Immediate Breast Reconstruction With Transverse Latissimus Dorsi Flap Does Not Affect the Short-term Recovery of Shoulder Range of Motion After Mastectomy

Abstract

Immediate breast reconstruction, depending on the surgical strategy, can result in anatomic modifications that may affect the shoulder apparatus. This study compares the recovery of shoulder range of motion (ROM), after mastectomy, in women with and without immediate breast reconstruction with latissimus dorsi flap (LDF). This was a prospective study with 87 women who underwent mastectomy (41 with LDF). Shoulder ROM was assessed with goniometry, with a universal full-circle manual goniometer, prior to surgery, and on a weekly basis during the first 4 weeks postoperatively. Reconstruction with LDF was not associated with a decrease in shoulder ROM (P = 0.84). By the end of the 4-week assessment program, women in both groups still had an average reduction of 30 degrees in their shoulder ROM compared with baseline. Factors significantly associated with a reduction in shoulder ROM during the recovery period were complete dissection of the axilla, current smoking behavior, and presence of painful axillary cords. It is likely that breast reconstruction with LDF has little or no effect on shoulder ROM in the immediate postoperative period. It is also possible that LDF effects (if any) are overridden by the major reduction (over 30% in the immediate postoperative period, subsiding partially during the first weeks postoperatively) in shoulder ROM caused by mastectomy.

Immediate Breast Reconstruction with a Latissimus Dorsi Flap Has No Detrimental Effects on Shoulder Motion or Postsurgical Complications up to 1 Year after Surgery

“…13 During the first 4 postoperative weeks, latissimus dorsi flap reconstruction did not affect the initial recovery of shoulder range of motion. However, by the end of that short-term follow-up period, neither flexion nor abduction had recovered completely, being reduced by 30 percent compared with baseline.…”

“…13 In the present report, previously published baseline data on shoulder range of motion 13 are partially reused for comparison with follow-up data. Because the selection criteria for the present study included attending at least three of the four follow-up visits, to compare the present cohort with our previous report, new patients had to be included and a few had to be excluded.…”

“…14-16 Assessments were performed 1, 3, 6, and 12 months after surgery (data from four weekly range-of-motion reassessments during the first month have already been published). 13 Women who missed two or more consultations were excluded from the study.…”

“…[10][11][12] In a recent report, we preliminarily assessed the impact of the latissimus dorsi flap procedure Immediate Breast Reconstruction with a Latissimus Dorsi Flap Has No Detrimental Effects on Shoulder Motion or Postsurgical Complications up to 1 Year after Surgery on women who underwent immediate breast reconstruction compared with their counterparts who were treated with mastectomy alone. 13 Although the reduction of shoulder motion was severe on immediate postsurgical assessment, there was no detectable latissimus dorsi flaprelated restriction of shoulder range of motion up to 4 weeks postoperatively. However, that analysis was restricted to the short term, being aimed at examining shoulder recovery during the first few postoperative weeks.…”

The musculoskeletal consequences of breast reconstruction using the latissimus dorsi muscle for women following mastectomy for breast cancer: A critical review

“…There are a number of reasons why one particular reconstruction method is preferred over another. Following mastectomy, the LD is dissected along with a skin paddle and overlying fat (de Oliveira, Pinto e Silva, Gurgel, Pastori-Filho, & Sarian, 2010;Kim et al, 2013;Smith, 2014). Reconstruction using the LD muscle has been described in a variety of reconstructive methods since 1906 (Hamdi et al, 2008).…”