Shoulder function after mastectomy with and without breast reconstruction: Balancing aesthetic benefit and functional cost.

Objective

To compare postoperative shoulder function between women undergoing mastectomy alone and those undergoing mastectomy with immediate reconstruction.

Background

Shoulder morbidity after oncologic breast surgery may significantly affect postoperative recovery and quality of life. However, the differential functional impact of mastectomy alone versus mastectomy with immediate reconstruction remains insufficiently characterized. MATERIAL AND

Methods

Prospective multicenter study (Oct 2022-Jun 2024). Women undergoing oncologic mastectomy were enrolled; 329 were analyzed (mastectomy, n = 163; immediate reconstruction, n = 166). Outcomes were analyzed at each patient's final available postoperative assessment; follow-up ranged 12-82 months.

Results

At the final assessment, immediate reconstruction was associated with higher pain scores (VAS 2.19 ± 2.67 vs. 1.39 ± 2.30; p = .004), more ROM limitation (40.96% vs. 23.93%; p = .001), and more SFS- functional limitations (39.16% vs. 27.61%; p = .027), whereas validated QuickDASH scores were comparable (14.98 ± 19.77 vs. 12.55 ± 10.97; p = .170). Exploratory SFS classifications indicated minimal impairment in 93.4% of reconstruction patients and 95.7% of mastectomy-only patients (p = .351). Physiotherapy recipients had higher disability scores; because referral was non-random and treatment was not standardized, these descriptive comparisons cannot estimate physiotherapy effectiveness. Radiotherapy (p = .012) and hormonal therapy (p = .018) were associated higher exploratory SFS values among reconstructed patients. In BMI stratified analysis leaner patients (≤25 kg/m2) had higher SFS values after reconstruction (p = .029). Patient satisfaction was higher following reconstruction (82% vs. 63%; p < .001).

Conclusions

At the final available assessment, immediate breast reconstruction was associated with greater pain and more frequent ROM limitation, whereas validated QuickDASH scores were comparable between groups. Radiotherapy and hormonal therapy were associated with greater shoulder morbidity among reconstructed patients, while BMI showed limited predictive value. Because only one assessment per patient was analyzed, the temporal course of these outcomes could not be determined. These findings primarily reflect an implant-based reconstruction population.