The Value of a Great Physiotherapist Before and After Breast Surgery

08 Mar 2016 by Krystal Barter
The Value of a Great Physiotherapist Before and After Breast Surgery

Physiotherapy-pagePink Hope Outreach Ambassador Ally describes her personal experience working with a physiotherapist to prepare for her risk reducing mastectomy with DIEP flap reconstruction.

Have you ever wondered why some women appear to recover quite quickly from major breast surgery and others seem to linger for ages, even years with muscular complaints?

Granted, it helps to be fit and healthy and have a great surgical team on your side when planning any type of surgery, but what part could targeted core and strength building play in your surgical outcome?

In 2013, it was my turn to find out. I was facing a prophylactic bilateral mastectomy with immediate DIEP flap reconstruction, an 6 – 8 week recovery period including a lot of time flat on my back, avoiding strain on my abdominal muscles and then in an elastic brace for three months.

I was 41 years old with 3 children, a chronic bad back that I needed to make a concerted effort to get under control, not to mention a dodgy knee. I was a little concerned about how I would bounce back from such a huge surgery with three children and no family close by. This surgery was major, it was necessary, but on the upside it wasn’t an emergency and I had 6 months to prepare.

Priority to do list:

  • Husband to organize time off work
  • Prepare a list of questions for my surgeons
  • Book in pre-op blood tests and scans
  • Check out my surgeons’ recommended hospital
  • Consult with my private health insurer regarding costs
  • Buy some appropriate hospital attire – buttons down the front
  • Take friends up on offers to help with the children and meals
  • Clean the house and/or book a cleaner
  • Explain to people who would notice I wasn’t around for a few months
  • Google easy meals to bake and freeze – and then do it
  • Explain to my children’s teachers that I would be out of touch for a while and if there’s an issue please call DAD
  • Get my chronic lower back pain and my dodgy knee under control
  • Mental health check – it is major surgery after all, a lot of processing required
  • Lose weight, eat properly and start taking recommended vitamin supplements

My life changing conversation:
I had been attending weekly clinical Pilates classes for a while, but I wasn’t that committed to the follow-up home exercises so I wasn’t really seeing results. As fate would have it I changed classes, and mentioned my upcoming surgery to my new instructor.

In hindsight, this casual conversation with my new Physio/Pilates instructor probably dramatically altered my recovery time, comfort, mobility and final surgical outcome.

Time to get serious:
With this new information in mind my Physiotherapist personalized my Pilates program to build my core and upper body strength, and quads to help my knees. He believed in my ability to achieve these goals, even though I had reservations, and he pushed me in a kind way to step out of my comfort zone. I became motivated and attended 45 minute classes twice a week including a mix of reformer, trapeze and mat exercises, rarely missing a beat. I also committed to regular physiotherapy treatments to relieve my back/disc/knee issues so I would be fighting fit on surgery day.

I regularly performed my weekly exercises at home and walked a LOT – this is embarrassing to say but I didn’t know that walking would actually help my lower back pain. I’ll admit I could never have done this on my own, clearly the consistency, motivation and goal setting was enough to get me across the line – for the first time in my life I had muscle definition – (ok only if you looked very closely!). When surgery day came around I felt strong and ready, I had done all I could to prepare and ensure the best recovery outcome.

After 12 and a half hours on the operating table, four blood transfusions, 10 days in hospital and LOTS of pain killers – my surgical team were impressed by my speedy recovery, lack of complications and excellent mobility. I was thankful for my new upper body strength when in the first few days post op I had to haul myself up with my arms so the nurses could change my bed sheets – now that would not have happened without Pilates!!!

Road to recovery – MOVE MOVE MOVE!
At Week 3 post-op with my physiotherapist’s guidance I started walking VERY SLOWLY on my treadmill for a few minutes per day building up in tediously small increments. The structure and guidance of the increases were critical, while doing too little exercise was not helpful, neither was doing too much, getting dizzy and falling flat on my face.

Reminder emails came thick and fast, KEEP MOVING was the key theme. It was hard work after being in bed for so long and I didn’t really think such a small amount of movement could be worth it. My first attempt at walking on the treadmill in my lounge room lasted 5 minutes on an extremely slow speed and no incline – I nearly passed out and slept for hours afterwards. But it didn’t take long before I was outside walking around the block in the fresh air and feeling human again.

‘Fuel in the tank’:
At Week 5 I had my first physiotherapy treatment – my shoulders were painful from lying flat on my back for so long. I remember my physiotherapist saying that most people present for their first post op session with lots of back pain and stiffness, and extensive generalized weakness from the inactivity. But thank goodness that wasn’t me – I had managed to minimize the degree of both these problems through my pre op preparation, and a post op structured program. I was a mess at this first appointment, it was the first time I’d driven in 5 weeks and I hadn’t really been upright for that long either. However I was feeling strong and positive after that treatment, buoyed by my physio’s support and words of encouragement on how he planned to get me back to full strength.

I returned to my regular Pilates class at Week 10 post-op. I obviously had lost some form but we started slowly and it didn’t take long to get back to pre-surgery condition. My physio always reminded me that my hard work in Pilates would pay off post-surgery as I’d have some ‘fuel in the tank’ to get going again and wouldn’t be starting on empty. He turned out to be CORRECT!

I surprised myself, as my road to recovery wasn’t as long and arduous as I expected, that’s not to say that there weren’t a few tears and frustrations along the way.


Luckily my physio/pilates instructor had a good sense of humor and LOTS of patience. I may have complained once or twice, impatient that I wasn’t back to optimum strength faster, rolled my eyes a little in Pilates when he pushed me harder than I thought I could – he knew my limits better than I did and was always honest, supportive and positive with his advice.

In a nutshell:
You’re unlikely to find a physiotherapist/Pilates instructor quite like mine, (or so he thinks!). All jokes aside, if you find yourself looking down the barrel of major surgery why not consider some physical preparation like Pilates and or physiotherapy, and how it could improve your recovery outcome. Surely it’s better to start the journey on a full tank of fuel.


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