When Can You Start Arm Exercises After Mastectomy?

Most people can start gentle arm exercises within the first week after mastectomy, as soon as their care team says it is OK. The American Cancer Society describes simple movements for the first 3 to 7 days, some stretches that wait until drains and stitches are out, and strength training that usually begins about 4 to 6 weeks after surgery. Your surgeon sets the timing based on your surgery and healing.

Key takeaways

• Gentle movement often starts within days, guided by your care team.
• Some stretches wait until drains and stitches are removed.
• Research shows early exercise helps shoulder motion, with a small increase in wound drainage.
• A structured program starting 7 to 10 days after surgery improved arm function at 1 year in a large trial.
• Ask for a physical or occupational therapy referral if your arm is still stiff after 3 to 4 weeks.

Arm and shoulder recovery after breast cancer surgery connects closely with swelling risk. Our overview of breast cancer-related lymphedema is a good place to start on that topic.

Why do arm exercises matter after mastectomy?

Arm exercises help you get back the shoulder motion and strength that surgery, scarring and guarding can take away. Without regular movement, the shoulder can become stiff and harder to use for daily tasks.

A mastectomy removes breast tissue, and many people also have lymph nodes removed from the armpit, called the axilla. Some have reconstruction at the same time. The chest and armpit tissues heal with scar tissue that can feel tight, and many people naturally hold the arm close to the body to protect it. Over time, that can limit how far you can lift your arm. Our post on surgical options for breast cancer explains the common procedures, and our breast cancer related lymphedema exercise and recovery guide covers the full path from the first days after surgery to long-term strength work.

A Cochrane review by McNeely and colleagues pooled 24 randomized trials with 2,132 participants. It found that structured exercise programs after surgery improved shoulder flexion, the motion of lifting the arm forward, by about 13 degrees in the short term. Physical therapy added more benefit for shoulder function, both right after the program and at 6 months.

What can you do in the first week?

In the first days, most people can do simple movements such as gentle shoulder rolls, deep breathing, and hand, wrist and elbow motion, plus raising the arm only to shoulder height if allowed. The aim is to keep things moving without pulling on drains or incisions.

The American Cancer Society describes gentle movements for the first 3 to 7 days, once your healthcare team gives the OK. These include using the affected arm as you normally would to comb your hair, bathe, get dressed and eat, and raising your arms to shoulder height, or as high as you can without pulling on your drains, 3 or 4 times a day. With the arm raised, you can open and close your hand 15 to 25 times and bend and straighten your elbow. Deep breathing exercises help keep normal movement in the chest.

Drains are thin tubes placed during surgery to carry away fluid from the wound. The American Cancer Society notes that some exercises should not be done until drains and stitches are removed, so ask which movements are safe while yours are in.

When do bigger stretches start?

Larger stretches, such as lifting the arm overhead or reaching out to the side, usually start once your care team says it is OK, which the American Cancer Society says usually happens a week or more after surgery. Some of these stretches wait until drains and stitches are out.

The American Cancer Society describes doing each exercise 5 to 7 times, twice a day, holding each stretch for a slow count of 5, and moving slowly until you feel a gentle stretch, with no bouncing or jerky movements. Common stretches it lists include:

• Wand exercises. Holding a stick or wand with both hands and lifting it forward and overhead.
• Wall climbs. Walking the fingers up a wall in front of you until you feel a stretch.
• Elbow winging. Lying on your back with hands clasped behind your neck and moving the elbows apart and down.
• Shoulder blade squeezes. Drawing the shoulder blades together to help posture.
• Chest wall stretch. Standing in a corner with forearms on the walls and leaning the chest gently forward.

Some home programs also use an over-the-door pulley, where the other arm helps lift the affected arm. Ask your therapist whether it fits your plan.

Strength training, such as light weights, usually begins about 4 to 6 weeks after surgery, according to the American Cancer Society. It starts with light weights and increases slowly.

Is early exercise safe?

Early gentle exercise is generally considered safe, and it helps shoulder motion. Starting larger stretches very early can increase wound fluid, which is why many teams time them around drain removal.

The McNeely Cochrane review looked at 10 trials that compared early with delayed exercise. Early exercise improved short-term shoulder flexion by about 10.6 degrees. It also increased wound drainage volume and kept drains in about 1.15 days longer. The review found no evidence that exercise raised lymphedema risk at any time point.

An earlier systematic review by Shamley and colleagues found that delaying exercises lowered the chance of seroma. A seroma is a pocket of clear fluid that can collect under the skin after surgery. The review could not draw firm conclusions about long-term arm movement.

These findings explain why many care teams start with small, gentle movements right away and add bigger stretches after the first week or so. Read more about swelling risk in our post on risk factors for developing breast cancer-related lymphedema.

What does a structured program add?

A structured exercise program, led by a physical therapist, can improve arm function and lower pain over the following year. This is especially helpful for people at higher risk of shoulder problems.

The UK PROSPER trial, published in the BMJ in 2021, included 392 women at higher risk of arm problems after breast cancer surgery. Half received usual care with information leaflets. The other half also received a physiotherapy-led program of stretching, strengthening and physical activity, introduced 7 to 10 days after surgery, with follow-up visits at 1 and 3 months.

At 12 months, the exercise group had better arm function, measured with the DASH questionnaire, a standard score for arm, shoulder and hand disability. Their average score was 16.3, compared with 23.7 for usual care, where lower scores mean less disability. Pain was lower, and the trial found no increase in complications or lymphedema.

What if your arm is still stiff after a few weeks?

If you do not have full use of your arm after 3 to 4 weeks, ask your care team about a referral to a physical or occupational therapist. In the McNeely review, physical therapy added benefit for shoulder function.

The American Cancer Society notes that you might need help from a physical therapist, occupational therapist or certified cancer exercise specialist if you do not have full use of your arm within 3 to 4 weeks after surgery. The American Cancer Society also notes that radiation can affect your arm and shoulder long after treatment is finished, which makes regular exercise even more important. Our post on lymphedema and restricted shoulder mobility after radiation therapy covers this in more detail, and our post on treatment of shoulder dysfunction in relation to lymphedema explains how therapists approach it.

When to call your doctor

Call your surgeon or care team promptly if you notice:

• Redness, warmth, increasing pain or drainage from the incision
• Fever or chills
• A swollen, tight or fluid-filled area near the incision
• New swelling, heaviness or tightness in the arm, hand or chest on the surgery side
• Pain that keeps getting worse with exercise
• New weakness, loss of balance, headaches, dizziness, blurred vision, or new numbness or tingling in the arm or chest

Talk with your clinician before you start or change any exercise after surgery.

How RangeMaster products fit

The PinkPulley Cancer Care Shoulder Pulley is designed for gentle home range-of-motion work. It has a smooth nylon roller, wooden handles, a metal door bracket, a 77-inch adjustable line and a breast cancer patient guide. Use it only within the timing, range and precautions provided by your care team.

The Cancer Recovery Strength and Mobility Kit (Pink) combines the PinkPulley with the ShoulderWand, ShoulderFit resistance tools and a patient guide, so you can move, stretch and later strengthen as your team allows.

Related reading

• Breast cancer related lymphedema: exercise and recovery guide
• Breast cancer-related lymphedema
• Treatment of lymphedema
• Surgical options for breast cancer
• Treatment of shoulder dysfunction in relation to lymphedema

Your next step

When your care team clears you for stretching, the PinkPulley Cancer Care Shoulder Pulley offers a gentle way to keep up your arm exercises at home.

Common questions

Can I raise my arm above my head after mastectomy?

In the first days, the American Cancer Society describes raising the arm to shoulder height, or as high as you can without pulling on drains. Overhead stretches come later, once your team says it is OK.

Can I exercise with drains in?

Gentle movements are often allowed with drains in. Avoid big stretches that pull on the drains, and follow your care team's advice.

Do I need physical therapy after mastectomy?

Many people recover motion with a home program. If your arm is still stiff after 3 to 4 weeks, or you are at higher risk of arm problems, a physical therapist can help.

Is it normal for my armpit to feel tight?

The American Cancer Society says some tightness in the chest and armpit is normal after surgery and should ease as you do your exercises. Tell your care team if it does not ease, gets worse, limits your motion, or comes with swelling.

When can I start lifting weights?

The American Cancer Society says strength training usually begins about 4 to 6 weeks after surgery, starting with light weights. Your care team will tell you when and how to begin.