Background <p>Postoperative pain is a common complication following breast cancer surgery, adversely influencing recovery and quality of life. Exercise-based prehabilitation, initiated before surgery to enhance physical readiness, has shown benefits in other surgical settings. However, its specific impact on postoperative pain in breast cancer patients remains unclear.</p> Methods <p>This systematic review and meta-analysis evaluated the effectiveness of exercise-based prehabilitation in reducing postoperative pain in women undergoing breast cancer surgery. Following PRISMA guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science up to June 2025 (search conducted prior to submission). Eligible studies were randomized controlled trials (RCTs) comparing exercise-based prehabilitation with usual care or educational interventions. The primary outcome was pain at one month post-surgery. Risk of bias was assessed using the Cochrane RoB 2 tool, and methodological quality via the TESTEX scale.</p> Results <p>Six RCTs (<i>n</i> = 519) were included in the qualitative synthesis, and three (<i>n</i> = 157) in the meta-analysis. Interventions varied in duration (1–9 weeks), modality (aerobic, resistance, mobility, stretching), and supervision. Pain was measured using tools such as VAS, NPRS, EORTC QLQ-C30 and SPADI. Meta-analysis showed a small, non-significant effect (SMD = -0.24; 95% CI: -0.55 to 0.08; <i>p</i> = 0.14). Heterogeneity was statistically low (I² = 0%; 95% CI: 0% to 79%), although this estimate was based on only three studies and should not be interpreted as evidence of true consistency across trials.</p> Conclusions <p>Exercise-based prehabilitation was reported as safe and feasible in the included studies, with a possible but non-significant benefit in reducing postoperative pain. Given the low certainty of evidence, further high-quality RCTs are needed to clarify its role in breast cancer surgical care.</p> Graphical abstract <p></p>