Mobile application-based monitoring in post-breast reconstruction surgery: current trends and future directions

Article information

Arch Aesthetic Plast Surg. 2025;31(1):1-9

Publication date (electronic) : 2025 January 30

doi : https://doi.org/10.14730/aaps.2025.01284

Jae Hoon Jeong

Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

Correspondence: Jae Hoon Jeong Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea E-mail: psdrj2h@gmail.com

Received 2025 January 6; Revised 2025 January 14; Accepted 2025 January 14.

Abstract

INTRODUCTION

Technology’s growing role in healthcare has significantly enhanced postoperative patient care. Traditionally, postoperative care has depended heavily on in-person visits, requiring patients to attend follow-up appointments to monitor their recovery. This approach, however, can be time-consuming, resource-intensive, and challenging for both patients and healthcare providers, especially in remote or underserved areas.

Mobile health apps have recently emerged as a promising solution to these challenges [1]. Mobile apps have become valuable tools for enhancing communication between patients and healthcare providers and for monitoring recovery post-surgery, thanks to the widespread adoption of smartphones and mobile technology [2]. These apps enable real-time monitoring of symptoms, medication use, and key recovery factors, thereby enhancing patient outcomes and reducing the need for in-person visits [3].

The increase in published papers reflects a growing interest in mobile app monitoring. A review of postoperative care studies across various surgical specialties reveals a clear trend of increased research in this field [4-20]. This upward trajectory is evident in the growing number of publications available on platforms such as PubMed, highlighting the expanding interest and potential of mobile health technologies in improving postoperative patient monitoring and care (Fig. 1). In 2012, only one paper was published, but by 2024, the number had surged to 67, indicating a greater focus on this area of research. Particularly, between 2021 and 2022, over 50 papers were published, and 2024 saw the highest number of publications to date. This trend suggests that the academic community is increasingly engaged with the subject. The rise in publications also reflects the significance of the topic not only in academic circles but also in related industries and policy discussions. It is expected that research in this area will continue to expand in the coming years.

Fig. 1.

Articles about postoperative care using mobile application. The increasing interest in mobile health technologies for postoperative care is evident in the rising number of publications on platforms such as PubMed. In 2012, only one paper was published on this topic, but by 2024, the number surged to 67. This trend suggests that the academic community is increasingly engaged with the subject.

Research on using apps for postoperative care in breast cancer patients has increased alongside their growing use in medicine. However, studies specifically focusing on postoperative care for breast reconstruction patients remain scarce [21,22]. This indicates a gap in the literature, emphasizing the need for focused studies on the specific needs of breast cancer patients, especially those receiving breast reconstruction, regarding digital health solutions. The purpose of this paper is to review the development and research of mobile apps in postoperative care across various medical fields. It seeks to identify important factors for creating and studying mobile apps for breast reconstruction patients.

MOBILE APPLICATIONS FOR POSTOPERATIVE CARE

Apps assist breast cancer survivors in swiftly recovering and reintegrating into society by collecting digital health information, including symptom data and personal health details such as images of affected areas. Apps are hosted on a cloud platform comprising a database server, web server, and application server (Fig. 2) [23]. The server software facilitates remote communication between the web and application servers in a networked environment, allowing users to access the system through the mobile app or via web browsers at partner hospitals through a cloud domain name system. Apps are designed to detect acute issues that may arise post-surgery, a period critical for healing, and provide services to help identify potential problems during this acute phase.

Fig. 2.

App and web server architecture diagram. Apps are hosted on a cloud platform that includes a database server, web server, and application server. The server software enables communication between the web and application servers remotely in a networked environment, allowing users to access the system through the mobile app or partner hospitals’ web browsers via Cloud DNS (domain name system).

Mobile apps for postoperative care have been explored across various surgical specialties [3-23]. In surgical oncology, including breast cancer surgeries, mobile apps have been studied for their role in managing recovery and patient follow-up post-surgery [4]. Mobile apps are now utilized in orthopedic surgery for joint replacements and spinal procedures to monitor rehab progress and track complications [5-9]. In cardiac surgery, mobile apps are increasingly used to assist with recovery following heart surgeries and transplants, enabling real-time health monitoring and communication between patients and healthcare providers [10]. General surgery, which includes abdominal, colorectal, and gastrointestinal surgery, employs mobile apps to monitor postoperative symptoms and detect potential complications early [11-13]. In urology, postoperative care for procedures such as prostatectomy and kidney surgery is enhanced by mobile health apps that assist in patient monitoring and recovery [14]. Similarly, in neurosurgery, mobile apps are used to track recovery after brain or spinal surgeries, helping manage pain and rehabilitation [15,16]. In gynecology, particularly post-hysterectomy or pelvic surgery, mobile apps provide a way to track recovery progress and manage symptoms [17]. Pediatric surgery, including postoperative recovery for children, has incorporated mobile technology to improve patient care and assist parents in managing recovery [18,19]. Finally, in trauma surgery, mobile health apps help in monitoring recovery after injury or emergency surgery, improving postoperative care management [20]. These studies underscore the growing importance of mobile apps in supporting postoperative recovery, managing complications, and enhancing communication in surgery.

Recent studies have examined mobile apps for the postoperative care of breast cancer patients [24-44]. Mobile apps have been developed to monitor postoperative symptoms such as pain, swelling, and wound healing, offering patients real-time feedback and guidance. These apps enable remote follow-up care, reducing the need for in-person visits and facilitating prompt interventions if complications occur. Research has indicated that mobile apps improve recovery and patient satisfaction for breast cancer patients post-surgery. A recent study reviewed articles focusing on mobile health apps used in postoperative care for breast cancer patients [4]. Mobile apps designed to support breast cancer patients during their recovery journey offer a range of features aimed at promoting patient engagement and improving clinical outcomes. Key features include data export, allowing patients to share important health details, such as wound photos or treatment updates, with healthcare providers for remote monitoring and prompt care [3,4,21-45]. Apps also provide educational resources, such as video tutorials on exercises, cancer care content, and recovery expectations, helping patients better understand their condition and treatment options. Personalized plans enable customized exercise, diet, and recovery schedules tailored to each patient’s needs. Reminders for medication adherence, exercise routines, and appointments support patient compliance. Community forums and virtual consultations improve emotional well-being by providing peer support and access to healthcare professionals. Finally, tracking tools allow patients to monitor important recovery metrics, including physical activity, pain intensity, mood, weight, sleep patterns, and treatment progress, ensuring ongoing assessment and adjustments to their care plans. These features promote recovery, empower patients, and improve communication with healthcare providers.

A wide range of assessment tools and indicators have been used to measure various aspects of patient outcomes in research evaluating the effectiveness of mobile apps for breast cancer patients [3,21-44]. These include psychological and emotional well-being measures such as the Concern About Recurrence Scale, Hospital Anxiety and Depression Scale, and Fear of Progression Questionnaire. Quality of life was assessed using tools like the BREAST-Q, EuroQoL-5, EORTC QLQ-BR23, and FACIT-Sp-12, while physical health was measured through the dual-energy X-ray absorptiometry, the Pain Impact Questionnaire, and International Physical Activity Questionnaire-Short Form. The SCNS-SF34 and satisfaction surveys were used to evaluate patient needs and satisfaction with the mobile app services. Other evaluations included self-reported questionnaires, qualitative interviews, and focus group discussions to gather subjective feedback on the user experience. These comprehensive tools enabled researchers to evaluate the mobile app’s impact on emotional well-being, physical recovery, patient engagement, and overall health outcomes, providing a thorough understanding of its effectiveness in supporting breast cancer patients throughout their recovery.

The following are representative apps that can be used for postoperative management by patients who have undergone breast reconstruction surgery (Table 1). Few mobile apps have been designed specifically for the postoperative management of patients who have undergone breast reconstruction (Fig. 3). Instead, most apps available for post-surgery care generally focus on breast cancer surgery or general postoperative management. However, specialized apps addressing the unique needs of breast reconstruction patients remain limited, and many individuals rely on broader platforms designed for cancer recovery or general surgical aftercare. To the best of the author’s knowledge, the first paper on breast reconstruction apps was published in 2016 [22]. Smartphones in medicine have primarily aimed to improve healthcare professionals’ convenience and efficiency, not patient comfort. The integration of mobile apps aimed to support clinicians in various aspects of care, such as communication, documentation, education, and monitoring. Apps such as PicSafeMedi and Elogbook enhance medical workflow by facilitating quick communication, multimedia sharing, and electronic patient data storage. Educational apps such as FlapApp and PubMed on Tap offer valuable resources for surgeons to improve their knowledge and skills. These advancements have improved decision-making and procedural training for healthcare providers, but have prioritized clinical efficiency over enhancing patient experiences. These apps were designed for surgeons and medical staff, enabling faster responses, improved collaboration, and easier documentation.

Table 1.

Apps that can be used for postoperative management by patients who have undergone breast reconstruction surgery

Fig. 3.

The screenshot of the PinkDoc app. (A) Patient’s symptom recording. (B) Screen for healthcare providers.

These technologies for personalized care and convenience are still in the early stages. Mobile apps are essential in postoperative care, allowing patients to access healthcare remotely and assisting ongoing communication with providers. This form of communication can enhance patient engagement, increase adherence to postoperative instructions, and enable healthcare providers to intervene promptly if any complications arise, potentially leading to better outcomes and reduced readmissions. Despite the promising potential of mobile apps in postoperative care, the adoption and effectiveness of these technologies remain areas of active research.

DEVELOPING MOBILE APPS FOR BREAST RECONSTRUCTION

Breast reconstruction surgery can significantly enhance both physical appearance and emotional health, though it may lead to complications requiring vigilant monitoring. Common complications include infections at the surgical site, which can delay healing and necessitate additional treatment [46-48]. Hematoma and seroma, where fluid accumulates under the skin causing swelling and discomfort, are also frequent issues. Moreover, complications such as wound dehiscence and skin necrosis may occur, particularly if the blood supply to the reconstructed tissue is compromised. Lymphedema, or swelling in the arm due to disrupted lymphatic drainage, is another potential complication, especially in patients who have undergone axillary lymph node dissection [49,50]. The psychological impact of these complications can be significant, causing some patients to suffer from anxiety or depression due to altered appearance or prolonged recovery [51,52]. Ongoing postoperative care and monitoring are crucial to promptly identify and address complications, thereby improving recovery outcomes. A checklist for monitoring patients after breast reconstruction surgery is shown in Fig. 4, highlighting key aspects for inclusion in mobile care apps.

Fig. 4.

The checklist of essential complications to be monitored postoperatively in breast reconstruction patients: highlighting the key features that should be included in mobile applications for postoperative care. DTI/TE, direct-to-implant/tissue expander; DIEAP, deep inferior epigastric artery perforator flap.

Table 2 presents key features of mobile apps designed to support breast cancer patients throughout their recovery. These apps provide a comprehensive suite of tools to enhance care and communication. Personalized recovery plans deliver tailored care instructions, including guidelines on wound care, exercise, and nutrition. Features for wound monitoring and photo sharing allow patients to securely upload images of their surgical site, enabling healthcare providers to monitor healing and manage complications remotely. Pain and symptom tracking tools help patients record daily pain levels and symptoms, offering alerts for complications and personalized management strategies. The medication management feature includes push notifications and dosage tracking to assist patients in adhering to their medication schedules. Virtual consultations and support are available for healthcare professionals to provide consultations, follow-up appointments, and emotional support, ensuring continuous care and patient reassurance. Educational resources provide vital information on post-surgery recovery, complications, and mental health, boosting patient awareness and emotional wellness. The activity and mobility tracker helps monitor physical activity, suggests exercises, and reminds patients about physical therapy sessions. Emotional and mental health support features include mindfulness exercises, peer support forums, and access to mental health counselors, aiding patients in navigating emotional challenges. Data export facilitates the secure sharing of symptom logs, wound updates, and activity data between patients and healthcare providers. Community forums and peer support connect patients with others who have similar experiences, offering emotional and informational support. Visual progress tracking allows patients to view their recovery milestones through charts and timelines, providing visual indicators of healing and progress, while reminders for follow-up appointments ensure that patients maintain their scheduled check-ups and therapy sessions. Collectively, these features facilitate a comprehensive, patient-centered approach to recovery, enhancing outcomes and improving the patient experience.

Table 2.

Key features for an app designed for postoperative care in breast reconstruction patients

When utilizing mobile apps for doctor-patient communication, understanding the relevant policies and regulations of the country is crucial. For instance, under the Medical Device Act of Korea, a medical device is defined as any instrument, apparatus, implement, machine, device, material, software, or similar product used alone or in combination on humans or animals, excluding pharmaceuticals, quasi-drugs, and prosthetics/assistive devices [53,54]. These devices are intended for use in the diagnosis, treatment, alleviation, management, or prevention of diseases; the diagnosis, treatment, alleviation, or correction of injuries or disabilities; the examination, replacement, or modification of anatomical structures or functions; or for controlling pregnancy. If an app meets these criteria, it is classified as a medical device and must undergo necessary procedures such as regulatory approval, testing, and certification before it can be implemented in practice. The clinical trial process for medical devices in South Korea includes several steps: submission of a clinical trial application, ethics review by an Institutional Review Board, approval by the Ministry of Food and Drug Safety, conducting the clinical trial, monitoring and reporting adverse events, reporting clinical trial results, and applying for market authorization. If the trial confirms the device’s safety and effectiveness, it receives market approval, followed by ongoing monitoring for safety and performance. It is important to recognize that if an app is used for medical diagnosis or treatment, or if it analyzes patient data and presents results to the patient, it may be classified as a medical device. This distinction is crucial, as such apps must comply with regulations and receive approval before clinical use.

DISCUSSION

The concept of “homespital,” a fusion of “home” and “hospital,” refers to a system where patients can receive hospital-level services at home [55]. This model reflects the shift in healthcare paradigms from a disease-centered model to a patient-centered model. In the traditional disease-centered approach, the focus is primarily on the short-term treatment of illness. In contrast, the patient-centered model expands the focus to long-term health management, disease prediction, and prevention. It prioritizes patient respect, information sharing, patient engagement, and collaboration. The COVID-19 pandemic accelerated the adoption of telemedicine and enhanced digital healthcare technologies, facilitating the provision of homespital services [56-58]. According to a 2021 report by the American digital health investment firm Rock Health, investment in digital healthcare fields such as telemedicine has doubled annually since 2019 [59].

Innovative digital healthcare technologies, including artificial intelligence, cloud services, and health-monitoring wearables, are driving this transformation. A key feature of the current medical device industry is the integration of patient data, such as medical imaging and biometric signals, with advanced technologies. This integration is yielding meaningful clinical insights that support accurate diagnosis, reduce treatment times, and enhance patient safety [53,54]. Research and development in this area focus primarily on creating clinical value by improving outcomes. Consequently, the infrastructure required to implement homespital systems is rapidly evolving, enabling the continuous delivery of high-quality medical services to patients needing ongoing care and monitoring. This evolution is transforming healthcare by enabling the delivery of hospital-level services at home.

Digital healthcare offers significant advantages in managing cancer survivors [60]. Technologies such as online patient portals and mobile health apps provide survivors with real-time access to their health information, facilitate communication with healthcare providers, and promote active engagement in their care. Interactive tools that track symptoms, create personalized health plans, and offer self-management resources further enhance patient involvement, thereby improving their overall well-being and quality of life [61]. Digital healthcare also enhances care coordination by enabling seamless information sharing among healthcare providers, which helps reduce medical errors [62]. Additionally, mobile technology improves access to support services like counseling and peer groups, particularly for individuals with disabilities, by eliminating barriers such as transportation issues or long wait times. Features like user-friendly interfaces, adjustable text sizes, and high-contrast visuals ensure that all users, including those with sensory impairments, can access comprehensive healthcare services, thereby increasing both accessibility and patient satisfaction.

In South Korea, a healthcare crisis is leading to significant shortages of resident and fellow physicians in tertiary hospitals, exacerbating the strain on emergency departments. This shortage of on-call staff has resulted in hospitals increasingly struggling to respond effectively to unexpected emergency room visits, potentially compromising patient care and safety. Mobile apps for patient monitoring present a viable solution. By integrating real-time data tracking with predictive analytics, these apps can anticipate potential emergency visits and provide early warning signs, even in scenarios that are typically challenging to predict. This proactive monitoring system allows healthcare providers to better manage resources, optimize staffing, and prepare for unexpected increases in emergency cases, thus enhancing the overall efficiency and responsiveness of emergency care despite staffing shortages.

Mobile apps can effectively monitor postoperative progress, although they may not offer significant economic benefits to healthcare providers. While these apps can improve outpatient visits by providing continuous monitoring and potentially reducing the duration of in-person consultations, the long-term financial benefits for physicians are not always evident. The challenge lies in ensuring that these mobile tools provide lasting value to healthcare providers. For mobile apps targeting physicians to be successful, they must incorporate features that enhance patient engagement, improve clinical outcomes, and decrease costs by optimizing resource utilization and reducing the need for follow-up visits. Without these sustained benefits, the economic incentives for physicians to adopt and integrate mobile health tools into their practices remain uncertain.

The variety of data collection tools used in studies complicates consistent and reliable meta-analysis [3,21-44]. Variation in assessment methods leads to difficulties in synthesizing findings and comparing results across studies. To increase the consistency and quality of future research, it is necessary to adopt standardized, universally accepted evaluation tools that can be used across various studies. This approach would yield stronger, comparable data, facilitating clearer conclusions and more effective interventions for breast reconstruction patients. Standardizing data collection instruments would not only enhance methodological rigor but also ensure that findings are meaningful and applicable across different contexts and populations.

CONCLUSION

To successfully implement postoperative care through mobile apps, it is crucial to develop an app that not only includes all essential features for patient monitoring and support but also addresses administrative procedures. Additionally, it is necessary to ensure that both patients and healthcare providers are motivated to actively use the platform. This involves adhering to regulatory standards and ensuring the app meets healthcare, privacy, and data security requirements. Establishing incentives that encourage both physicians and patients to consistently engage with the app is important. For healthcare providers, incentives could include demonstrating how the app can improve clinical outcomes, simplify follow-up care, and reduce the need for in-person consultations, thereby saving time and reducing costs. For patients, motivation may come from personalized care, improved recovery tracking, and the convenience of virtual consultations and support. The successful adoption of mobile apps for postoperative care depends on aligning the interests of both patients and providers while ensuring the app provides tangible benefits in terms of health outcomes and operational efficiency. As technology continues to advance, there is also potential to expand its use into plastic surgery. Incorporating similar postoperative care and monitoring features could significantly improve recovery experiences and outcomes for patients undergoing both cosmetic and reconstructive procedures.

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