TY - JOUR
T1 - Effect of breast reconstruction modality on the development of postmastectomy shoulder morbidity
AU - Woo, Kyong Je
AU - Lee, Kyeong Tae
AU - Mun, Goo Hyun
AU - Pyon, Jai Kyong
AU - Bang, Sa Ik
N1 - Publisher Copyright:
© 2018
PY - 2018/12
Y1 - 2018/12
N2 - 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.
AB - 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.
KW - Breast reconstruction
KW - Deep inferior epigastric artery perforator flap
KW - Expander-implant
KW - Latissimus dorsi flap
KW - Rehabilitation
KW - Shoulder morbidity
UR - http://www.scopus.com/inward/record.url?scp=85055110762&partnerID=8YFLogxK
U2 - 10.1016/j.bjps.2018.07.033
DO - 10.1016/j.bjps.2018.07.033
M3 - Article
C2 - 30360958
AN - SCOPUS:85055110762
SN - 1748-6815
VL - 71
SP - 1761
EP - 1767
JO - Journal of Plastic, Reconstructive and Aesthetic Surgery
JF - Journal of Plastic, Reconstructive and Aesthetic Surgery
IS - 12
ER -