Post Mastectomy Physical Therapy Protocol

Note: This information is not intended to replace your surgeon’s instructions, but to supplement them so that you are better prepared to make your recovery process as smooth as possible. Always follow your surgeon’s instructions, and call them with any concerns you may have. For questions or comments about this page, email us at

Mastectomy is the surgical removal of the breast tissue including the nipple to treat or prevent breast cancer.* Your surgeon may also remove one or more lymph nodes from under your arm. You may have a single breast removed, or both. For women who want conventional breast reconstruction, their surgeon may suggest a “skin-sparing” or “nipple-sparing” procedure. More about the mastectomy process itself at BreastCancer.org.

Aesthetic flat closure is surgical contouring of the chest wall to produce a smooth, flat result post-mastectomy. This can be done at the time of the mastectomy, at a subsequent revision surgery, or after explant. Also known as “going flat, ” aesthetic flat closure is a valid and healthy reconstructive alternative to conventional breast mound reconstruction (eg. implants, autologous flaps). After the removal of the breast tissue, i.e. the mastectomy itself, an additional 30-60 minutes of surgical contouring work may be required to produce an aesthetic flat closure.

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Revision is “Corrective” Surgery. After a mastectomy without conventional reconstruction, some patients find themselves with a less than optimal aesthetic outcome. Unless you have a medical contraindication, revision surgery is an option to improve your chest wall contour, should you decide to pursue it. In our 2019 survey, revision drastically improved patient’s satisfaction with their aesthetic outcome. But not everyone is willing to undergo additional surgery to achieve a “flatter” chest. It’s a very personal decision.

Procedure & Recovery. Revision surgery can look very different for different patients. For minor “nips & tuck” revisions, the procedure can often be done in office with local anesthetic and may involve only a short recovery period of a week or two. More extensive revisions for very large “dog ears” and significant excess skin may involve general anesthesia, surgical drains, and a longer recovery process approaching that of your initial mastectomy. Speak with your revision surgeon about your specific medical situation and what to expect for your surgery. For tips on finding a revision surgeon, visit the Revision Surgery page.

Removal of the unaffected breast at the time of a mastectomy for unilateral breast cancer is called “contralateral prophylactic mastectomy” (CPM). In the absence of genetic risk factors that elevate your risk for a new primary breast cancer, the decision to pursue CPM is generally at the discretion of the patient.

Physical Therapy For Post Mastectomy Patients

Studies clearly show that CPM does not improve survival or significantly reduce your risk of recurrence, either local or metastatic, of your initial breast cancer. But it does reduce your risk of a new primary breast cancer, and that risk reduction can be more significant for younger women. Discuss CPM with your surgeon so that you can understand the risks and benefits of keeping or removing the unaffected breast. It can also be helpful to speak with other women who have lived single-breasted, and those who decided to have a double mastectomy, about their experiences (more).

For the initial recovery period after your mastectomy, i.e., the first 1-2 weeks, you may need assistance with basic self-care duties. Some patients manage fine on their own, but others struggle, and it’s better to be prepared. Routine chores like preparing food, washing dishes, and light housework should all be minimized initially to prevent overuse of the arms, which engages the muscles underlying the mastectomy site. Rest is critical in allowing those tissues to heal.

If you have a partner, friend, family member or neighbor who can assist you for part or all of the day, it will help you to focus on resting and healing. Also, you will not be able to drive until your surgical drains are removed and you are no longer taking narcotic painkillers. Line up help in advance, with backup if possible. If you live alone and aren’t sure who to ask for help, ask your doctor’s office for recommendations or contact a patient services organization like Triage Cancer for assistance.

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If you are a primary caregiver of small children or other dependents, you should know that during the first couple of weeks after your surgery you will most likely be unable to fulfill any of your usual duties that involve engaging your chest muscles. That includes any lifting or carrying of your dependent charge. Even walking a dog, especially a large dog, is unadvisable during your initial recovery period.

While everyone’s recovery is different, it’s hard to predict in advance. Making the following preparations will ensure that you won’t be tempted to overexert yourself when you should be resting after your surgery:

Wherever you plan to sleep during your recovery, you should be able to get in and out of the sleeping position easily without requiring the use of your arms. This typically means sleeping with your back leaning against a pile of pillows, or on a foam wedge. Some people find that sleeping in a recliner provides a more comfortable night’s sleep than a bed.

Post Mastectomy, Hawley, White Mills, Lake Ariel, Pa

Positioning your arms so that they are elevated through the night is a good idea if you had lymph nodes removed – a stack of pillows under each arm is a good way to do this and is adjustable to your comfort level. You should have a surface (table, nightstand) within reach on which to put your pain medication and water so you can stay pain-free and hydrated. Set up your sleep environment before your surgery so that when you arrive home, you don’t need to make any further arrangements.

Wearing loose-fitting zip-front or button down shirts, dresses or robes until you can comfortably raise your arms above your head will allow you to dress and undress without overextending your arms. This may take a week or longer. Many women say their husband’s work or flannel shirts worked well for them. You can also purchase special post-surgical robes.

You will likely be sent home from the hospital in a surgical bra, which is a loose fitting soft cotton bra that serves two purposes: to protect the surgical site (you can use “fluff dressings” to pad and protect your chest from accidental impacts) and to hook your surgical drains to (you can just use safety pins). Alternatively, you may want to use a pocketed apron, or purchase a special garment for holding your drains. These come in various designs, from belts and neck straps, to stick on pockets, to robes with integrated drain pockets.

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You may be given a compression bandage or garment, or told to purchase one – or you may be told to avoid compression. Follow your surgeon’s specific instructions about compression.

Some common problems women experience during their surgical recovery can be prevented or mediated by proper planning. It’s worth taking the time to discuss these issues with your surgeon, particularly if you have experienced similar issues in the past.

Your Desired Aesthetics. This is your body, and your choice. Make sure you feel comfortable that your surgeon understands your expectations for how your chest will look after the surgery. What incision pattern will your surgeon be using? How will they ensure a smooth flat contour? Visit the Going Flat Guide for a complete list of questions and more information.

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Surgical Adhesives. Some women have skin that is reactive to surgical tape or adhesives – if your surgeon is aware of this, they can use alternative products known to be less likely to irritate your skin to close and dress your wound(s).

Anesthesia. If you know that you tend to experience nausea from general anesthesia, your surgeon may be able to prescribe a scopalamine patch as a preventative or take other steps to minimize the risk that you’ll experience nausea.

Narcotic Painkillers. If you have had nausea or other adverse reactions to narcotic painkillers before, your surgeon should be able to prescribe an anti-nausea drug (ex. Zofran) or an alternative type of pain medication regimen. There may also be options for anesthetic pain management.

Living With Post Mastectomy Pain Syndrome

Scar Management. Some people’s bodies react to wounds, including surgical wounds, by forming a hypertrophic or “keloid” scar. Most scars lie flat, but these scars are raised. Hypertrophic scars may flatten over time, whereas keloid scars are more pronounced and do not flatten over time. The good news is that this type of scarring can be reduced or prevented by using silicone sheets and/or taping to reduce skin tension (source). Scars can also be treated after they’ve formed, but prevention is preferable. People with darker skin tones are particularly prone to this type of scarring. Note: while plastic surgeons are usually familiar with aesthetic scar management, breast and general surgeons may not be, so you may need to request a referral (either to a plastic surgeon, or a dermatologist).

Physical Therapist Referral. If your health insurance requires a referral for you to see a physical therapist or rehabilitation specialist, ask your surgeon for a referral. Having a plan in place will help you get

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