Yoga

There are many styles of yoga, my own practice encompasses both Iyengar yoga (with yoga props and focus on alignment) and Kundalini yoga (with physical postures and movement, breathing exercises, and meditation).

Stretching exercises by the American Cancer Society advises not to stretch too soon or too aggressively to avoid seroma formation. However I have found stretches to be helpful when fluid built up after drain removal. One possibility are passive stretches, for example placing the arm overhead on a pillow.  The fish pose is a nice chest opener, when it gets uncomfortable to lie on the back for much of the time, and it stretches the scar.

Restorative yoga has been very helpful immediately after surgery and it is still part of my daily practice,  both for relaxation and stretches [ref: Lasater JH]. There are some earlier blog posts with photos: restorative yoga.

For about 3 months after surgery I avoided yoga poses that are static with arms lifted and held (e.g warrior pose)  or weight bearing exercises on arms (e.g. downward dog, sun salutation, planks) due to the lymphedema risk as discussed in the guidelines by Step up, Speak out. Since I continue to get swelling under one arm (site of the sentinel lymph node excision and site of a fine needle aspiration of one of the lymph nodes before surgery) when doing arm weight bearing exercises, I continue to be cautious. Two studies that motivated my choices:

• A Pilates study with 15 women who were at least 6 weeks post surgery mentions the lymphedema risk, since the DVD provided had statically held arm exercises [ref: Stan et al]. Thus I preferred to focus on moving exercises. 
• A yoga study after breast cancer diagnosis with 30 women showed positive effects (relaxation, feeling of wellness, stress reduction) [ref: Pruthi et al]. Participating women had positive comments about the breathing exercises during their initial meetings with a yoga therapist. There are many yoga breathing meditations that may be helpful. A previous blog post describes a breathing meditation from the Japanese system of Reiki.

Kundalini yoga is the yoga of awareness. It should not be confused with weird things written about "Kundalini" on the internet which is a generic term. I restarted my practice 3 months after mastectomy, since it can be vigorous, and I wanted to focus on other exercises and meditations first. My favorite yoga set is the basic spinal energy series. The number of times or length of time for each exercise can be reduced. For example, 26 or 52 instead of 108 repetitions is fine or doing each exercise for 1 minute.  This yoga set includes spinal flexes and shoulder shrugs that are also mentioned in an article for cancer patients to reduce fatigue [ref: Shannahoff-Khalsa DS]. The article includes breathing meditations, but it would be best to find a Kundalini yoga teacher, if you don't have experience with this style of yoga.

References:

1. Judith H Lasater. Relax and Renew. Shambala 2005.
2. Stan DL et al. Pilates for breast cancer survivors. Clin J Oncol Nurs. 2012 Apr;16(2):131-41.
3. Pruthi S, et al. A Randomized Controlled Pilot Study Assessing Feasibility and Impact of Yoga Practice on Quality of Life, Mood, and Perceived Stress in Women With Newly Diagnosed Breast Cancer. Global Advances in Health and Medicine. 2012;1(5):30-35. [link]
4. Shannahoff-Khalsa DS.  Patient perspectives: Kundalini yoga meditation techniques for psycho-oncology and as potential therapies for cancer. Integr Cancer Ther. 2005 Mar;4(1):87-100. [link]