Kyong-Je Woo1, Kyeong-Tae Lee2, Goo-Hyun Mun2, Jai-Kyong Pyon2, Sa Ik Bang3. 1. Department of Plastic Surgery, College of Medicine, Ewha Womans University, 1071 Anyangchen-ro, Yangchen-ku, Seoul, Korea. 2. Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, Korea. 3. Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, Korea. Electronic address: si55.bang@samsung.com.
Abstract
BACKGROUND: The aim of this study was to evaluate the impact of breast reconstruction modality on the incidence of shoulder morbidity. METHODS: Breast cancer patients who underwent immediate reconstructions using three modalities, namely, tissue expander-implant, latissimus dorsi (LD) pedicled flap, and deep inferior epigastric artery perforator (DIEP) flap, from 2008 to 2013 were examined. The cumulative incidence of shoulder morbidity was compared among the reconstruction modalities, and risk factor analysis was performed using multivariable analysis. RESULTS: A total of 430 reconstructions (223 expander-implant, 44 LD flap, and 163 DIEP flap) in 420 patients were analyzed in this study. Shoulder morbidity developed in 95 patients (22.1%) and was most common in the LD group (43.2%) followed by the expander-implant (23.8%) and the DIEP (14.1%) groups over a mean follow-up of 52 (range: 24-120) months. The multivariable analysis showed that the expander-implant (odds ratio (OR) 2.15, p = 0.010) and the LD flap (OR 6.27, p < 0001) were significant risk factors for shoulder morbidity, compared to the DIEP flap. Old age (p = 0.041), presence of tumor-positive lymph nodes (p = 0.014), and receiving neoadjuvant chemotherapy (p = 0.002) were independent risk factors for the development of shoulder morbidity. Early rehabilitation within 2 postoperative-months reduced the risk of sustained shoulder morbidity. CONCLUSION: The choice of reconstruction modality might affect the development of postmastectomy shoulder morbidity. Understanding the risk factors for shoulder morbidity would help to improve the informed consent process and assist surgeons in the early diagnosis and initiation of rehabilitation therapy to prevent chronic shoulder dysfunction after breast reconstruction.
BACKGROUND: The aim of this study was to evaluate the impact of breast reconstruction modality on the incidence of shoulder morbidity. METHODS:Breast cancerpatients who underwent immediate reconstructions using three modalities, namely, tissue expander-implant, latissimus dorsi (LD) pedicled flap, and deep inferior epigastric artery perforator (DIEP) flap, from 2008 to 2013 were examined. The cumulative incidence of shoulder morbidity was compared among the reconstruction modalities, and risk factor analysis was performed using multivariable analysis. RESULTS: A total of 430 reconstructions (223 expander-implant, 44 LD flap, and 163 DIEP flap) in 420 patients were analyzed in this study. Shoulder morbidity developed in 95 patients (22.1%) and was most common in the LD group (43.2%) followed by the expander-implant (23.8%) and the DIEP (14.1%) groups over a mean follow-up of 52 (range: 24-120) months. The multivariable analysis showed that the expander-implant (odds ratio (OR) 2.15, p = 0.010) and the LD flap (OR 6.27, p < 0001) were significant risk factors for shoulder morbidity, compared to the DIEP flap. Old age (p = 0.041), presence of tumor-positive lymph nodes (p = 0.014), and receiving neoadjuvant chemotherapy (p = 0.002) were independent risk factors for the development of shoulder morbidity. Early rehabilitation within 2 postoperative-months reduced the risk of sustained shoulder morbidity. CONCLUSION: The choice of reconstruction modality might affect the development of postmastectomy shoulder morbidity. Understanding the risk factors for shoulder morbidity would help to improve the informed consent process and assist surgeons in the early diagnosis and initiation of rehabilitation therapy to prevent chronic shoulder dysfunction after breast reconstruction.
Authors: Margaret J Higgins; Nisha Kale; Christopher Homsy; Kelsey L Alabaster; Peter Ferrin; Cadence Miskimin; Abigail E Chaffin; Mary K Mulcahey Journal: JPRAS Open Date: 2021-09-20
Authors: Justin M Broyles; Ethan M Balk; Gaelen P Adam; Wangnan Cao; Monika Reddy Bhuma; Shivani Mehta; Laura S Dominici; Andrea L Pusic; Ian J Saldanha Journal: Plast Reconstr Surg Glob Open Date: 2022-03-11