Impairment of upper extremity function following mastectomy and lumpectomy

Breast cancer surgery may lead to impairments in upper body function, which can negatively affect quality of life. The aim of this study is to evaluate the long-term impact of breast cancer surgery on arm and shoulder function.

This prospective multicentre study included patients who underwent mastectomy or lumpectomy between 2016 and 2019. Arm and shoulder function were assessed preoperatively, and at three and six months, one and two years postoperatively using the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, grip strength and range of motion (ROM). ROM measures included: anteflexion, abduction, exorotation, retroflexion and endorotation. Changes over time and differences between groups were analysed using linear mixed models.

A total of 497 patients were included, of whom 369 (74%) underwent lumpectomy and 128 mastectomy (26%). In both groups, DASH-scores were significantly worse at two years postoperatively compared with baseline (mastectomy: 6.1 ± 0.9 vs 9.1 ± 1.0, lumpectomy: 6.4 ± 0.5 vs 8.7 ± 0.6, P < 0.05), indicating a persistent functional impact. The patients after mastectomy showed a significantly greater increase in DASH-score at one year postoperatively, rising from 6.1 ± 0.9 at baseline to 11.1 ± 1.0 (P < 0.001), but were similar to the lumpectomy group at two years postoperatively. Mean grip strength in both groups remained within normative values (25.9 ± 0.4 kg - 29.5 ± 0.8 kg) over time. Anteflexion, retroflexion and exorotation all declined postoperatively and, with the exception of anteflexion in the lumpectomy group, did not return to baseline levels. Anteflexion in the lumpectomy group had recovered by the two-year follow-up. At one year postoperatively, the lumpectomy patients demonstrated a significant better abduction compared to those who underwent mastectomy (167.6 ± 1.1 vs 163.7 ± 1.9, P = 0.03), however, by two years both groups had returned to their baseline values. Endorotation showed a significant decline in the mastectomy group at two years postoperatively (P < 0.05).

Both lumpectomy and mastectomy are associated with postoperative decline in upper extremity function, with more pronounced functional limitations observed after mastectomy. However, these findings should be interpreted with caution since postoperative physiotherapy was not accounted for. Nevertheless, it is important to counsel patients on what to expect after breast cancer surgery and to raise awareness for any loss in upper extremity function, especially in mastectomy patients.