By Katie McGee, PT, DPT (they/them) & Brianna Durand, PT, DPT (she/her)

It’s likely that you’ve been waiting for top flattening surgery for some time now and you may want to do everything you can to ensure the best possible outcome. Exercise – at the level and amount that feels right for your body – is one path to a smoother recovery after surgery. Read on to learn about some simple exercises you can do to better prepare.

Deep breathing

During the first few days after top flattening surgery, taking a deep breath can feel difficult and even scary for some people. Fortunately, you can improve your ease of breathing following surgery by practicing ahead of time. Training yourself to breathe deeply before surgery has also been shown to reduce the risk of lung issues such as an infection or blood clot after an operation1,2. Pick the amount of breathing exercise that feels manageable to you. You could start with 10 deep breaths per day or try 15 minutes of deep breathing along with a guided meditation. Looking for an app to help you with breathing? You could check out Insight Timer (free) or Headspace (both are available in the App Store or Google Play).

Shoulder stretching

Your top flattening surgeon may recommend that you avoid lifting your arms over your head after surgery, for weeks or possibly even months. You can imagine how your shoulders might start to feel pretty stiff. Stretching your shoulders ahead of time can lessen some of this tightness. What shoulder stretches are a good idea to try? I usually recommend that people start with shoulder rolls and arm circles, each repeated 10 times per day (see below for video demonstrations.)

Here are some other options:

1. Stand close to a wall and slowly walk your fingers up as high as you can go.  Repeat 10 times per side.  

2. Sweep your arms up and down as if you are making a snow angel. Repeat 10 times.

Occasionally, big arm movements can bring on feelings of chest dysphoria. If this is the case, please do not feel obligated to continue. Your body’s ability to heal from top flattening surgery does not hinge on whether you do arm stretching prior. It is fine to stop stretching and try other activities that honor your body. Note: If you have shoulder pain or issues prior to surgery, be sure to let your medical team know. They may have unique guidelines for you to follow in order to balance the health of your shoulders with your healing from surgery.

Cardiovascular exercise

Cardiovascular exercise refers to movement that makes your heart pump harder than usual. It’s also known as aerobic exercise. Examples include propelling in a manual wheelchair, walking, jogging, swimming, using an arm bike, and stepping in place. Multiple studies regarding recovery from a variety of different surgeries suggest that cardiovascular exercise prior to surgery can improve outcomes. One of the exciting parts of cardiovascular exercise is that the health benefits start at just one minute of activity3! When choosing cardiovascular exercise to get ready for surgery, I recommend picking whatever activity feels most comfortable for your body, and aiming for 10 to 30 minutes of that activity most days of the week. Looking for help getting started with cardiovascular exercise? You can reach out to your medical team or a physical therapist for guidance. Another excellent resource is Nonnormative Body Club (also on Facebook) which has a diverse collection of exercise resources for transgender and non-binary people of all exercise levels. 

Upper Body Weightlifting

Weightlifting before top flattening surgery is a common topic that comes up in online forums. Some people believe that a more muscular chest will allow a surgeon to better line up scars. Other people couldn’t care less how their scars line up with their chest muscles. If you have specific goals about the way your top flattening scars look, it is best to ask your surgeon what they recommend. If a more muscular chest is a goal, one might consider bench press, pushups, and dumbbell chest fly. Additionally, certain nutrition changes, such as adequate protein intake for muscle development, may be needed and are best discussed with a registered dietitian. It can take a month or longer to notice changes in the bulk of chest musculature, called “hypertrophy”, so plan accordingly before surgery. Be assured that upper body weightlifting is not required to have a successful outcome for top flattening surgery. 

Surgery happening quicker than expected?

Sometimes people get scheduled for top flattening surgery months out, only to have the surgeon offer an immediate operation date due to a cancellation. In a situation like this, don’t worry if you hadn’t been exercising diligently ahead of time. Exercise after surgery can still promote recovery. Check out the next article in this series, coming soon: When Can I Start Exercising After Top Flattening Surgery?

Sample daily exercise programs to prepare for top flattening surgery: 

Basic 

• Deep breathing

  • 10 deep breaths (video demonstration above)

• Shoulder stretching

  • 10 shoulder rolls

  • 10 shoulder circles 

  • 10 arm snow angels 

  • 10 seated or hands and knees cat/cow

• Cardiovascular

  • 20 minutes of chosen activity

  • Can be broken into smaller sections, such as four 5-minute walks 

• Upper body weightlifting

  • 30 wall push ups 

Advanced 

• Deep breathing

  • 5 minutes of deep breathing against resistance band crossed around the chest

• Arm stretching

  • 5-minute upper body yoga flow 

• Cardiovascular exercise

  • 30 minutes of preferred cardiovascular exercise

• Upper body weightlifting 

  • 10 reps, 3 sets bench press

  • 10 reps, 3 sets pushup

  • 10 reps, 3 sets dumbbell chest fly 

Citations 

1. Ge X, Wang W, Hou L, Yang K, Fa X. Inspiratory muscle training is associated with decreased postoperative pulmonary complications: Evidence from randomized trials. J Thorac Cardiovasc Surg. 2018;156(3):1290-1300.e5.

2. Levett DZH, Grocott MPW. Cardiopulmonary exercise testing, prehabilitation, and enhanced recovery after surgery(Eras). Can J Anaesth. 2015;62(2):131-142.

3. Gillen JB, Martin BJ, MacInnis MJ, Skelly LE, Tarnopolsky MA, Gibala MJ. Twelve weeks of sprint interval training improves indices of cardiometabolic health similar to traditional endurance training despite a five-fold lower exercise volume and time commitment. PLOS ONE. 2016;11(4):e0154075.