Postoperative Physical Therapy After Breast Reconstruction: A Systematic Review
In brief
Starting physical therapy within two weeks speeds shoulder recovery after reconstruction
Across 15 studies involving 1,020 patients, early structured physical therapy improved short-term shoulder movement, arm function, and quality of life; recovery of shoulder flexion and abduction was faster than with four weeks of immobilization. Complications did not increase, but varied methods and low-quality evidence leave the best rehabilitation approach and long-term benefits uncertain.
- Journal
- Aesthetic surgery journal (Q1)
- Published
- 3 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Sevasti Panagiota Glynou, Annie Fritsch, Fedra Britvic, Dimple K Gajjar, Rebecca Knackstedt, Tae Chong, et al.
- PMID
- 42827398
- DOI
- 10.1093/asj/sjag211
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (top studies of the week, 4 October 2026): Early PT improves shoulder ROM, no increased complications
- Picked for Complementary and Alternative Medicine (top studies of the week, 4 October 2026): Systematic review of postoperative PT after breast reconstruction
- Picked for Plastic and Reconstructive Surgery (top studies of the week, 4 October 2026): Systematic review PT after breast reconstruction
- Picked for Rehabilitation (top studies of the week, 4 October 2026): Postoperative PT, not stroke rehab
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.