by Shanna Nasche

I was diagnosed with breast cancer and in February 2014 I had a double mastectomy. At age 54, the mastectomies were my first major surgery. As any of us yogis know, our breath—including basic breath awareness and simple, calming forms of pranayama—is the practice we can always turn to, so my breath was my regular companion during the various tests and while waiting in pre-op. As a yogi, who temporarily on medical leave, one flame that flickered within me was the desire to return to my physical practice. I mentally visualized Adho Mukha Svanasana (Downward-Facing Dog pose) as my goal. For me, finding my lost dog meant an open chest, shoulders, armpits, and straight arms, none of which I could access after surgery. I couldn’t even shrug my shoulders! I’ve never been motivated by the repetitious nature of lifting weights or the thought of 100 sit-ups to tone my muscles. But Vinyasa yoga offers me creativity, freedom of movement, and a spiritual aspect to taking care of my body. 

For those of you going through a similar journey (or who are teaching people recovering from this surgery), I’ve recreated a summary of my physical journey with recommendations for initial poses after the breast surgery. As you practice, you should not feel pain but might notice a pulling or stretching sensation. Please review this or any other plan for exercise with your surgeon, especially if you’ve experienced complications, began reconstruction using tissue expanders, or had lymph nodes affected by surgery. 

First Things First

While drains remain, walk at a comfortable pace as much as an hour a day (less if you did not exercise regularly prior to surgery). Moving helps the body heal, increasing blood flow and oxygen. Don’t do any weight bearing or lifting with the arms but reach outward (with the remote!), upward (to wash your hair), or behind you to put on a jacket. Avoid letting others do what you can do for yourself, even if it takes longer. Use deep breathing to reduce physical tension and to gently expand the chest muscles. Practice engaging the muscles used to shrug your shoulders, possibly rolling them up and back several times a day. As you release the shoulders, imagine your shoulder blades pulling down toward your waist. 

Approximately 10-14 Days After Surgery

Begin light stretches at this time (even if drains remain). Walking your hands up a wall is the best post-surgery “asana,” and officially recommended by all experts. 

Stand with your arm on the effected side at a 90 degree angle to the wall. Walk your hand upward and hold for about five breaths (3-5 sets). Repeat about 3 times day. As your shoulder opens, move your hand above your head along the wall and inch the outer edge of your foot closer. A fully extended arm with hip touching the wall is the final pose, which may take several months to achieve. Ask permission to move your arm higher than your shoulder from your surgeon, often approved around two weeks. Use breath awareness or an extended exhalation for each of the stretches with the goal of releasing tension in your body as you hold the stretch. 

The next stretch requires reaching your elbow behind your body. You can grasp a strap (or a towel) in one hand and take it behind your back (arm straight or slightly bended). The other hand reaches behind to grab the other end of the strap. Walk the hands toward each other along the strap. Allow your shoulder blades to move toward each other. Don’t arch your back, and allow your tailbone to move toward your heels. Turn your palms away from the body. Over time, you may be able to interlace your fingers behind your back. 

This photo shows an advanced version with heels standing on the strap (looped), hands grasping the top of the strap (palms out). Elbows move toward each other as your chest opens over time. As your body allows, your elbows may bend slightly, pointing straight behind. 

The third stretch uses a strap or towel in both hands (try gripping with palms up and down). Reach your arms in front, in line with your shoulders or lower if needed (review video). 

Raise your hands (arms straight or slightly bent) upward toward ceiling until you reach the edge of your flexibility. Keep your arms no higher than shoulder height until the drains are removed. Keep your spine long with your tailbone pointing toward your heels and your lower ribs stacked below the others. 

You can also do these lifts on your back with knees bent and soles of feet on the floor. Arms above your head can be helpful to reduce swelling if lymphedema is a concern. Another option for this stretch is to face the wall and walk your hands upward, inching closer to the wall as your body allows. These stretches are pre-cursors to Child’s pose (Balasana) and Downward-Facing Dog pose.

End with a restorative pose with the arms out to the side and your elbows bent in Cactus arms (in line with shoulders) or in the shape of a “W” if your elbows need to move lower (toward your hips).

This photo shows elbows touching the ground but that is unlikely in the beginning. If they don’t easily touch the ground, support your elbows and hands with blocks, blankets, or pillows, and allow gravity to open your chest instead of force. Relax in this pose at the end of your stretches, reducing the height of the props over time as your body allows. Once you can easily rest your elbows on the floor, another option to further open the heart and shoulder areas is to place a rolled blanket under your spine (keeping the back of your pelvis—the sacrum—on the floor) As you regain your range of motion, continue these or similar stretches at least once time a day to help reduce scar tissue around the incisions. 

In the Classroom

Each body heals at its own rate. Complications will likely extend your healing “schedule.” I returned to an official class (specific to cancer patients) about three weeks after surgery. I started with chair yoga. Without the ability to place much weight on the arms, I felt clumsy trying to move around on the mat. Stay with gentle versions of the stretches outlined above. My surgeon released me for physical activity five weeks after surgery, encouraging moving and stretching to reduce scar tissue. My first attempt at Downward-Facing Dog was around that five-week mark. My spine resembled an old gray mare, curving like a “U” in the middle to accommodate the tightness in my shoulders and chest. It helped to bend my knees, but my arms tired quickly, keeping me from holding the pose more than a few breaths. But despite my limitations, it was healing to return to my mat. I was thrilled! The photo at the beginning of this post shows my latest version, which I estimate at four to six months to achieve. 

In addition to the overall goal to regain range of motion, consider Downward-Facing Dog pose as a yoga “carrot” to visualize your healing after breast cancer surgery. 

Shanna Nasche, RYT-200 is a Yoga Bridge instructor and a student at Yoga Bridge. Yoga Bridge is a 501(c)(3) nonprofit that provides evidence-based coping strategies to complement medical treatment for cancer and recovery. They offer free and low-cost yoga programs to all people affected by cancer. Students are part of a nurturing community where they find relief from fatigue, muscle weakness, and stress. Yoga Bridge also offers teacher trainings in yoga for cancer twice a year. Email yogabridge@hotmail.com for more information.


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