title: Randomized clinical trial on the preservation of the medial pectoral nerve following mastectomy due to breast cancer: impact on upper limb rehabilitation.
abstract: OBJECTIVE
  Systematic modifications to the surgical technique of mastectomy have been proposed with the objective of minimizing injuries to the pectoral nerves and their effects. The aim of this study was to compare muscle strength and mass of the pectoralis major muscle (PMM) and abduction and flexion of the homolateral upper limb following mastectomy among women with breast cancer undergoing either preservation or sectioning of the medial pectoral nerve (MPN).
  
  
  METHODS
  Randomized, double-blind, clinical trial on 30 women with breast cancer who underwent mastectomy between July 2002 and May 2003 in Campinas, Brazil.
  
  
  METHODS
  The women were allocated to a group, in which the MPN was preserved, or to another group in which it was sectioned. Fisher's exact and Wilcoxon tests were used to analyze the data, along with Friedman and ANOVA analysis of variance.
  
  
  RESULTS
  In the MPN preserved group, 81% of the women did not lose any PMM strength, compared with 31% in the sectioned MPN group (confidence interval, CI = 1.21; relative risk, RR = 2.14; P < 0.03). There were no differences between the groups regarding muscle mass (CI = 0.32; RR = 0.89; P = 0.8), shoulder abduction (CI = 1.36; RR = 0.89; P = 0.28) and shoulder flexion (CI = 1.36; RR = 1.93; P = 0.8).
  
  
  CONCLUSIONS
  Preservation of the MPN was significantly associated with maintenance of PMM strength, compared with nerve sectioning. No differences in muscle mass or in abduction and flexion of the homolateral shoulder were found between the groups.
  
  
  BACKGROUND
  ANZCTR - 00082622.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), São Paulo, Brazil.
authors.forename: Andrea de Vasconcelos
authors.initials: Ade V
authors.lastname: Gonçalves
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Teixeira
authors.forename: Renato
authors.initials: R
authors.lastname: Torresan
authors.forename: César
authors.initials: C
authors.lastname: Alvarenga
authors.forename: César
authors.initials: C
authors.lastname: Cabello
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D002277:Carcinoma / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods / Q000534:rehabilitation*; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology; D010369:Pectoralis Muscles / Q000294:innervation* / Q000502:physiology; D010525:Peripheral Nerves / Q000502:physiology / Q000601:surgery; D034941:Upper Extremity / Q000502:physiology*