Post-Op Recovery: Expectations and Intervention
Breast cancer recovery doesn’t end with surgery. It continues through physical healing, emotional adjustment, and functional restoration. For some people, breast reconstruction after mastectomy is an empowering step forward. For others an aesthetic flat closure provides a sense of autonomy and comfort in their post-cancer body.
But what comes next? That’s where an OT, Certified Lymphedema Therapist (CLT-LANA) can make all the difference. An occupational therapist who is also LANA-certified has advanced training in post-surgical rehabilitation, including soft tissue interventions such as manual lymphatic drainage, scar mobilization and specialized exercises. The therapist plays a unique role in helping patients after mastectomy.
Whether you’ve gone flat or if you have had reconstruction, partnering with a specialized OT can help you regain comfort, strength, and confidence in your everyday life after mastectomy.
Types of Breast Reconstruction: Implant-Based vs. Tissue Flap
There are two main approaches to breast reconstruction, each with unique implications for rehabilitation:
Implant-Based Reconstruction
This is the most common method for reconstruction and involves using saline or silicone implants to recreate the breast(s). Some people undergo a 2-stage surgery where a tissue expander is first used to stretch the skin to prepare for the permanent implant. The expander generally stays in place for 3 months, then an “exchange surgery” is performed to remove the expander and place the permanent implant. In my experience, people report that tissue expanders are stiff and uncomfortable. Once the permanent implants are in place, the reconstructed breasts feel softer and move better.
Some may have the implant(s) placed at the same time as the mastectomy. This is called “direct-to-implant” or a 1-stage surgery. Newer mastectomy techniques called skin-sparing or nipple-sparing procedures may be an option for some and can offer a more natural appearance. Not everyone is a candidate for this technique, though.
Regardless of 1-stage or 2-staged surgeries, the implant(s) may be placed under the pectoralis (chest) muscle or under the skin using an acellular tissue to support the implant. Your surgeon works with you to determine the best approaches used for your reconstruction.
Tissue (Flap) Reconstruction
This technique uses your own tissue (commonly from the abdomen, back, or thigh) to reconstruct the breast. These surgeries are typically more extensive but may offer more natural results and long-term comfort. These surgeries require a skilled microvascular surgeon to take tissue from one area of the body (called a flap) that is then shaped into a breast with the vasculature attached to large vessels in either the chest or lateral chest wall. These surgeries may also be performed in stages, with or without a tissue expander. Revision surgery is common for shaping and contouring.
Common Options:
- DIEP Flap (Deep Inferior Epigastric Perforator): Uses skin and fat from the lower abdomen, along with the blood supply to the tissue. The DIEP flap is a contemporary version of the TRAM flap that came into favor as the technology of microvascular surgery and skill of plastic surgeons grew. The DIEP spares the need to use muscle tissue as the donor for reconstruction but involves taking a large area of soft tissue from the abdomen. The scar transverses the lower abdomen.
- TUG Flap (Transverse Upper Gracilis): Transfers tissue from the thigh, along with the blood supply to the tissue. As with the DIEP, this procedure is a contemporary option with modern techniques in plastic and microvascular surgery. The scar from the donor site is located on the upper, inner thigh. If soft tissue from only one thigh is needed, the volume of the thighs becomes asymmetrical. If someone does not have enough abdominal fat, the TUG or a “stacked TUG” may be an option.
- Latissimus Dorsi Flap (Lat Flap): Another option for people who do not have enough belly fat or for people who are not candidates for the “free” tissue transfer, the Lat Flap is a surgical option that has been used over many years’ time. This surgery uses muscle and skin from the upper back and may need to be combined with a small implant for improved breast volume. In a lat flap, the blood supply from the donor site is not “disconnected” and then “re-attached” as in the DIEP or the TUG. Because the donor tissue is near the area to be reconstructed, the surgeon is able to re-orient a portion of the muscle to rebuild the breast. Lat muscle fibers remain connected so the breast tissue can move when the arm moves. This phenomenon is called “animation”. If you have animation and it bothers you, your plastic surgeon may be able to take steps to improve this.
Sensation following reconstruction
People should be advised that the reconstructive tissue often lacks sensation. Many people with whom I have worked are displeased with this outcome, so if you are determining surgical options, ask the surgeon about this. Some surgeons are incorporating nerve grafting to promote sensation in the reconstructed tissue, but it is not commonplace.
Aesthetic Flat Closure (Going Flat)
Some individuals choose to forego reconstruction altogether and opt for a smooth, contoured chest closure. This is known as aesthetic flat closure, a valid and empowering choice for many survivors. “Going flat” can be planned at the time of the mastectomy and done by a plastic surgeon or the surgical oncologist to avoid future surgeries.
What Can Be Expected After Mastectomy?
Breast reconstruction or flat closure can restore physical form after the loss of the breasts, but the journey often includes:
- Scar tissue restrictions
- Shoulder stiffness or limited range of motion
- Weakness in the musculature around the surgical area(s)
- Nerve sensitivity or numbness
- Postural changes
- Swelling in the arm or chest wall
- Fatigue and functional challenges with daily activities
These are common and manageable issues, but left unaddressed, they can impact quality of life. You can expect the following care to be given to you post-operatively by your OT, CLT-LANA.
Restoring Shoulder & Upper Body Mobility
Post-surgical tightness, scar adhesions, and protective posture can limit your ability to:
- Reach overhead
- Dress independently
- Lift or carry items
- Perform hobbies or exercise
- Gradually resume daily life activities
OTs guide gentle, progressive range-of-motion exercises, posture correction and tailored home exercise programs to help you safely regain movement without compromising surgical sites, causing undue swelling/scar tissue build up.
Scar Management and Soft Tissue Work
After surgery, scar tissue can lead to tightness, pulling, or discomfort. Your OT may use:
- Scar mobilization and desensitization techniques
- Elastic taping to reduce scar thickness
- Soft tissue massage to improve mobility and decrease pain
- Specialized stretching exercises
- Self massage instruction
Activity Modification and ADL Training
Even routine tasks like washing your hair, cooking, or sleeping comfortably can become tricky post-surgery. An OT helps with:
- Adaptive strategies to make daily activities safer and easier
- Positioning for optimal joint alignment during ADL
- Pacing and energy conservation techniques
- Safe return-to-work, home management or hobby planning
- Safe return to fitness activities
Lymphedema Screening
Mastectomy, lymph node removal, or radiation can disrupt the lymphatic system, putting some at risk for lymphedema. We know that there are factors that put people at greater or lower risk for lymphedema.
A CLT-LANA therapist provides:
- Information on your individualized risk
- Early detection and limb volume monitoring
- Manual lymphatic drainage (MLD) to reduce swelling
- Compression garment recommendations based on your level of risk
- Education on risk reduction strategies for self-monitoring
View this publication for more information on lymphedema risk (click on the link to publications, upper right of the tool bar):
Brunelle, C. L., Jackson, K., et al. (2024). Evidence-based recommendations regarding risk reduction practices for people at risk of or with breast cancer-related lymphedema. Medical Oncology, 41(11), 298
Emotional Support and Empowerment
Healing isn’t just physical. Occupational therapists are trained to consider the emotional and psychosocial side of recovery, supporting you as you rebuild routines, roles, and self-image after breast cancer.
You Deserve Support
With the right therapy, you can move beyond healing and toward thriving. If you’re navigating life after mastectomy, we can guide your recovery with skill, compassion, and personalized care. Don’t wait for symptoms to appear. Early rehab leads to better outcomes.
Heal, move, thrive and feel confident : you are a survivor!
Need an Occupational Therapist in Evanston, IL? Click the link to make an inquiry on my website. Providing Breast Cancer Rehab in Evanston IL and serving clients in the Chicago area and North Shore.
If you live outside of the Evanston, IL but need a practitioner, you can search for a local specialist on the LANA website:
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