I have a 60+ year old Mat Pilates student who has a hard time activating her core. Her abdominal muscles were pulled through to replace her breast tissue after breast cancer surgery 10 - 20 years ago. It was "cutting-edge" surgery at the time. Does anyone have experience with this form of reconstruction? (1) She says she does not feel her core because she donesn't have any abdominal muscles left. Her stomach is very flat and she enjoys Pilates. (2) Does anyone have exercise suggestions to get her to feel what's left of her abdominals? I teach this woman in a group class.

I'm not an instructor (yet!) but know many women who have had TRAM flap reconstruction. Her rectus muscle was used, and if she had a bilateral reconstruction, then both sides were used. Can you start her by focusing on her pelvic floor and TVA? Then the obliques? I'm sure she's using a lot of compensatory mechanisms to replace what her rectus can no longer do. I'll be interested to what some of the instrutors have to say about this, too!

Getting an ultrasound to see what core muscles she is or isn't activating could be a good idea. A Pilates studio in my area provides this service, it's amazing to see!