Physiotherapy Outcomes Following Modified Radical Mastectomy: A Narrative Review

Background Modified radical mastectomy (MRM) remains an important surgical treatment for breast cancer in patients requiring mastectomy with axillary lymph-node management. Although surgery contributes substantially to cancer control, postoperative physical impairments may include pain, reduced shoulder range of motion (ROM), muscle weakness, altered scapular mechanics, upper-limb dysfunction, lymphedema, and reduced quality of life. Physiotherapy is an important component of multidisciplinary breast cancer rehabilitation and aims to minimize these impairments and facilitate recovery of functional independence.  Objective To narratively synthesize contemporary evidence regarding changes following physiotherapy in patients undergoing MRM, with particular emphasis on pain, shoulder ROM, upper-limb strength, functional ability, lymphedema, posture, and quality of life.  Methods A narrative literature review was undertaken using PubMed/MEDLINE, PEDro, ScienceDirect, Google Scholar, and the Cochrane Library. Literature published predominantly between January 2015 and August 2026 was considered, with earlier studies included when they provided important foundational evidence. Search terms included combinations of modified radical mastectomy, breast cancer surgery, physiotherapy, physical therapy, rehabilitation, exercise, shoulder range of motion, upper limb function, pain, scapular strengthening, lymphedema, and quality of life. Randomized controlled trials, controlled clinical trials, systematic reviews, meta-analyses, and relevant narrative reviews were considered. The reporting structure was informed by the Scale for the Assessment of Narrative Review Articles (SANRA).  Results The reviewed evidence indicates that exercise-based physiotherapy can improve several postoperative outcomes following breast cancer surgery. Recent meta-analytic evidence demonstrates significant improvements in shoulder flexion, shoulder abduction, and upper-limb function following physical exercise. Exercise may also improve pain and muscle strength. Early ROM appears beneficial for postoperative mobility without evidence that appropriately prescribed early exercise adversely affects most wound outcomes. MRM-specific evidence suggests that scapular strengthening can further improve shoulder pain, ROM, and functional disability. Contemporary evidence also supports appropriately prescribed exercise and physiotherapy as components of prevention and management of breast cancer-related lymphedema. Conclusion Physiotherapy should be considered an integral component of rehabilitation following MRM. Therapeutic exercise, shoulder ROM exercises, progressive strengthening, scapular rehabilitation, postural correction, functional training, education, and individualized lymphedema management may contribute to improved physical function and quality of life. Rehabilitation should be individualized according to surgical procedure, wound healing, axillary treatment, adjuvant therapy, symptoms, and functional goals. Further MRM-specific research using standardized rehabilitation protocols and long-term follow-up is warranted.