—Ellen Pearce Mathews
Jaki Nett's reply:
There are different types of mastectomies, but whichever the type, it is always a major operation. Several muscles may be cut or weakened including the pectoralis minor, pectoralis major, and parts of the latissimus dorsi. Because certain muscles will be compromised your student may have difficulty with weakness and loss of range of motion. But there are many ways to modify practice–you may need to try different approaches to find out what works best. Validate her resolve to get back to her practice and teach her Pranayama in a supine position. Let her eagerness be expressed in standing poses with her hands on her hips. In seated poses concentrate on the movement of the pelvis and the twisting of the spine. Teach her restorative poses.
Do not put her in poses that require her to bear weight on the arms too soon. Instead, do simple movements by taking the shoulder blades and arms through their full range of movements noting that the sides will not be balanced due to muscle removal, adhesions, sutures, and trauma. Here is a sequence of arm variations she can try: Anjali Mudra (Salutation Seal), Urdhva Hastasana (Upward Salute), Urdhva Anjali Mudra (Upward Salutation Seal), Gomukhasana (Cow Face Pose) , Paschima
Anjali Mudra (Reverse Salutation Seal), and Garudasana (Eagle Pose) .
When she is ready to do poses that demand that the arms be held out in space like Trikonasana (Triangle Pose) and Virabhadrasana I and II (Warrior I and II ) , make sure the arms are supported with a prop like wall ropes. Wait before asking her to do poses that require bearing weight on the upper body. Place wall ropes around her hip creases and have her hang forward in Adho Mukha Svanasana (Downward-Facing Dog) to reestablish the action of the arms without it being weight bearing.
There is one more condition associated with mastectomies that you and your student should be aware of; it is called lymphadema. It occurs because the body's normal fluids don't drain as well after a mastectomy. This can become an issue when asking a student to raise the arm or bear weight on it–as in Downward-Facing Dog. Generally people will know that they have it, but they will probably not know how to modify yoga practice to make it safer. For more information check your local hospital for someone who teaches yoga to breast cancer patients.
As a teacher you must be keen with your observation. Do not use force to get movement and stability. Use your wisdom and insight to guide her and yourself. She will compare her old self to the new. Hear her.
When I see my students' frustration, I pass on an adage: When there is struggle in our body learn from it. Let it teach you. The easy side teaches correct action, the injured side teaches patience.
Jaki Nett is a certified Iyengar Yoga instructor in St. Helena, California, and a faculty member of the Iyengar Yoga Institute of San Francisco. She teaches public classes in the San Francisco Bay Area and leads workshops in the United States and Europe, including specialty workshops on female issues.