Upper Extremity Reachable Workspace After Mastectomy: A Case Series

Following mastectomy for treatment of breast cancer, women may choose between several types of breast reconstruction or pursue no reconstruction. Selection depends on a variety of factors including patient/surgeon preference. Reconstruction procedures can impact shoulder mobility, pain, and strength. Currently used measurements do not comprehensively assess the range of motion or functional outcomes post mastectomy and reconstruction.

Reachable workspace assesses where the hand can reach in space away from the body (outer) and close to the body (inner). Reachable workspace was measured using a 3-dimensional motion capture system with real-time feedback for 3 women who underwent mastectomy and reconstruction. Reachable workspace data were collected for each arm. Timing of assessments varied by patient. A 10% or greater change in percentage workspace reached was considered clinically relevant. A normative dataset was used for exploratory comparisons.

All 3 patients showed the greatest deficits in the ipsilateral, behind-the-body reach postmastectomy, with additional limitations overhead and in inferior/anterior/contralateral reach in the outer workspace. Inner workspace deficits were also consistent, particularly in behind-the-head and ipsilateral/anterior thoracic and abdominal reach. Most workspace differences improved or normalized by 4-8 months postsurgery, but persistent deficits were noted.

The deficits in posterior outer and inner reach both involve stretching the pectoralis major across the chest wall and operative site. The inferior/anterior/contralateral octant requires low reach across the torso, applying direct pressure to operative site and implant. This case series indicates that reachable workspace is a relevant outcome measurement tool for mastectomy and breast reconstruction populations.