The impact of mastectomy and subpectoral breast reconstruction on arm and shoulder function: A two-year follow-up.

Abstract

Breast surgery may be associated with impairment of arm and shoulder function, which can negatively affect quality of life. The aim of this study was to evaluate the long-term impact on upper body function after mastectomy and subpectoral breast reconstruction. This prospective multicenter study included patients who underwent unilateral mastectomy between 2017 and 2019. Patients were divided into two groups: mastectomy and subpectoral breast reconstruction. Arm and shoulder function were measured preoperatively, at 3 and 6 months, 1 and 2 years postoperatively using the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, grip strength, and range of motion (ROM). ROM evaluated included anteflexion, abduction, exorotation, retroflexion, and endorotation. Changes over time and differences between the groups were analyzed using linear mixed models. A total of 128 patients were included, among them 49 (38%) underwent reconstruction. The overall mean±SD baseline DASH-score was 5.6±1.1, which significantly increased to 10.6±1.1 at 1 year and 8.6±1.1 at 2 years, indicating greater disability. The reconstruction group showed a significantly higher DASH-score at 1 year compared to the mastectomy group. Grip strength remained stable over time for both groups. All ROM measurements declined significantly postoperatively, and only abduction returned to preoperative values at 2 years. Retroflexion significantly declined in the subpectoral reconstruction group and remained stable in the non-reconstruction group. Arm- and shoulder function remained impaired 2 years after breast surgery, except for grip strength. The reconstruction versus non-reconstruction groups showed minor differences. These findings highlight the importance of counseling and early referral to physiotherapy when postoperative complaints arise.