How to Start Working Out Again After Top Surgery

So you’ve had or are about to have top surgery. If one of the first things on your mind is when you can get back to the gym after top surgery, you probably know that the idea of waiting to be able to work out might be frustrating or even scary. Transitioning back into the gym can be difficult after any surgery — this might be especially true for such an emotionally-charged procedure.

For many transmasculine and nonbinary people, top surgery is a potentially life-saving component of gender-affirming medical care that involves surgically removing chest tissue and reconstructing the chest either with or without nipple grafts. Whether you’re new to working out or a seasoned gym rat, navigating how and when to work out after top surgery can involve figuring out a lot of new skills. Even if you’re very experienced, you might find that you’ll feel like you’re learning different skills than you used before.

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Performing your first full push-up or bench press post-surgery can feel like a big PR, especially if you’ve had experience with the moves before. The movement will go through a full range of motion and the bar or floor will lightly touch your new chest. Because of that increased range of motion, it may just feel like training a new lift.

Editor’s note: The content on BarBend is meant to be informative in nature, but it shouldn’t take the place of advice and/or supervision from a medical professional. The opinions and articles on this site are not intended for use as diagnosis, prevention, and/or treatment of health problems. Speak with your physician if you have any concerns.

Working Out Before Top Surgery

The amount and intensity at which you can work out after top surgery depends — at least a little — on how much you were working out beforehand. Say you can do 20 push-ups in a single set before surgery. Even after you heal, your body will still remember how to do them. It might take some time to build up to where you were before — this is a major procedure, and your body will have to heal — but you have a bigger baseline of experience to work from.

On the other hand, if you’ve never trained or haven’t in a very long time when you have surgery, you’ll be both recovering from surgery and learning to work out at the same time. There is absolutely nothing wrong with that. But, it is an important factor to consider when it comes to recovery time. Studies have shown that people who are more physically active may have an easier time recovering from surgery than folks who are less active. (1)

So, if gender dysphoria allows, you may want to get some practice before surgery if you’d like. If you can’t, there’s nothing wrong with learning after the fact. It can be a very gleeful experience to do your first push-up with your actual chest.

If working out intensely isn’t in the cards for you before surgery, you might consider doing some shoulder mobility activities in the weeks or months leading up to surgery. You’ll have a limited range of motion for a few months after surgery, and making yourself as mobile as possible beforehand can help prevent a buildup of pain from those restrictions.

How to Maintain Shoulder Mobility During Top Surgery Recovery

Many surgeons advise that you not raise your hands above your head for two to three months after surgery to avoid your scars stretching and becoming wider. But even during that eight to 12-week window, you can take some action to maintain or build some level of mobility to avoid stiffness and pain.

Dr. Ginger Slack, M.D., an Assistant Clinical Professor in the UCLA Division of Plastic Surgery, told BarBend in an email that it helps to focus on your range of motion between zero and 90 degrees during recovery. Since you can’t lift your hands above your head for a while, she encourages patients to follow their surgeon’s specific advice about maintaining mobility between 0 and 90 degrees.

To do this, try bending your elbows and raising them slightly above your shoulders, with your hands pointed at the ceiling. Exhale and move your elbows out to face the sides of the room, then move back. Perform these shoulder sweeps for three sets of 10 to 15 repetitions once or twice a day after you’ve gotten your drains out (a medical device that draws out fluid that builds up under your incisions). It’ll help remind you to stand up as straight as you can. It might produce a small stretching sensation in your chest, which is common given that you’re likely to be hunched over protectively during your early recovery (especially if you hate your drains).

You can also perform sets of 10 to 15 band pull-aparts with a resistance band to strengthen your upper back and rear shoulders. This will take your shoulders through the horizontal ranges of motion you can handle after surgery, remind you to stand tall, and strengthen your end ranges of motion.

When Can You Lift Heavy After Top Surgery?

This depends on what you consider “heavy,” what type of top surgery you had, and — first and foremost — what your surgeon says. If you’ve never trained before and an empty 45-pound barbell is heavy, it’s amazing that you want to get started. After an initial five or six weeks of smooth recovery, check in with your surgeon about building up to lifting the barbell. 

If you have more experience and consider 135 pounds or more to be heavy, build up in a similar way — but you’ll have to wait a little longer. The three month mark is when your surgeon is more likely to clear you to start lifting more normally if you’re experienced. In the long run, waiting an extra two weeks to go heavy will be easier than hurting yourself and jeopardizing your results. Go slowly.

According to Dr. Slack, it pays off to prioritize patience after surgery.

To maximize your results, minimize your complications, and have the best scars, just plan to take some time off to recover and set the next part of your life up for success.

By focusing on recovery, you’ll be better able to lift heavier, safer, and with more potential gender euphoria in the future.

How to Start Conditioning Workouts After Top Surgery

Typically, you’ll be advised to wait a full three weeks before vigorous activities that will get your heart rate up. That includes conditioning workouts that extend beyond going for a long walk. For the first few weeks after surgery, if you can feel your heart starting to race, you probably want to go slower. Dr. Slack explains that more intense activity within the first three weeks can cause complications like seromas or fluid build-up. So, take it slow.

Once the three weeks are up, with the go-ahead from your surgeon, you can usually feel free to start jogging. If you’re not used to working out, that might be more than enough intensity for you. But even if you’re a seasoned athlete or lifter, stick with jogging for at least a few sessions to make sure it feels good and your incisions remain pain- and swelling-free from the natural increase in your blood pressure during exercise.

You can often start doing more intense conditioning workouts around weeks five or six after surgery. That might mean sprinting or performing box jumps or kettlebell swings. Be thoughtful about your exercise choices, though. Burpees, for example, involve your chest touching the ground with each rep — and that’s not something you’ll want while your incisions are still tender and healing.

How to Start Lower Body Workouts After Top Surgery

Once you’ve reached the five or six-week mark and are cleared for more intensive exercises, you might want to start with bodyweight lower body workouts first. That’s because your lower body may well be tired from recovery, but it’s not the part of you that was operated on.

Go slowly — don’t jump right back into trying to squat or deadlift your max. “I recommend no heavy lifting until around six weeks postop,” Dr. Slack told BarBend. She advises “slowly advancing to weights at eight weeks postop.” Consider starting with some lunges and bodyweight squats to start re-acclimating to weight-bearing exercises. When you feel ready to start integrating weights, be mindful of the positions your body will be put in.

For example, high bar back squats are a great choice after surgery if you’re experienced with a barbell. The bar sits directly on your traps, and you typically don’t need a generous stretch in your chest to properly hold the bar. But you might want to wait until the three month benchmark to try a heavy low bar back squat. Because the bar sits lower on your back in this version, you need to more actively pin the bar to you. This involves a more intense stretch of your chest, shoulders, and elbows to keep the bar in position.

A good rule of thumb is that when you and your surgeon decide you can perform much heavier upper body lifts — often, that’s around 12 weeks or three months — you can also start performing heavy low bar back squats. In the meantime, focus on moves that don’t put your chest in compromising positions, like the deadlift, heavy dumbbell lunges, and single-leg Romanian deadlifts.

How to Start Upper Body Workouts After Top Surgery

Once you’re cleared for running, it’s tempting to just jump right into upper body training. Letting a barbell touch your chest for the first time after surgery can feel like hitting a huge PR. The last thing you want to do is ruin that moment by doing it too soon and jeopardizing your healing.

Bench Presses and Push-Ups After Top Surgery

If you’re new to lifting in general, that means you’ll likely be lifting lighter weights than you would if you were more experienced. For the first few weeks, surgeons often advise that people of any lifting experience should avoid picking up anything heavier than five pounds. Your body may then be ready to start lifting more weights — around 20 pounds — around five to six weeks after surgery. Start very slowly, even if you’re feeling confident. Better to go slower and heal well than to move faster and put your recovery at risk.

Even for experienced lifters, this might mean performing push-ups from your knees for the first few sessions. Always test your body with lighter weights and less challenging movements before moving on to something heavier and more complex. You’ll want to avoid weights that are very heavy for you — as well as ballistic movements — for around three months. Otherwise, you risk hurting your muscles, stretching your scars, pulling at your still-healing incisions. “Less tension equals more fine line scars” as opposed to wider scars, Dr. Slack points out.

Overhead Lifts After Top Surgery

Be extra cautious if you’ve had a double incision procedure. That’s one where you’ll have a horizontal scar all across your chest. You probably don’t want those scars to stretch out and become wider than the original incisions. Because of this, your muscles may be able to handle overhead movements — like shoulder presses, pull-ups, and lat pulldowns — within five to six weeks after surgery. But if you’re concerned about your scars stretching, you may want to proceed with more caution.

Lifting your elbows over your ears repeatedly can cause your scars to stretch, even if you’re diligent with your scar care. To make sure your scars heal well, many surgeons advise waiting at least two or three months before raising your arms over your head. 

If you’re concerned about your shoulder mobility, there are certain exercises you can perform (described above). Check in with your surgeon and a physical therapist to maintain both your shoulder mobility and your surgery results.

Final Thoughts

After waiting so long to finally get top surgery, it’s tough to have to wait even longer to lift weights. But listening to your body and to your surgeon can help ensure that you have a holistic recovery, both for your muscles and your scars.

The moral of the story is airing on the side of checking with your surgeon first. And if it hurts, stop. But if you have the go-ahead from your surgeon and it’s not causing you pain, congratulations. Enjoy those heavy weights.

FAQs

Both before and after surgery, it’s likely that you’ve got a lot of questions. That’s definitely a normal part of recovery — and the more questions you ask, the better your training can become.

When is it safe to exercise after top surgery?

Most surgeons will tell you that you can start getting your heart rate up after three weeks of recovery. During those weeks, you shouldn’t be picking anything up that weighs more than about five pounds. After five to six weeks, with the clearance of your surgeon or doctor, you can often start gradually returning to a more intensive exercise routine. Three months, or 12 weeks, is the average benchmark for returning to both heavy lifting and overhead lifting and reaching.

When is it safe to bench press and do push-ups after top surgery?

If you’re modifying your push-ups and using light weights, you can often start doing chest exercises around five to six weeks after top surgery. Experienced lifters will likely want to wait three months before getting back to heavy lifting. As with everything in this process, check in with your surgeon whenever you’re unsure.

When is it safe to do overhead exercises after top surgery?

Since you probably want to avoid stretching your scars and making them wider, you’ll likely want to skip overhead exercises like shoulder presses, pull-ups and chin-ups, and lat pulldowns for a while. Even after you start lifting again at five to six weeks, try to keep your hands below your head until at least two or three months post-op. After those two or three months have passed, you can start reintroducing overhead lifts into your program.

References

  1. Hoogeboom TJ, Dronkers JJ, Hulzebos EH, van Meeteren NL. Merits of exercise therapy before and after major surgery. Curr Opin Anaesthesiol. 2014;27(2):161-166.

Featured Image: yurakrasil / Shutterstock

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