Recovery After Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction Surgery

Dell, Deena Damsky; Weaver, Carolyn; Kozempel, Jeannie

doi:10.1188/08.onf.189-196

Cited by 8 publications

(8 citation statements)

References 10 publications

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“…There are studies reporting on women who underwent autologous reconstruction also suggesting some impairment of physical functioning, but these report on TRAM flaps, and ascribe the effect to the transposition of the rectus abdominis muscle, which in turn affects the motion of the trunk, leading to postural changes. 16,26 The current techniques used to perform LDF may contribute additional pain and tissue tightness to abdominal wall and rib cage and at the surgery site, 26 which would in turn impair the recovery of shoulder movement. Moreover, it is not known whether the excess surgical manipulation during LDF procedures may impose significant damage to the muscular apparatus responsible for shoulder motion.…”

Section: Discussionmentioning

confidence: 99%

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

Oliveira

Silva

Gurgel

et al. 2010

Annals of Plastic Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

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

Oliveira

Silva

Gurgel

et al. 2010

Annals of Plastic Surgery

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“…The most common complications associated with autologous flap reconstructions are flap necrosis (5%), abdominal hernia or weakness (4%), infections (5%) and seroma (4%) (94). Reoperation is often required in patients who develop flap necrosis (95). Less common complications include bleeding and chronic pain (95,96).…”

Section: What Are the Risks And Benefits Associated With Breast Rmentioning

confidence: 99%

“…Reoperation is often required in patients who develop flap necrosis (95). Less common complications include bleeding and chronic pain (95,96). DIEP flaps have been shown to carry a higher risk for fat necrosis and flap loss (96) but lower donor-site morbidity (ie, bulge formation, hernia) (97,98) compared with muscle-sparing TRAM flaps.…”

Section: What Are the Risks And Benefits Associated With Breast Rmentioning

confidence: 99%

“…Mastectomy flap necrosis can necessitate reoperation and removal of the implants (86). As with autologous reconstruction, implant-based reconstruction may be associated with bleeding (86) and chronic pain (95,96). Implant rupture or malposition (63,64) and capsular contracture may occur more frequently in patients undergoing radiation therapy (83,99).…”

Section: What Are the Risks And Benefits Associated With Breast Rmentioning

confidence: 99%

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Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

Budgell¹,

Quan²,

Mehling³

et al. 2014

CAN J PLAST SURG

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“…Physical therapy addressing core strength is especially important in those who have undergone breast reconstruction with an autologous transverse rectus abdominis myocutaneous flap. Harvesting from the transverse rectus abdominis may result in a core weakness and a subsequent increase in the incidence of lower back pain, especially in those with pre-existing low back pain [23,24].…”

mentioning

confidence: 99%

A review of Recent Advances in the Management of Breast Cancer Related Pain

Zocca¹,

Valimahomed

et al. 2018

Breast Cancer Manag.

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• As death rates have declined from breast cancer, more women are living with chronic pain relating to tumor-related pain, treatment-related pain and debility.• Physical therapy is grossly underutilized in women with breast cancer.• Physical therapy can be beneficial for acute breast cancer related pain such as shoulder pathology relating to protective posturing post surgery. It can also be beneficial for lymphedema, radiation fibrosis, arthralgias from aromatase inhibitors and hyperalgesia.• Novel interventional options for breast cancer related pain include the Pecs Block and Modified Pecs block (Pecs II).• Additional targets include the serratus plane block and the intercosteobrachial nerve.• Autologous fat grafting is beneficial for chronic pain related to mastectomy and breast conservative therapy.• Future directions for research include neuromodulation, radiofrequency ablation and chemoablation. We also feel that tailored anatomic approaches to breast cancer related pain will be the future of management.The incidence of breast cancer has stabilized over the past 10 years, while death rates have declined. Thus, many women are living with long-term effects of breast cancer, including pain syndromes relating to breast cancer. As our understanding of these types of pain syndromes improves, delivery of care to this population becomes paramount. In this review, we discuss advances in rehabilitation and interventional pain management to improve pain and symptom management. Appropriate use of physical therapy may significantly improve a patient's functional status, while fascial plane blocks can lead to pain relief which may last for months. Targeted therapies for pain relief may result in better quality of life for individuals suffering from breast cancer related pain. Breast cancer-related pain can be divided into three distinct categories: tumor-related pain, treatment-related pain and debility or pain unrelated to cancer, and can occur as acute, subacute or chronic pain. Tumor-related pain usually occurs during active treatment and in advanced disease stages. Treatment-related pain can present acutely and become chronic during treatments consisting of chemotherapy, radiation or hormonal therapy [3]. Subacute breast cancer-related pain is most often associated with arm and shoulder pain following breast cancer surgery [4].

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Recovery After Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction Surgery

Abstract: Nurses and physical therapists can positively influence recovery from TRAM flap breast reconstruction by educating patients.

Cited by 8 publications

References 10 publications

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

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

Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

A review of Recent Advances in the Management of Breast Cancer Related Pain

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