title: Is immediate reconstruction after mastectomy in breast cancer patients beneficial to shoulder function?
abstract: BACKGROUND
  To compare shoulder morbidity between patients who received transverse rectus abdominis myocutaneous (TRAM) flaps after mastectomy (MX + TRAM) and patients who underwent mastectomy only (MX).
  
  
  METHODS
  Thirty patients in each group were followed for a minimum of 2 postoperative years. Visual analog scale (VAS) score, restricted range of motion (ROM), rotator cuff disease, muscle strength, shoulder function scores (American Shoulder and Elbow Score and Shoulder Pain and Disability Index), measurement of scapular tilt on chest radiography and standing position in each group were compared.
  
  
  RESULTS
  There were no significant differences in VAS, restricted ROM, rotator cuff disease, muscle strength, shoulder function scores or scapula tilt on physical examination. However, lower angles of the scapula on chest radiography (4.0 ± 13.2 versus -3.4 ± 12.4 mm; P = 0.029) and pectoralis minor index (0.4 ± 7.7 mm versus 7.8 ± 9.1 mm; P = 0.001) were significantly different between the two groups.
  
  
  CONCLUSIONS
  Immediate breast reconstruction after a MX had advantages for preserving scapular resting alignment but did not provide benefits for shoulder morbidity on short-term follow-up.
authors: Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
authors: Bong Gun
authors: BG
authors: Lee
authors: Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
authors: Joon Kuk
authors: JK
authors: Kim
authors: Department of Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
authors: Sung Hyouk
authors: SH
authors: Choi
authors: Department of Plastic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
authors: Hee Chang
authors: HC
authors: Ahn
authors: Department of Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
authors: Min Sung
authors: MS
authors: Chung
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D064827:Myocutaneous Flap; D009367:Neoplasm Staging; D016059:Range of Motion, Articular; D020127:Recovery of Function; D017568:Rectus Abdominis / Q000637:transplantation; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: breast cancer; breast reconstruction; scapula tilting; shoulder and arm morbidity; transverse rectus abdominis myocutaneous flap