ask your breast care nurse to refer you to the
outpatient physiotherapy department.
 Call the oncology physiotherapy team at Guy’s
Hospital on 020 7188 5103 between 9am and
4.30pm, Monday to Friday. If your call is answered by
our answerphone, please leave a message and we
will call you back.
 Call the hospital switchboard on 020 7188 7188 and
1. Place your hands at the
back of your neck and raise
your elbows out in front of
you to 90 degrees
(shoulder height). Then
lower your elbows to your
sides.
Repeat five times.
2. Place your hands on
your shoulders and raise
your elbows outwards,
away from your body, to 90
degrees (shoulder height).
Then lower your elbows to
your sides.
ask for the bleep desk. Ask for bleep 2744 and wait
for a response. This will connect you to the senior
oncology physiotherapist directly.
 You can email the oncology physiotherapist for any
questions or to self-refer at
breastoncologyphysio@gstt.nhs.uk
Repeat five times.
3. Place your hand on your
lower back.
Repeat five times.
4. Keeping your arms by
your side, push your
shoulder blades forwards
and then pull your shoulder
blades back – squeezing
your shoulder blades
together.
16 Repeat five times. 5 There are two stages to your exercise plan:
Appointments at King's
Stage 1
Start these exercises one to two days
after your operation and continue to do
them for four weeks (unless you have
been advised otherwise by your doctor or
physiotherapist).
Stage 2
Start these exercises in the fifth week
after your operation (unless you have been
advised otherwise by your doctor or
physiotherapist).
We recommend that you continue with these exercises
every day, even after you have regained full shoulder
movement.
We have teamed up with King’s College Hospital in a
partnership known as King’s Health Partners Academic
Health Sciences Centre. We are working together to
give our patients the best possible care, so you might
find we invite you for appointments at King’s. To make
sure everyone you meet always has the most up-to-date
information about your health, we may share information
about you between the hospitals.
Contact details
If you have any questions or concerns about your
exercise plan, please contact the Physiotherapy
Department on 020 7188 5106 (Monday to Friday,
8.30am to 4.45pm).
For more information leaflets on conditions, procedures,
treatments and services offered at our hospitals, please
visit www.guysandstthomas.nhs.uk/leaflets
Link the exercises with something you do every day
(such as mealtimes) and they will soon become part of
your routine.
Your exercise plan – stage 1
Do these exercises for the first four weeks after your
operation (unless advised otherwise by your doctor or
physiotherapist).
Frequency: Four times a day, five repetitions each. If
you develop a seroma (a collection of fluid which
can develop in the area where tissue has been
removed from your breast), reduce the exercises to
two times a day only.
4 17 This leaflet explains more about returning to your
everyday activities after your operation, and
provides you with some exercises to follow. If you
have any further questions or concerns, please
speak to your doctor or physiotherapist.
Notes
Why do I need to exercise after my
reconstructive breast surgery?
It is important that you follow the exercise plan in
this leaflet because it will:

prevent shoulder stiffness

help you regain and maintain full movement in
your shoulder

encourage your circulation and healing of your
scar tissue

prevent or ease any back pain caused by the
operation

encourage back movement and increase your
abdominal (stomach) muscle strength.
If needed, these exercises will also help you to get into
the required position for radiotherapy within a short
period of time – see picture below for the radiotherapy
position.
18 3 Notes
Contents
p.3
Why do I need to exercise after my
reconstructive breast surgery?
p.4
Your exercise plan – stage 1
p.6
Your exercise plan – stage 2
p.11 What can I do to aid my recovery?
p.15 Can I still exercise after a seroma?
p.15 How do I know if I need further
physiotherapy?
p.16 How do I arrange further physiotherapy?
p.17 Contact details
p.18 Notes
p.20 Further information
2 19 Further information
Pharmacy Medicines Helpline
If you have any questions or concerns about your
medicines, please speak to the staff caring for you or
call our helpline.
t: 020 7188 8748 9am to 5pm, Monday to Friday
Patient Advice and Liaison Service (PALS) – To make
comments or raise concerns about the Trust’s services,
please contact PALS. Ask a member of staff to direct you
to the PALS office or:
t: 020 7188 8801 at St Thomas’ t: 020 7188 8803 at
Guy’s e: pals@gstt.nhs.uk
Language support services – If you need an interpreter
or information about your care in a different language or
format, please get in touch using the following contact
details.
t: 020 7188 8815 fax: 020 7188 5953
NHS Choices – Provides online information and guidance
on all aspects of health and healthcare, to help you make
choices about your health.
w: www.nhs.uk
Physiotherapy Department
Physiotherapy advice
after breast
reconstruction surgery
using a latissimus
dorsi flap with or
without implant
Leaflet number: 2579/VER3
Date published: November 2014
Review date: November 2017
© 2014 Guy’s and St Thomas’ NHS Foundation Trust
20