title: Chest and upper body morbidity following immediate postmastectomy breast reconstruction.
abstract: OBJECTIVE
  The performance of a mastectomy for the treatment or prophylaxis of breast cancer may have long-term implications for both physical and mental well-being in women. The development of breast numbness and phantom breast sensations following mastectomy is well-known; however, relatively little is known about physical morbidity following postmastectomy breast reconstruction. The primary objective of this study was to evaluate the level of physical morbidity experienced following three surgical approaches: mastectomy alone, postmastectomy tissue expander/implant reconstruction, and postmastectomy autogenous tissue reconstruction.
  
  
  METHODS
  We conducted a cross-sectional survey of a sample of women who had undergone mastectomy with or without reconstruction. Chest and upper body morbidity were evaluated using the BREAST-Q. Physical well-being was compared across three types of breast surgery.
  
  
  RESULTS
  In total, 308 of 452 women who received a questionnaire booklet returned completed questionnaires. There was an overall difference in physical morbidity attributable to surgical treatment (P < 0.001). Patients who underwent autogenous tissue reconstruction had the highest (i.e., best) mean physical well-being score. Women who underwent expander/implant reconstruction also had less chronic physical morbidity than women who underwent mastectomy alone (P < 0.05).
  
  
  CONCLUSIONS
  Our findings suggest that women who undergo immediate autogenous tissue reconstruction experience significantly less chest and upper body morbidity than those who undergo either mastectomy with implant-based reconstruction or mastectomy alone. This information can be used to facilitate clinical decision-making, to validate individual experiences of breast cancer survivors, and to inform future innovations to decrease the long-term physical morbidity associated with breast cancer surgery.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCarthy
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.forename: Tua
authors.initials: T
authors.lastname: Long
authors.forename: Paula
authors.initials: P
authors.lastname: Garcia
authors.forename: Nina
authors.initials: N
authors.lastname: Kropf
authors.forename: Anne F
authors.initials: AF
authors.lastname: Klassen
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Cano
authors.forename: Yuelin
authors.initials: Y
authors.lastname: Li
authors.forename: Karen
authors.initials: K
authors.lastname: Hurley
authors.forename: Amie
authors.initials: A
authors.lastname: Scott
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009017:Morbidity; D018908:Muscle Weakness / Q000209:etiology* / Q000503:physiopathology; D011183:Postoperative Complications; D011379:Prognosis; D011788:Quality of Life; D016059:Range of Motion, Articular; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D035441:Thoracic Wall / Q000473:pathology*; D015625:Tissue Expansion Devices