Background After breast cancer, some patients report residual pain-related upper limb disability without physical impairment. Although pain and altered proprioception are known to affect the working body schema (WBS), there is little available evidence investigating the WBS of breast cancer survivors (BrCS). WBS—body representations in the brain—affect the “neuromatrix” that modulates pain sensitivity and the threshold for threatening stimuli. The aim of this study was to investigate whether WBS was disrupted after mastectomy with immediate breast reconstruction (IBR) for breast cancer and whether pain and proprioceptive changes affected WBS. Methods Thirty-five BrCS participated in the 4-month follow-up study. They were observed at 1 and 4 months postoperatively. The main outcome measures were the left right judgement test (LRJT) results, absolute angle error, pectoralis minor length index (PMI), pain, and Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score. They were measured at each observation, and parametric tests were performed to identify the nature of WBS. Results Both the reaction time and accuracy of the hand LRJT were poorer than those of the foot and back LRJT (p < 0.001). The hand LRJT reaction time and accuracy were unchanged over the total follow-up period (p = 0.77 and p = 0.47, respectively). There was a weak correlation between the LRJT reaction time and PMI (r = −0.26, p = 0.07), pain severity (r = 0.37, p = 0.02), and Q-DASH score (r = 0.37, p = 0.02). There was also a weak correlation between LRJT accuracy and Q-DASH score (r = −0.31, p = 0.04). The LRJT accuracy of BrCS who underwent surgery on their dominant side was higher than that of BrCS who underwent surgery on their non-dominant side (p = 0.002). Regression analysis found a weak but significant relationship between the early hand LRJT results and late pain severity (adjusted R2 = 0.179, p = 0.007). A similar relationship was found between early hand LRJT results and Q-DASH score (adjusted R2 = 0.099, p = 0.039). Conclusion To the best of our knowledge, this is the first study providing the nature of WBS after mastectomy with IBR. In this population, it is necessary to postoperatively preserve WBS integrity for pain and upper limb disability.

Purpose With improvements in surgical techniques, the number of immediate breast reconstructions (IBRs) after mastectomy is increasing. Based on reports regarding postoperative shoulder function, scapular alignment and strength recovery have been confirmed, while movement accuracy has deteriorated. As this might induce residual shoulder discomfort, proper rehabilitation may manage the situation. Along with the recommendation for early rehabilitation after breast cancer surgery, this study was designed to identify the relationship between shoulder function and acute postoperative breast cancer survivors (BrCS) after IBR. Methods In this prospective observational study, subjective and objective functions of 67 BrCS were observed over 4 months. Hierarchical regression and correlation studies were conducted to reveal the relationship between functional improvement. Results The improvement of the QuickDASH score was significantly explained by the improvement of six shoulder functions after adjusting for covariates (R2 = 0.21, p = 0.01). Among the variables, the change in range of motion and neuropathic pain was statistically significant (p < 0.03). The BrCS with chemotherapy group showed deterioration of subjective shoulder function, compared with the BrCS without chemotherapy group (t = 2.97, p = 0.004). This might be owing to the difference in neuropathic pain score changes between the two groups. There was no major difference in functional improvement between the two IBR options. Conclusion Regular exercise focused on pectoral tightness may be effective in improving general shoulder flexibility. Given that neuropathic pain did not change, specific interventions may be required. In addition, rehabilitation should be differentiated based on the chemotherapy plan.

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