Distorted body schema after mastectomy with immediate breast reconstruction: a 4-month follow up study

Abstract

Background After breast cancer, some patients report residual pain-related upper limb disability without physical impairment. Although pain and altered proprioception are known to affect the working body schema (WBS), there is little available evidence investigating the WBS of breast cancer survivors (BrCS). WBS—body representations in the brain—affect the “neuromatrix” that modulates pain sensitivity and the threshold for threatening stimuli. The aim of this study was to investigate whether WBS was disrupted after mastectomy with immediate breast reconstruction (IBR) for breast cancer and whether pain and proprioceptive changes affected WBS. Methods Thirty-five BrCS participated in the 4-month follow-up study. They were observed at 1 and 4 months postoperatively. The main outcome measures were the left right judgement test (LRJT) results, absolute angle error, pectoralis minor length index (PMI), pain, and Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score. They were measured at each observation, and parametric tests were performed to identify the nature of WBS. Results Both the reaction time and accuracy of the hand LRJT were poorer than those of the foot and back LRJT (p < 0.001). The hand LRJT reaction time and accuracy were unchanged over the total follow-up period (p = 0.77 and p = 0.47, respectively). There was a weak correlation between the LRJT reaction time and PMI (r = −0.26, p = 0.07), pain severity (r = 0.37, p = 0.02), and Q-DASH score (r = 0.37, p = 0.02). There was also a weak correlation between LRJT accuracy and Q-DASH score (r = −0.31, p = 0.04). The LRJT accuracy of BrCS who underwent surgery on their dominant side was higher than that of BrCS who underwent surgery on their non-dominant side (p = 0.002). Regression analysis found a weak but significant relationship between the early hand LRJT results and late pain severity (adjusted R2 = 0.179, p = 0.007). A similar relationship was found between early hand LRJT results and Q-DASH score (adjusted R2 = 0.099, p = 0.039). Conclusion To the best of our knowledge, this is the first study providing the nature of WBS after mastectomy with IBR. In this population, it is necessary to postoperatively preserve WBS integrity for pain and upper limb disability.

Factors affecting upper limb function recovery after mastectomy with immediate breast reconstruction: a STROBE study

“…However, there was no relationship with upper limb disability. We only found a trend for a positive relationship between the improvement of body schema and the improvement of social function (Supplementary Table S2) and con rmed the predictive value of LRJT accuracy (Supplementary Table S8), as we reported previously [15]. Brain-targeted intervention, such as Graded Motor Imagery (GMI), to improve LRJT results has been recently studied in various pain conditions.…”

“…Third, the measurement method may have decreased study quality. The length of the pectoralis minor was palpated rather than imaged by X-ray; the absolute angle error was modi ed from the standard position, and the test-retest reliability was approximately 0.7 [15]. Fourth, the data on non-protocol exercises such as yoga, which may have affected upper limb function, were not recorded.…”

“…D. Absolute angle error: A passive/active protocol for internal rotation was used to measure shoulder proprioception [15]. The average absolute differences were used for the analysis.…”

“…E. Upper limb body schema: A hand left right judgement test (LRJT) was performed to examine the WBS of the upper limb [15,24]. The average accuracy was used for the main analysis.…”

“…Given that current rehabilitation has shown that neuropathic pain [13] and working body schema (WBS) [14,15] could be related to subjective upper limb dysfunction, investigating previously reported shoulder functions with common patient-reported outcome measures in this population would further the understanding of upper limb dysfunction after IBR. Therefore, we designed a 4-month prospective observational study of breast cancer survivors (BrCS) to understand upper limb function and its change during cancer therapy and postoperative rehabilitation; this study reports correlations between functional changes and reports the predictive value of shoulder function for subjective shoulder disability.…”