ORIGINAL ARTICLE Physical side-effects following breast reconstructive surgery impact physical activity and function Deirdre E. McGhee 1 & Julie R. Steele 1 Received: 13 February 2020 /Accepted: 14 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Purpose To investigate the incidence and severity of physical side-effects experienced by women following breast reconstructive surgery and the effect of these side-effects on physical activity and function. Methods Two hundred and thirty-one Australian women (55 years SD 6.5) who had previously had breast reconstruction surgery retrospectively self-reported the incidence and severity of eight physical side-effects and the perceived effect of these side effects on six physical functions, at three time points after their surgery. The frequency of the combined incidence/severity scores and their impact at the three time points were tabulated and compared using Chi-squared tests. A general linear regression was used to identify characteristics associated with moderate–very high (≥ 5/10) combined incidence/severity scores. Results At 6 months following surgery, approximately 50% of respondents reported moderate to very high incidence/severity scores for physical side-effects across multiple body regions, which were perceived to limit their physical function and activity levels. The highest incidence/severity scores were associated with the following: (i) pre-existing physical problems before surgery, (ii) post-operative complications (seroma, infection, necrosis), and (iii) autologous rather than implant-based reconstructions. Conclusion A large percentage of women reported moderate to severe physical side-effects across multiple body regions fol- lowing breast reconstructive surgery. These side-effects were perceived to negatively impact both physical function and activity. Early intervention, education and treatment are recommended to alleviate these issues and minimise their negative impact. Keywords Breast cancer, breast reconstruction . Physical side-effects, physical activity Introduction In conjunction with the aesthetic and psychological benefits of breast reconstructive surgery [1], women also experience physical side-effects beyond those caused by a prior mastec- tomy [2–16]. These physical side-effects include loss of shoulder range-of-motion and muscle strength [5, 8–13, 17, 18], low back and abdominal pain [7, 13, 14], reduced trunk flexion or extension strength [6, 13], chronic pain [4, 7, 15] and difficulty finding a comfortable bra [19]. The combined incidence and severity of these physical side-effects, how they change over time and their accumulated effect on physical activity and function are, however, unknown because most previous research has reported the incidence of these side- effects in isolation. This has been because the primary focus of most previous studies in this field has been post-operative complications [3, 16, 18, 20, 21], specific types of breast re- construction surgery [2, 4, 6, 9–12, 17, 18], the immediate post-operative period [21] or psychological or quality of life issues [5, 22–24], rather than physical function per se. Similar physical side-effects reported by women after mas- tectomy surgery have been found to limit physical activity and the ability to perform common tasks at home and at work [13, 25–34]. Furthermore, less than 50% of women meet the phys- ical activity recommendations after breast cancer surgery [35], despite the well-documented positive effects of exercise and its risk reduction in breast cancer reoccurrence [ 36]. Considering the increasing number of women having breast reconstructive surgery [37, 38] and the shift in focus to “how * Deirdre E. McGhee dmcghee@uow.edu.au Julie R. Steele julie_steele@uow.edu.au 1 Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia Supportive Care in Cancer https://doi.org/10.1007/s00520-020-05534-6