Postoperative Physical Therapy After Breast Reconstruction: A Systematic Review.

BACKGROUND

Postoperative physical therapy (PT) is well established after mastectomy to reduce upper-limb dysfunction, pain, and quality-of-life impairment. However, its role following breast reconstruction remains less clearly defined, largely due to concerns regarding reconstruction-specific complications.

OBJECTIVES

To evaluate the effects of PT on functional shoulder range of motion (ROM), pain, upper-limb function, and quality of life (QoL) after breast reconstruction.

METHODS

A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD420251025047). PubMed/MEDLINE, Embase, Scopus, CINAHL, and CENTRAL were searched from inception to July 2025. Eligible studies included adults undergoing implant-based or autologous reconstruction receiving preoperative or postoperative PT interventions. Quality was assessed via RoB 2 and ROBINS-I. Due to heterogeneity, a narrative synthesis was conducted.

RESULTS

Fifteen studies (n = 1,020) were included. Early and structured physiotherapy consistently improved short-term shoulder ROM, upper-limb function, and quality-of-life outcomes without increasing surgical complications. Initiating rehabilitation within two weeks postoperatively accelerated flexion and abduction recovery compared with traditional four-week immobilization protocols. Functional outcomes varied by reconstruction type, suggesting differing rehabilitation needs following implant-based versus autologous procedures. Massage-based interventions showed limited additional benefit from adjunctive therapies such as acupuncture or meditation. Evidence regarding optimal intervention type, delivery mode, and long-term benefit was limited by heterogeneity and variable study quality.

CONCLUSIONS

Postoperative PT is probably associated with earlier functional recovery and does not appear to compromise surgical safety, although certainty in this evidence is low across outcomes. However, the current evidence base is limited. High-quality, powered randomized controlled trials with standardized measures and longer follow-up are necessary to establish definitive clinical guidelines.