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, 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.
Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil.
Riza Rute
RR
de Oliveira
Marcela Ponzio
MP
Pinto e Silva
Maria Salete Costa
MS
Gurgel
Leo
L
Pastori-Filho
Luís Otávio
LO
Sarian
D001943:Breast Neoplasms / Q000601:surgery*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000534:rehabilitation*; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D011184:Postoperative Period; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012785:Shoulder Joint; D013524:Surgical Flaps; D013997:Time Factors