Why Can't You Raise Arms Overhead After Double Mastectomy

What are the actual reasons why a woman is told not to lift her arms overhead for two weeks after a double mastectomy?

Here is the answer – as it pertains to a prophylactic double mastectomy.

I’m scheduled for a prophylactic (preventive) double mastectomy after learning that my sister was diagnosed with breast cancer.

I was told that I will not be able to lift my arms over my head for the two weeks following the surgery.

But is this due to a mechanical inability or is it some kind of precaution?

After all, a preventive bilateral mastectomy does not involve cutting into any musculoskeletal or lymphatic tissue.

Here is what my breast care nurse, who is handling my case, responded when I asked her to explain why the restriction of overhead arm use for two weeks after a double mastectomy.

“Sometimes it can be difficult to raise your shoulder because it pulls on the drains…”

All patients of such a procedure must put up with drains for one to two weeks. But pulling on drains falls under the category of discomfort rather than an inability.

However, there’s more…

The restriction is lifted after the drains are removed, said the nurse. She also said, “I do know women who’ve had mastectomies who do feel comfortable lifting their arm above their head. Each person is kind of individual.”

However, my nurse explained that for those two weeks, even if you feel comfortable, you are not to do “long stretches over the head because it can ruin the incision, pull on the area. You can lift above your shoulder but no long stretches.”

A long stretch would be what you’d have to do when putting on a shirt over your head and taking it off.
A brief stretch would be, for example, while you’re seated at your computer, you raise your hand over your head to reach the switch on a lamp to put it on. That’s two seconds.

“But no long stretches; that could injure the surgical.”

This would include activity such as stocking high shelves with food or other items like linens, yoga positions, hair styling, or any other prolonged overhead motions, even if there’s intermittent lowering – such as in the case of placing several pieces of glassware in a cupboard.

So in summary, the reason you are instructed not to move your arms overhead for two weeks after a prophylactic double mastectomy is due to precaution rather than patient comfort or mechanical impairment.

However, some degree of mechanical impairment or difference will occur during recovery.

10 Percent of Women

“Poor range of motion after double mastectomy can occur in about 10 percent of women based on some small studies,” says Mylaine Riobe, MD, founder of Riobe Institute of Integrative Medicine. Dr. Riobe, who’s board certified in ob/gyn and integrative medicine, is the author of “The Answer to Cancer” and has over 15 years’ experience using integrative techniques to treat diverse patients.

Dr. Riobe explains, “Numbness and swelling were the most common symptoms [in the study].

“Some theories regarding the reason for reduced range of motion is because of the amount of skin removed during the mastectomy.

“A variation of mastectomy which is more ‘skin-sparing’ can be done which may theoretically reduce the likelihood of reduced range of motion.

“Most of the time, however, the chest area is kept as flat as possible to allow for proper fitting of a prosthesis.”

EDIT/UPDATE! I’m now 22 days postop, and I will tell you that lifting your arms straight over your head soon after a double mastectomy is problematic (but not impossible) due to the sensation that your skin is pulling so tightly that it feels that it will rip.

This is NOT related to two weeks of inactivity. It’s related to the surgery, though my muscle tissue was NOT touched. I guess the skin was traumatized and just needs to rebound from the shock.

Anyways, at 22 days postop, I have no problem lifting my arms/hands straight over my head, but initially, the skin felt as though it was being pulled too tightly.

UPDATE 2 — Three and a half months post-double mastectomy … I can dead hang (holding onto bar above head with straight arms, feet not touching floor) for a whole minute.

A sustained dead hang is the last thing to come back after a double mastectomy — in my opinion, anyways.
Even a pull-up is easier because the arms are bending.

Level of physical fitness going into a double mastectomy plays a key role in how soon you’ll mechanically be able to effortlessly lift your arms/hands completely over your head.

The more strength trained or yoga trained your body is, prior to a double mastectomy, the less likely any postop doctor restrictions will stiffen your muscles and impede return to full range of motion!