Working out again after top surgery

Hey docs! So I have had my first exposure to strength training last December when I started my linear progression with the Starting Strength method. I had originally posted my question to their forum, but the owner didn’t want to publish my post and sent me a very unsavory private message, instead. I thankfully found you guys through reddit, though. Anyway. I had top surgery a month ago. I was told beforehand that training my pecs would really help with the result and that’s what lead me to the gym. I was doing that program up until surgery. So I had my drains pulled recently and was very surprised when my surgeon recommended I do not lift my arms over my head for the next 9 months. He said I also shouldn’t be benching or squatting during this time. I had a small cup size and was bordering on being able to get away with keyhole surgery, but we wanted to make sure it’s all gone in one go and went with double cuts. I know that this might complicate the healing process a bit more than keyhole would have done, but 9 months is such a long time. I know my surgeon is just trying to be extra careful before clearing me, but it would be a shame to lose all the progress I have made by being idle for just too long. My questions are what your thoughts on this 9 month period are, if I should maybe start working out again sooner. And if there are movements I should be doing or absolutely not be doing. Thanks!

Graeme

Unfortunately can’t say I’m surprised by this coming from him. Sorry that happened to you.

Yeah, a large proportion of post-operative restrictions are not based on clear/strong evidence, but are often made up and influenced by a high degree of risk aversion. Unfortunately this does not take into account the potential risks of you having essentially immobilized arms for the next 9 months.

We are not able to provide direct recommendations for patients that contradict those of their physicians via this forum (for obvious reasons), but I will say that if I were in this situation, I would not be keeping my arms down and essentially avoiding their use for 9 whole months post-op. Given what we know about usual tissue healing times, it is implausible that this amount of time is necessary for you to be able to use your arms fully. Unfortunately I do not have extensive experience with this particular procedure in order to give more specific recommendations, however with some cursory searching I am finding a wide variety of recommendations for return to activity after double-incision top surgery that are significantly less than 9 months. It may be worth asking your surgeon if there are specific reasons for such a long time frame, considering obtaining a second opinion, or simply going about this process on your own after you’re feeling comfortable.

I didn’t expect it from a group of people who claims to want to get everybody and their mother strong. But I guess it was better to make that experience from the comfort of my home rather than being put on the spot at a seminar or something. Thanks for the response, Austin! I have a checkup appointment on Friday and will ask my surgeon to clarify. I’ll report back then.

I had to wear a chest bandage for a month and was cleared to stop wearing that yesterday! My surgeon previously suggested a low sodium diet and no alcohol or sexual activity during this first month.
Then I asked about raising my arms or working out. I’m not supposed to lift anything heavier than 5lbs or raise my heart rate for some weeks to come. After those, I could slowly introduce moderate exercise again. No heat or ice on my chest during this time. He recommends just going on walks for the time being. His primary concern is that the cuts could burst open. And then I’ll need stitches again. Which will negatively impact the result and pose a risk for infection and blood loss. Then, after the cuts are healed, he is worried that straining too soon could create fluid buildups or even hematoma in the chest. In his experience, scars become wider and also significantly darker if they are stretched too soon. This could cause discomfort physically and mentally. He said all of this can also stretch or even kill off nipple transplants in people who opted to get them. If patients experience pain or immobility in the shoulders or chest he will actually order physiotherapy but warn them about the above. He asked if I have had an injury or surgery before on either shoulder (nope!) and that it would be a case of prioritizing what is more important to me. So that’s why he recommended I do not raise my arms or lift heavy for 9 months. I also shouldn’t allow any direct sun light on the scars during those months. I get what he is saying and am glad he took the time to explain all that to me, but it still seems a little extreme. Then again ,I have never seen stretched or torn scars.

Hi Graeme, I had a double mastectomy for breast cancer with a masc reconstruction with nipple grafts from an onco-plastic surgeon at the same time (very gender affirming, I’m non-binary). Because the primary purpose was to remove all breast tissue due to the cancer, I have one super long scar from armpit to armpit. I lifted pre-surgery and asked the surgeon a million questions about when I could return to activity after. Basically at the 6-week mark she let me out of the compression vest and to start doing almost anything I want, as long as I took a slow approach to building back up. I’m 8 months post surgery and the scars are totally fine, as are the grafts and the lifting. Just one anecdote, so take it for whatever it’s worth. And enjoy your new chest! :slight_smile:

(PS I followed SS for a long time as well and just tried to tune out all the hate. Not worth it when there are much better lifting communities around to join.)

Thanks for sharing

Thanks for sharing your stories. I am at risk of breast cancer, and I have started to think about having a mastectomy on at least one of my breasts. And I was wondering what my body would look like after the surgery.

I believe that your doctor is not a fool and should know his business well. If he has given you such thorough advice, then he has reason to be concerned.