Patient-reported upper extremity impairment following mastectomy with breast reconstruction: A systematic review

Background: Mastectomy is known to cause upper extremity impairment due to biomechanical disturbance and shoulder girdle instability. Forty percent of the patients undergoing mastectomy have immediate breast reconstruction, which may further alter the biomechanics of the chest, shoulder, and arm. However, the clinical significance of these alterations remain unknown. The authors present a systematic review of patient-reported upper extremity dysfunction following autologous or alloplastic breast reconstruction. Methods: A systematic review was conducted using PubMed, Cochrane Library, and Scopus databases according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies were screened according to title and abstract, and those that met the criteria for inclusion were read in full. Patient-reported outcomes focusing on upper extremity function were extracted. Overall, 7946 unique articles were identified; after title and abstract screening and full-text review, 29 studies met the inclusion criteria. Results: There was no consensus on upper extremity dysfunction associated with reconstruction compared to mastectomy alone. Patients with subpectoral implants had worse symptoms and functionality compared to preoperative state or prepectoral implant-based reconstruction. Patients with latissimus dorsi autologous reconstruction had worse symptoms and functionality compared to preoperative state and other autologous flap types. Conclusions: When considering upper extremity function, the current evidence suggests no difference in the setting of mastectomy with or without reconstruction. Moreover, current evidence favors prepectoral implant-based reconstruction or abdominal-based flaps as the preferred options, while latissimus flaps have the highest reported impairments. Choice of reconstruction is multi-factorial and this review aids in comprehensive counseling and shared- decision making. (c) 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.