Factors affecting upper limb function recovery after mastectomy with immediate breast reconstruction: a STROBE study

Abstract

Purpose With improvements in surgical techniques, the number of immediate breast reconstructions (IBRs) after mastectomy is increasing. Based on reports regarding postoperative shoulder function, scapular alignment and strength recovery have been confirmed, while movement accuracy has deteriorated. As this might induce residual shoulder discomfort, proper rehabilitation may manage the situation. Along with the recommendation for early rehabilitation after breast cancer surgery, this study was designed to identify the relationship between shoulder function and acute postoperative breast cancer survivors (BrCS) after IBR. Methods In this prospective observational study, subjective and objective functions of 67 BrCS were observed over 4 months. Hierarchical regression and correlation studies were conducted to reveal the relationship between functional improvement. Results The improvement of the QuickDASH score was significantly explained by the improvement of six shoulder functions after adjusting for covariates (R2 = 0.21, p = 0.01). Among the variables, the change in range of motion and neuropathic pain was statistically significant (p < 0.03). The BrCS with chemotherapy group showed deterioration of subjective shoulder function, compared with the BrCS without chemotherapy group (t = 2.97, p = 0.004). This might be owing to the difference in neuropathic pain score changes between the two groups. There was no major difference in functional improvement between the two IBR options. Conclusion Regular exercise focused on pectoral tightness may be effective in improving general shoulder flexibility. Given that neuropathic pain did not change, specific interventions may be required. In addition, rehabilitation should be differentiated based on the chemotherapy plan.