Dear OncoLink "Ask The Experts,"
I was diagnosed with breast cancer about 4.5 years ago, and had a mastectomy and TRAM flap reconstruction. Since that time, I have had to wear a support on my abdomen. I originally gained weight, but have lost some of it. I started an intense exercise program about 6 months ago, and now my abdomen is much more distended and painful without the support garment. Could this be related to the exercise? I have done mostly weight training for my legs, arms, & chest, but have also been doing abdominal crunches. I noted that in your answer to a previous question, you said that ab crunches after a TRAM reconstruction could be a problem. I have been very disappointed with the fact that I continue to have major discomfort in my abdomen. Any suggestions you can make would be greatly appreciated.
Lora Packel MS, PT, Coordinator of Cancer Therapy Services for the Hospital of the University of Pennsylvania, responds:
Firstly, congratulations on starting and maintaining an exercise program! Exercise will help reduce your risk factors for problems such as heart disease, high blood pressure, and diabetes. Exercise is also good for the mind and soul!
After TRAM reconstruction, one needs to be extremely careful about exercise. Immediately after the surgery, the only exercise that is recommended is walking. With your surgeon's permission, you may then begin other exercises after about two months. If you had the rectus muscle removed from both sides of your abdomen (bilateral TRAM), there is no muscle to "crunch" during sit-ups. If you had a unilateral TRAM, the rectus muscle is missing from one side of your abdomen and therefore can't be used to do a sit-up. The abdominal exercises that can be done should focus on the remaining abdominal muscles, the obliques. It is important to have a professional, such as a physical therapist (PT), evaluate your technique first so that you do not use improper form and injure your back or your reconstruction.
The pain you are feeling in your abdomen is of concern. I strongly recommend returning to your plastic surgeon to determine if you have a herniation at the donor site. You should not normally experience pain or abdominal swelling with sit-ups.
If your plastic surgeon approves, I recommend visiting a PT who specializes in women's health and oncology. A PT can help create an appropriate exercise program for you in light of your TRAM reconstruction and your goal to lose weight.
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