For decades, women who underwent a mastectomy were told they could not do much lifting or they might risk developing a painful arm swelling condition called lymphedema.
That meant no lifting of grocery bags, toddlers, heavy boxes or even buckets on the side of the mastectomy for the rest of their lives.
But according to a new study, in most cases, doctors should have said the opposite. Expert-guided weightlifting may reduce the uncomfortable leathery skin texture, heaviness, and pain symptoms of lymphedema, according to an article published Wednesday in the New England Journal of Medicine.
Although several small studies have found evidence that weightlifting didn't put women at risk for lymphedema, Wednesday's study was one of the largest of its kind and the first to show weightlifting may actually help symptoms.
When Jeanette Stephens-El was diagnosed with breast cancer in 2003, she already knew exactly how challenging living with a mastectomy could be, including lymphedema.
"I had two sisters before me who had had breast cancer," said Stephens-El, author of "BCV: Rites of Passage for Breast Cancer Victors" under the pen name Raining Deer. "My mom had five daughters and four of us have had breast cancer and we all survived."
Stephens-El's older sister, who was diagnosed in the 1980s, has suffered from lymphedema for 20 years. So after her own breast cancer battle and mastectomy, Stephens-El thought she'd get a head start and volunteer for the study.
She was one of 141 women with lymphedema participating in the study. The women were assigned either to twice-weekly weight training programs at a local YMCA, or to no weight training as a control group.
As researchers followed the women over a year, 14 percent of the women working out with weights reported exacerbating symptoms of their lymphedema. However, 29 percent of women who were not weightlifting reported exacerbating symptoms.
"Six years after the mastectomy, I still feel the effects. I feel the pulling from the muscle," said Stephens-El. However, she said she hasn't developed serious lymphedema since she started weightlifting, and she feels better all around.
Kathryn Schmitz, author of the study and an associate professor of epidemiology at the University of Pennsylvania, said she hoped her study would influence future guidelines for mastectomy survivors.
Schmitz said she saw the current "risk-adverse" approach with warnings about lifting heavy objects as a "crazy, backward situation that further stresses the survivors."
Researchers in the breast cancer field widely agreed that the study was well done, but disagreed about the impact it would have.
"The weightlifting study is nicely done," said Dr. Harold Burstein, of Harvard Medical School and the Dana-Farber Cancer Institute in Boston. "Fortunately, lymphedema is quite uncommon in modern surgical practice for breast cancer."
According to the Schmitz article, different studies have estimated that lymphedema affects up to 70 percent of women after breast cancer surgery.
In years past, surgeons used to take out many more lymph nodes during a mastectomy. The more lymph nodes missing, the greater the woman's risk for developing lymphedema. As medical techniques improved, not only has the rate of mastectomies declined, but so has the amount of tissue taken when a mastectomy is performed.