Abstract
BACKGROUND: Mastectomy and breast reconstruction aim to restore aesthetics and psychological well-being in breast cancer patients. However, postoperative shoulder pain and stiffness are common, with varying incidence rates across studies. This study assesses the incidence and risk factors for shoulder morbidity following breast reconstruction.
METHODS: A single-institution retrospective review was conducted from January 2015 to November 2023. Female patients who underwent mastectomy followed by reconstruction were included. Data on demographics, surgical details, therapies, and shoulder outcomes were collected. Unpaired t-tests, Fisher's Exact tests, and multivariable logistic regression models identified risk factors for shoulder impairment.
RESULTS: Among 773 patients, 192 (24.8%) reported shoulder impairment, associated with neoadjuvant chemotherapy (p=0.004), radiation (p=0.003), right-sided (p=0.001), and oncologic mastectomies (p<0.001). Axillary lymph node dissection (p<0.001) and lymphedema (p<0.001) were also linked. Shoulder impairment occurred, on average, 244.8 days post-surgery, lasting 293.4 days. Multivariable analysis identified prior shoulder impairment (OR 2.287; p=0.049), axillary lymph node dissection (OR 2.556; p=0.049), lymphedema (OR 5.677; p=0.003), and Hispanic race (OR 9.049; p=0.019) as significant predictors. Age and private insurance were protective factors.
CONCLUSION: Shoulder impairment is a prevalent complication after mastectomy and breast reconstruction, associated with previous shoulder issues and lymph node dissection. Early identification of these risk factors may inform targeted interventions to reduce shoulder morbidity and improve outcomes. Prospective studies are needed to refine prevention strategies for shoulder impairment in breast cancer survivors.