Delineating upper limb longitudinal recovery after simple mastectomy, implant or autologous breast reconstruction using wearable activity monitors.

Abstract

The demand for breast reconstruction has increased owing to the established benefits for patients. Given the long-term survivorship, objective data are vital to aid patients in making treatment decisions. This prospective longitudinal observational study was carried out to objectively quantify the impact of simple mastectomy (Mx), implant-based reconstruction (IBR) and deep inferior epigastric perforator (DIEP) on upper limb (UL) activity using wearable activity monitors (WAMs). Forty-eight consecutive patients who underwent breast and reconstructive surgery were identified from operating schedules. Recruited participants were invited to wear WAMs on both wrists for an average of 3 days preoperatively, for 2 weeks post-operatively and more than 6 months post-operatively. A significantly greater reduction in gross physical activity as a percentage of preoperative activity was observed in DIEP compared with Mx and IBR patients across week 1 (median: 40% versus 62% versus 62%; p<0.001) and week 2 (median: 60% versus 77% versus 84%; p<0.001). In the long-term follow-up, the average activity had reached or exceeded their baseline levels for all operative procedures, Mx=114%, IBR=98% and DIEP=103%. DIEP was an independent predictor of recovery in weeks 1 (F=4.796, p=0.043) and 2 (F=7.306, p=0.015). Despite DIEP patients having the lowest UL activity level in the acute post-operative period when compared with Mx and IBR patients, average activity levels returned to baseline in the long-term for all procedures. Objective monitoring of recovery using WAMs can support the development of a personalised rehabilitation programme for those at risk of developing complications.