When can I start exercising after top flattening surgery?

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

Exercise is an important key to success after any large surgery. Exercise can speed up the healing process, rebuild strength, and prevent complications like blood clots. After top flattening surgery, however, it is incredibly important to choose the right exercises at the right time to avoid complications such as excessive scarring or opening of incisions. Read on for advice to get back to working out. Remember, your surgeon and medical team know what is best for your unique situation. Always follow their advice as much as possible.

Walking:

Walking for exercise is typically started two days after surgery. Think leisurely stroll excessive arm swinging might bother the incision(s). A good goal for the first couple weeks after surgery would be 1,000 steps per day. Steps can be tracked on a smartphone or with a fitness wrist band. Many surgeons will give the go-ahead for longer walks around 15 to 21 days after the operation. After about a month, most people undergoing top flattening surgery no longer have restrictions on walking. While there might be guidelines around returning to walking, don’t worry about it being dangerous. Walking is one of the best ways to add healthy movement to your life. 

Running & Cycling:

Most people can resume running and cycling 21 days after top flattening surgery. It is best to ease back into any cardiovascular exercise. For example, if your daily run was 3 miles prior to surgery, you might want to start with a 1.5-mile jog while also incorporating rest breaks. With cycling, it might be best to start with a 20-minute ride and build up before, say, rejoining a Peloton class or biking 25 miles straight.   

Weightlifting:

Often, the biggest challenge to weightlifting after top flattening surgery is keeping elbows from going above shoulders for 6 months (although some surgeons may allow movement overhead as soon as 4 weeks after surgery). The concern is that overhead movement early in the healing process will stress the scars, leading to more visible or excessive scarring. This guideline may be especially important for people with a history of severe scarring, which is also known as keloid or hypertrophic scarring. Generally, only 5 pounds can be lifted at a time during the first three weeks. Afterwards, the lifting limit goes up 20 pounds at a time, although some surgeons may remove weight limits by 6 weeks. Bodybuilders and other strength athletes can begin more strenuous workouts around three months after surgery.  

Note: If more visible scarring is less of a concern than working out hard  - or perhaps you are thinking about tattooing your scars later anyway - it could be worth having a discussion with your surgeon about a modified plan for return to lifting. Even if a scar is more noticeable, it can still be healed and move well. 

Yoga & Stretching:

As with weightlifting, return to yoga is limited by no elbows over shoulders for the first 6 months, if directed by your surgeon. This rule applies to any position, not just when standing. This means that common movements, such as child’s pose and downward dog, might require modifications. Before dropping into a plank or arm balance, consider how much lifting you are currently permitted to do in your stage of healing. Be aware that some surgeons will place additional limits on arm and other joint movements. It can be stressful and overwhelming to think about all the movements that are off-limits or modified following surgery, but it can be helpful to use this time to focus on activities you can do such as breathwork and leg stretching. 

Swimming:

Walking in a pool may be resumed when scars are closed, as soon as three weeks after surgery. When walking in the pool, it will still be a good idea to wear your recommended bandages. However, swimming for exercise may need to be delayed until 6 months after surgery to allow optional healing. By 6 months out from surgery, it is unlikely that bandages will be needed for the duration of exercise. 

Note: Sun exposure can cause changes in scar color for some people (either extra light or extra dark).  If the color of your scars is important to you, be sure to wear sunblock when exercising outside to protect scars for at least the first 6 months. 

Exercise can be a powerful tool in bouncing back after surgery, giving you more energy, strength, and comfort in your body. Don’t hesitate to reach out to your medical team or a knowledgeable physical therapist for help with exercise after surgery. You deserve to feel comfortable and confident when moving in your body!