Etymology: L, post + Gk, mastos, breast, ektomē, excision
exercises essential to the prevention of shortening of the muscles, prevention of contracture of the joints, and improvement in lymph and blood circulation after mastectomy.
method The woman is asked to flex and extend the fingers of the affected arm in the recovery room and to pronate and supinate the forearm immediately on return to her room after recovery from anesthesia and surgery. The postoperative mastectomy exercises are begun gradually at the surgeon's discretion. Brushing her teeth and hair is encouraged as effective exercise. Other exercises are usually taught, including four specific exercises: climbing the wall, arm swinging, rope pulling, and elbow spreading. They are performed as follows: Climbing the wall: The patient stands facing a wall, toes close to the wall. The elbows are bent, and the palms of the hands are placed on the wall at shoulder height. The hands are moved up the wall together until the woman feels pain or pulling on the incision, then returned to the starting position. Arm swinging: While standing, the patient bends forward from the waist, allowing both arms to relax and hang naturally. The arms are swung together from the shoulders from left to right and then in circles parallel to the floor, clockwise and counterclockwise. She straightens up slowly. Rope pulling: A rope is attached over a shower rod or a hook. Each end of the rope is grasped, and the patient alternately pulls each end, raising one arm after the other to the height at which incisional pain or pulling is felt. The rope is shortened until the affected arm is raised almost directly overhead. Elbow spreading: The hands are clasped behind the neck, and the elbows are slowly raised to chin level while the head is held erect. Gradually the elbows are spread apart to the point at which incisional pain or pulling is felt.
interventions Specific exercises may be ordered. The patient is shown how to do them and is encouraged to continue them at home.
outcome criteria With proper exercise, full range of motion returns; both arms can be extended fully and equally high over the head. The woman benefits from having something active to do to help herself during the difficult period of adjustment after mastectomy. Many activities of daily life provide good exercise, such as reaching high shelves, hanging clothes, and gardening.