Speaker
Description
Introduction
DIEP flap reconstruction involves harvesting abdominal skin, adipose tissue, and perforating blood vessels to reconstruct one or both breasts following mastectomy. The procedure requires extensive abdominal wall dissection, affecting trunk muscle function, shoulder mobility, and posture, often leading to difficulty standing upright and shoulder impingement. Despite the complexity and duration of recovery, structured pre- and postoperative education and exercise-based rehabilitation remain limited. Many women access Accredited Exercise Physiologists (AEPs) several months postoperatively, suggesting missed opportunities for earlier intervention. This study aimed to identify postoperative functional limitations and gaps in exercise education to inform a phased, exercise oncology–led rehabilitation program.
Methods
Fifty-eight women (2 months–7 years post-DIEP) participated in a mixed-methods study comprising online surveys (n=22), facilitated roundtable discussions (n=12), and follow-up surveys (n=13). Quantitative data described recovery timelines, persistent functional impairments, and exercise prescription. Qualitative data explored patient-reported experiences of education, recovery expectations, exercise guidance, and unmet rehabilitation needs.
Results
Functional recovery was varied: 32% regained full function by 6 months, 23% by 12 months, 14% by 18 months, while 32%, who were between 2 months and 3.5 years post-surgery, remained functionally limited. Persistent impairments included numbness, limited range of movement and lymphoedema, all reported by 41%, abdominal limitations (36%), postural limitations and abdominal swelling by 23%. Although 85% received postoperative exercise prescription, only 10% included abdominal or core-specific exercises. Early rehabilitation primarily focused on shoulder mobility (77%), ambulation (68%), and safe transfers (64%). Participants reported insufficient preoperative education around expectations and post-operative care regarding abdominal recovery, fatigue management, and restoring posture. Eighty-six percent indicated willingness to engage with an AEP within the first four weeks postoperatively.
Conclusion
DIEP patients experience prolonged functional impairments, often compounded by delayed exercise intervention limited abdominal and trunk specific guidance. A structured, phase-based, exercise oncology–led rehabilitation model, including prehabilitation, early postoperative intervention, and long-term recovery support, may optimise functional outcomes, accelerate recovery, and improve patient confidence, psychological wellbeing, and quality of life.
Keywords
Exercise oncology; DIEP reconstruction; breast cancer rehabilitation; abdominal wall rehabilitation
| Abstract submitters declaration | yes |
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| Conflict of Interest & Ethical Approval | yes |
