Incidence of Shoulder Impairment in Breast Cancer Treatment and Reconstruction: A Single-Institution Study

Mastectomy and breast reconstruction aim to restore aesthetics and psychological well-being in patients with breast cancer. However, postoperative shoulder pain and stiffness are common, with varying incidence rates across studies. This study assessed the incidence of and risk factors for shoulder morbidity after breast reconstruction.

A single-institution retrospective review was conducted from January of 2015 through November of 2023. Women who underwent mastectomy followed by reconstruction were included. Data on demographics, surgical details, therapies, and shoulder outcomes were collected. Unpaired t tests, Fisher exact tests, and multivariable logistic regression models were used to identify risk factors for shoulder impairment.

Among 773 patients, 192 (24.8%) reported shoulder impairment, associated with neoadjuvant chemotherapy ( P = 0.004), radiation ( P = 0.003), right-sided mastectomies ( 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 after surgery, lasting 293.4 days. Multivariable analysis identified previous shoulder impairment (odds ratio [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.

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.