Incidence, predictive factors, and prognosis for winged scapula in breast cancer patients after axillary dissection.
OBJECTIVE
Axillary lymph node dissection is part of breast cancer surgery, and winged scapula is a possible sequela. Data regarding its incidence, predictive factors, and patient prognosis remains inconsistent. Ignorance of its diagnosis may lead to undertreatment with physical morbidity.


METHODS
Breast cancer patients with axillary lymph node dissection were prospectively recruited. Postoperative examinations by the physiotherapy staff were performed.


RESULTS
One hundred eighty-seven patients were recruited during July-October 2012; 51 patients had a positive diagnosis (27.2 %), with 38 patients (86 %) who recovered completely from the winged scapula, while 6 patients (13 %) still had winged scapula at 6 months after surgery. One hundred thirty patients underwent mastectomy and 100 cases had immediate reconstruction. Age, BMI, previous shoulder joint morbidity, and breast surgery were not associated with winged scapula. Neoadjuvant treatment, mastectomy or conservative surgery, immediate reconstruction, tumor size, and nodal involvement also did not show any correlation. Breast reconstruction with prosthesis, even with serratus muscle dissection, does not increase the incidence of winged scapula.


CONCLUSIONS
Winged scapula is not an uncommon incidence after breast cancer surgery. Physiotherapy is related to the complete recovery. The severity or grading of the winged scapula and the recovery time after physiotherapy should be investigated in the future studies.
Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy, LuizFelipe.NevolaTeixeira@ieo.it.
Luiz Felipe
LF
Nevola Teixeira
Visnu
V
Lohsiriwat
Mario Casales
MC
Schorr
Alberto
A
Luini
Viviana
V
Galimberti
Mario
M
Rietjens
Cristina
C
Garusi
Sara
S
Gandini
Luis Otavio Zanatta
LO
Sarian
Fabio
F
Sandrin
Maria Claudia
MC
Simoncini
Paolo
P
Veronesi
D000328:Adult; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012540:Scapula / Q000473:pathology* / Q000601:surgery