Breast Cancer Rehabilitation 
 
Pilates offers a gentle and thorough approach to recovery from breast reconstruction, breast reduction or breast enhancement. There are many aspects to recovery from breast surgery, but the principal guidelines are gentle, consistent, focused exercise on a regular basis. 
 
Exercise and daily stretching is the best way to recover post-surgery, beginning first and foremost, with your physician's approval. 
 
Austin Girl Pilates recommends a consistent program of reformer, mat and standing pilates twice per week to recover full range of motion and strength to the delicate post-surgical upper body.
 
Additionally, we recommend that all clients make a commitment to a 4–5 day program of walking 30–45 minutes daily. Not only does the cardio exercise enhance your general health, but your emotional well being through this trying transition. Remember: Walking is an upper body exercise. You will regain your strength and vitality through a consistent program of Pilates and regular cardio. You CAN have your body back!
 
Susan is a breast cancer survivor and is happy to share her first-hand knowledge of the mental, emotional and physical setbacks that pushed her further into her Pilates practice. She wants her clients to know that there is recovery, confidence, strength and well-being on the other side of treatment.
 
 
Pink Ribbon Pilates
by Becky Mollenkamp 
(From Pilates Style Magazine, September/October 2005)
 
Pilates can help breast cancer survivors reconnect with their physical strength and rebuild their self-esteem.
 
One out of eight women will be diagnosed with breast cancer in her lifetime. Donna Liebowitz became one of them in 2003, when she was just 43 years old.
 
A double mastectomy, chemotherapy and radiation treatments left Liebowitz feeling betrayed by her body. Prior to her diagnosis, she was healthy and happy. After surgery, although she was grateful to be a survivor, she was physically weak and emotionally shattered. Her challenge, and the challenge for the more than 2 million breast cancer survivors in the United States, is learning to live well after treatment.
 
“You don’t know where to turn or what to do,” says Liebowitz, a Towaco, New Jersey, mother of two. “You’re afraid to say you’re a survivor, because that’s admitting you were sick. You are numb to everything.”
 
Liebowitz’s doctors’ focus had been curative and aesthetic; they didn’t offer much guidance on the physical and emotional challenges she would face after treatment. Like many women who have lost one or both breasts to cancer, Liebowitz’s self-esteem plummeted and her body was sore and scarred. Although she began to regain physical strength fairly quickly, it took more than a year to muster the courage to enter a gym.
 
Before cancer, Liebowitz rode a stationary bicycle, lifted weights and practiced yoga. When she was finally ready to exercise again, she wasn’t sure how to do it. Since she lacked guidance from her doctors, she searched the internet for a program designed specifically for breast cancer survivors. She found the Pink Ribbon Program at The Pilates Center in Fairfield, NJ.
 
Liebowitz had been curious about Pilates but had never tried it. Her first one-on-one session had her hooked. “I felt so energized and calm and full of confidence. Throughout the class I kept saying thank you,” says Liebowitz, who now does Pilates about three times a week. “The way I used to reward myself was with ice cream. Now I am doing something for my body that makes me feel better.”
 
Holistic Healing
 
More and more postoperative cancer survivors are discovering the benefits of Pilates, often without the help of their health care providers.“The primary focus of the medical community is on treatment,” say Andrea Geduld, coordinator of The Mount Sinai Breast Health Resource Program in New York, which offers the Pink Ribbon Program to its clients. “A more holistic approach includes looking at the individual physically and emotionally, in addition to medically. The medical community is beginning to acknowledge that, but they are not quite up to it.” 
 
A mastectomy or lumpectomy can create scar tissue that restricts range of motion, particularly in the arms, shoulders and abdomen. A lymph-node dissection can cause lymphedema, a painful side effect that results in dangerous and restrictive swelling.
 
Women who choose reconstructive surgery can also have limitations. Doctors use muscles from another area of the body to create a breast. Without rehabilitation, such as Pilates, the scarred donor site remains tight and weak and the body can feel imbalanced. 
 
Breast cancer aftercare typically focuses on reconstructive surgery. Patients often receive information on support groups and an American Cancer Society packet that includes a few recommended stretches. Physical therapy or other exercise is seldom mentioned.
 
“It was very surprising to me that my doctors didn’t refer me to rehab,” say breast cancer survivor Sara Marek of Roswell, Georgia. Her doctors used her transversus abdominis, the deepest layer of abdominal, for her breast reconstruction. “For two years I couldn’t come into a sitting up position without hitching myself up on my elbows. I found this extremely frustrating and felt like half of my body did not work.”
 
After eight months of regular Pilates work, Marek was finally able to sit up normally. “ I was overwhelmed with emotion, I called everyone I knew,” says Marek, who became a Pilates instructor after her experience. “Pilates changed that whole dynamic in my body and gave me my body back.” 
 
Mellow Out
 
Unlike floor-pounding aerobics or strenuous weightlifting, Pilates is gentle, soft conditioning that often appeals to weary breast cancer survivors.“As you start collecting your strength, a slow progression of Pilates will help,” says Laurie Bochner, a breast cancer survivor in Alameda, California. “You see the benefit on your body, outside and inside, pretty quickly.” Bochner had a mastectomy in 1999 and started Pilates shortly after. She loved it so much that she recently trained to become a mat instructor. In addition to occasionally teaching, she takes Reformer class once a week and mat classes three times a week.
 
Rather than simply building bigger biceps, Pilates’ core concepts deal with unifying the body’s movement and increasing range of motion. Plus, many of the exercises are performed in a supine or upright seated position, which cause less strain on sore bodies.
 
“Your body is changed after surgery and treatment and it feels foreign,” says Geduld of Mount Sinai. “Pilates is something you can physically achieve - breathing, sitting, standing, being in touch with your center. The Pilates method is very sensitive to rehabilitation.” 
 
Mind Over Matter
 
Pilates is beneficial for not just the body, but also the mind. A recent study in the Journal of Psychosocial Oncology found that cancer survivors with higher levels of physical activity have improved quality of life, improved body image and decreased fatigue. 
 
“Pilates is complementary to a life-altering illness like cancer,” says physical therapist Suzanne Martin, who owns Pilates Therapeutics in Alameda, CA. “You have to get internal and focus on how you are doing. You have to be present for yourself on a lot of levels, and that helps you spiritually.”
 
Focused breathing eases tension and boosts the spirit. Concentrated and precise movements require focus and self-awareness. Breast cancer survivors also report that Pilates helps them recover a sense of femininity, which can be dashed after losing a breast.
 
“This cancer affects how you feel as a woman,” says exercise physiologist Doreen Jones, who founded the Pink Ribbon Program, then discovered she had breast cancer two years later. “Pilates makes you feel long and lean. When you are done, you are energized and you carry yourself well. The faster you get back to feeling confident, the faster your psychological recovery will be.” 
 
Your Own Pace
 
Some women are able to remain active during cancer treatment. Others find it impossible until several months to a year after acute therapy. With any postoperative exercise program, it is important to start slowly. Whether you did Pilates before cancer or are a novice, expect to start at square one. Some people make the mistake of trying to do too much, too soon. Listen to your body and give yourself permission not to push though an entire class. Pilates is a process, so take small steps until you are comfortable pushing harder. You can’t rush recovery. 
 
“I didn’t jump into anything 100 percent. I slowly did things as they felt good,” Bochner says. She focused on one objective at a time, working on her pelvic floor one week and staying in neutral spine the next week. She also avoided push-ups, side reaches or anything that put weight on her sore left side.
Jones starts her post-cancer treatment clients with simple stability and breathing exercises. When they become comfortable with those, they move on to more recognizable Pilates moves and then, after a few weeks or months, they work with the Reformer and other machines.
 
Before discovering Pilates, Donna Liebowitz was discouraged that she couldn’t do the same gym workout she did before cancer. She now realizes that her activities had to change because her body had changed. “If I can get even more beneficial results with Pilates without the strain of free weights, then why would I want to go back?” she muses.
 
Liebowitz’s advice to other breast cancer survivors is simple. “Don’t be afraid to try it,” she says. “Pilates can be so intimidating if you don’t know anything about it. But it is a wonderful exercise regimen to loosen up your body, and it helps so much emotionally, which is just as important.”
 
Post-op Pilates
 
Cancer-specific Pilates programs are popping up all over the country. If there isn’t one near you yet, heed this advice from Pink Ribbon Program founder Doreen Jones.
  1. FIND A PRO. A videotape or group mat class may not suit your specific needs. A group setting with other cancer survivors is ideal, but one-on-one instruction is often the best bet. Find a Pilates center with qualified instructors who deal with postoperative patients (some Pilates training programs offer such a certification). A Pilates-certified physical therapist is also a good choice.
     
  2. SEEK KINDRED SPIRITS. Don’t be afraid to ask your instructor if she’s had breast cancer. While not a prerequisite, personal experience with the disease will help her understand your abilities and limitations. “Once you go through it, you totally relate”, Jones says. “I know what they are going though, and they know that I know. You have to trust the person taking you through your workout.
     
  3. BE HONEST. Tell your instructor about your treatment plan and any restrictions in your movement. If you aren’t feeling 100 percent one day, say so. “The instructor has to realize you cannot push (a breast cancer survivor) the way you do the general population,” Jones says.
     
  4. DON’T OVERDO IT. If your only option is a mat class with a less experienced instructor or a video, be cautious. Observe the class or watch the video once before joining in. Take it slow and, as with any physical activity, stop if you feel any pain. 

Austin Girl Pilates Owner, Susan Caldwell, teaches private Pilates sessions – Reformer and Mat – and practices from her studio near Mt. Bonnell in Austin, Texas. Contact Susan at austingirlone@gmail.com or (512) 206-0537.