Regaining Mobility after TRAM Reconstruction following Breast Cancer

Any reconstructive breast surgery after cancer can impact your range of motion and strength, but some more than others. Even though TRAM flap reconstruction is not used as often today as in the past, many women still have them.

A TRAM (transverse rectus abdominus myocutaneous) flap consists of skin, fat, rectus muscle, and blood vessels taken from the abdominal wall and transferred to the chest to reconstruct the breast. The fat, blood and rectus abdominus are pulled through a tunnel that is created under the skin to form a breast mound or a pocket for a breast implant. This may disturb surrounding tissue because the abdominal muscles are rotated to the chest.

This particular surgery causes specific challenges to mobility and strength. Carol Michaels, founder of Recovery Fitness® and the author of Exercises for Cancer Survivors, offers these tips to help you get moving again…safely:

TRAM flap surgery can weaken the foundation or core of the body and in some cases is being replaced by newer techniques. Here are some specific outcomes:

Posture

With the diminished support from the abdominal wall, it may be difficult to stand erect and you may develop lordosis, an inward curvature of the spine. You may also suffer from abdominal and lower back weakness.

Flexibility

Upper and lower body flexibility may be compromised. You may find tightness in the hip flexors. This is due to leaning forward as a result of tightness from abdominal surgery.

Core Strength

The rectus abdominus stabilizes the spine. Since it is no longer in the same place, other muscles have to work harder to compensate for the change. Because rectus abdominus supports and stabilizes the spine, weakness in this area can pave the way for back problems. Your rectus muscle helps you maintain good posture and bend forward. This core muscle plays a role in strength, posture, balance and flexibility.

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The first step is for you to regain range of motion through a daily stretching routine, adding in strengthening and balancing movements.

Stretch

~ Start with neck rotation, shoulder shrugs, shoulder rolls and other gentle stretches. For more details, see Exercises for Cancer Survivors.

~ Slowly add the Pelvic Tilt and Bridge.

Pelvic Tilt: lie on your back with your knees bent and your feet flat on the floor. Inhale and fill your torso with air. Exhale while pressing your abdominals downward, bringing your navel to your spine. Lower and repeat for 5-10 reps.

Bridge: Lie on your back with your knees bent and your feet flat on the floor. Squeeze your glutes to lift your pelvis and ribs off the ground, leaving only your shoulders on the floor. Hold the bridge position for a few seconds, then lower and repeat. Complete 5-10 reps.

~ Add core strengthening exercises like those below after you have achieved 80-90% of your range of motion and you are cleared by your medical professional.

Core Strengthening Exercises

~ Pelvic tilt (see above).

~ Modified Pilates exercises in which the exercises are performed with the head and shoulders on the floor instead or off the ground.

~ Exercises to strengthen the obliques such as the cross-over crunch, modified criss-cross and the lateral crunch.

~ Exercises to strengthen the back such as the Bridge (see above) and the Bird Dog.

Bird dog: Begin on your hands and knees in a table top position. Make sure your knees are set directly below your hips, that your wrists, elbows and shoulders are in line with each other, and your head is in a neutral position. Contract your abdominals to maintain your balance while you slowly extend one leg directly behind you and simultaneously extend the opposite arm out in front (1). Hold for 10 seconds, then return to table-top position and reverse. When your balance is ready for a challenge, perform the exercise as described, then carry the extended arm out to the side (2) and then back to the front before returning to table top position.

Remember to start easy, progress slowly, and listen to your body. It is crucial to focus on strengthening the obliques and back muscles. Because the back can be vulnerable to injury, it is necessary to learn how to lift properly.

Balance Training

A complete balance program should be followed. Perform balance exercises such as front, side, and back leg lifts and engage in core strengthening.

There are some exercises that are contraindicated, such as:
~Sit-ups or any forceful movement to the abdominal area.
~If you have osteoporosis, do not perform forward bends or twists.
~Heavy lifting should be avoided to minimize the risk of a hernia.
~If you have or are at risk for lymphedema, see a lymphedema specialist before beginning an exercise program.

A safe exercise program will enable you to return to the activities that you enjoyed. As always, check in with your doctor before beginning any exercise program after surgery.