Postoperative Upper Extremity Function in Implant and Autologous Breast Reconstruction

Brandon Alba; Benjamin Schultz; Lei Alexander Qin; Danielle Cohen; Matthew DelMauro; Soyouen Ahn; Armen K. Kasabian; Adam D. Perry; Neil Tanna

doi:10.1055/s-0039-1698439

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2020; 36(02): 151-156
DOI: 10.1055/s-0039-1698439

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Postoperative Upper Extremity Function in Implant and Autologous Breast Reconstruction

Authors

Brandon Alba

¹Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, New York

²Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
Benjamin Schultz

¹Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, New York

²Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
Lei Alexander Qin

¹Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, New York

²Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
Danielle Cohen

¹Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, New York

²Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
Matthew DelMauro

¹Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, New York

²Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
Soyouen Ahn

³Sports Therapy and Rehabilitation Services, Northwell Health, Huntington, New York
Armen K. Kasabian

¹Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, New York

²Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
Adam D. Perry

¹Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, New York

²Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
Neil Tanna

¹Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, New York

²Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York

Abstract

Background After mastectomy and breast reconstruction, many patients experience upper extremity complications, such as pain, restriction in motion, and lymphedema. Despite an aesthetically satisfactory outcome, these occurrences can diminish a patient's postoperative quality of life. Several studies have investigated the causes and incidence of these complications. However, there is currently a paucity of data comparing postoperative upper extremity function according to reconstruction technique.

Methods A review was performed of patients enrolled in a physical therapy (PT) program after mastectomy and immediate breast reconstruction. PT initial encounter evaluations were used to gather data on patients' postoperative upper extremity function. Hospital records were used to gather surgical and demographic data. For each patient, data were collected for each upper extremity that was ipsilateral to a reconstructed breast. Data were then compared between patients who underwent implant-based versus autologous deep inferior epigastric perforator flap reconstruction.

Results A total of 72 patients were identified, including 39 autologous and 33 implant-based reconstruction cases. Proportions of patients who underwent sentinel lymph node biopsies and axillary lymph node dissections were similar between the two groups. The autologous-based reconstruction patients had significantly higher arm pain at rest (p = 0.004) and with activity (p = 0.031) compared with implant patients. Shoulder range of motion and manual muscle test results were similar between groups, with the exception of elbow flexion, which was weaker in implant patients (p = 0.030). Implant patients were also more likely to report “severe difficulty” or “inability” to perform activities of daily living (p = 0.022). Edema/swelling, axillary cording, and lymphedema girth measurements were similar between the two groups.

Conclusion Different techniques of breast reconstruction can result in different postoperative upper extremity complications. These data show specific areas where postoperative care and PT can be customized according to reconstruction type. Investigation is currently underway to determine the effect of PT on upper extremity function in these patients.

Keywords

breast reconstruction - upper extremity - physical therapy

Full Text

References

References
1 Cancer Treatment & Survivorship Facts & Figures 2016–2017. Atlanta: American Cancer Society; 2016
2 Runowicz CD, Leach CR, Henry NL. , et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol 2016; 34 (06) 611-635
3 Sprod LK, Janelsins MC, Palesh OG. , et al. Health-related quality of life and biomarkers in breast cancer survivors participating in Tai Chi Chuan. J Cancer Surviv 2012; 6 (02) 146-154
4 De Groef A, Van Kampen M, Dieltjens E. , et al. Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review. Arch Phys Med Rehabil 2015; 96 (06) 1140-1153
5 Young AE. The surgical management of early breast cancer. Int J Clin Pract 2001; 55 (09) 603-608
6 Scaffidi M, Vulpiani MC, Vetrano M. , et al. Early rehabilitation reduces the onset of complications in the upper limb following breast cancer surgery. Eur J Phys Rehabil Med 2012; 48 (04) 601-611
7 Del Bianco P, Zavagno G, Burelli P. , et al; GIVOM. Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lymph node dissection for breast cancer patients: results of the Sentinella-GIVOM Italian randomised clinical trial. Eur J Surg Oncol 2008; 34 (05) 508-513
8 Andersen KG, Aasvang EK, Kroman N, Kehlet H. Intercostobrachial nerve handling and pain after axillary lymph node dissection for breast cancer. Acta Anaesthesiol Scand 2014; 58 (10) 1240-1248
9 Crosbie J, Kilbreath SL, Dylke E. , et al. Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement. Phys Ther 2010; 90 (05) 679-692
10 Park JH, Lee WH, Chung HS. Incidence and risk factors of breast cancer lymphoedema. J Clin Nurs 2008; 17 (11) 1450-1459
11 Morone G, Iosa M, Fusco A. , et al. Effects of a multidisciplinary educational rehabilitative intervention in breast cancer survivors: the role of body image on quality of life outcomes. ScientificWorldJournal 2014; 2014: 451935
12 Pearce NJ, Sanson-Fisher R, Campbell HS. Measuring quality of life in cancer survivors: a methodological review of existing scales. Psychooncology 2008; 17 (07) 629-640
13 Sagen A, Kaaresen R, Sandvik L, Thune I, Risberg MA. Upper limb physical function and adverse effects after breast cancer surgery: a prospective 2.5-year follow-up study and preoperative measures. Arch Phys Med Rehabil 2014; 95 (05) 875-881
14 Freitas-Silva R, Conde DM, de Freitas-Júnior R, Martinez EZ. Comparison of quality of life, satisfaction with surgery and shoulder-arm morbidity in breast cancer survivors submitted to breast-conserving therapy or mastectomy followed by immediate breast reconstruction. Clinics (São Paulo) 2010; 65 (08) 781-787
15 Dominick SA, Madlensky L, Natarajan L, Pierce JP. Risk factors associated with breast cancer-related lymphedema in the WHEL Study. J Cancer Surviv 2013; 7 (01) 115-123
16 Miller CL, Colwell AS, Horick N. , et al. Immediate implant reconstruction is associated with a reduced risk of lymphedema compared to mastectomy alone: a prospective cohort study. Ann Surg 2016; 263 (02) 399-405
17 Petrek JA, Heelan MC. Incidence of breast carcinoma-related lymphedema. Cancer 1998; 83 (12, Suppl American): 2776-2781
18 Ahmed RL, Schmitz KH, Prizment AE, Folsom AR. Risk factors for lymphedema in breast cancer survivors, the Iowa Women's Health Study. Breast Cancer Res Treat 2011; 130 (03) 981-991
19 McLaughlin SA, Wright MJ, Morris KT. , et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors. J Clin Oncol 2008; 26 (32) 5220-5226
20 Ridner SH, Dietrich MS, Stewart BR, Armer JM. Body mass index and breast cancer treatment-related lymphedema. Support Care Cancer 2011; 19 (06) 853-857
21 Norman SA, Localio AR, Kallan MJ. , et al. Risk factors for lymphedema after breast cancer treatment. Cancer Epidemiol Biomarkers Prev 2010; 19 (11) 2734-2746
22 Kwan ML, Darbinian J, Schmitz KH. , et al. Risk factors for lymphedema in a prospective breast cancer survivorship study: the pathways study. Arch Surg 2010; 145 (11) 1055-1063
23 Meeske KA, Sullivan-Halley J, Smith AW. , et al. Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women. Breast Cancer Res Treat 2009; 113 (02) 383-391
24 Jagsi R, Jiang J, Momoh AO. , et al. Complications after mastectomy and immediate breast reconstruction for breast cancer: a claims-based analysis. Ann Surg 2016; 263 (02) 219-227
25 Moses S. Orthopedics Book. Shoulder Range of Motion 2017 : Available at: http://www.fpnotebook.com/ortho/Exam/ShldrRngOfMtn.htm . Accessed June 1, 2018
26 Sbitany H, Sandeen SN, Amalfi AN, Davenport MS, Langstein HN. Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes. Plast Reconstr Surg 2009; 124 (06) 1735-1740
27 Hallberg H, Rafnsdottir S, Selvaggi G. , et al. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg 2018; 52 (03) 130-147
28 Ozturk CN, Ozturk C, Soucise A. , et al. Expander/implant removal after breast reconstruction: analysis of risk factors and timeline. Aesthetic Plast Surg 2018; 52 (03) 64-72
29 Beals SP, Golden KA, Basten M, Kelly KM. Strength performance of the pectoralis major muscle after subpectoral breast augmentation surgery. Aesthet Surg J 2003; 23 (02) 92-97
30 Sood A, Xue EY, Sangiovanni C, Therattil PJ, Lee ES. Breast massage, implant displacement, and prevention of capsular contracture after breast augmentation with implants: a review of the literature. Eplasty 2017; 17: e41
31 Bachour Y, Verweij SP, Gibbs S. , et al. The aetiopathogenesis of capsular contracture: a systematic review of the literature. J Plast Reconstr Aesthet Surg 2018; 71 (03) 307-317
32 Cheffe MR, Valentini JD, Collares MVM, Piccinini PS, da Silva JLB. Quantifying dynamic deformity after dual plane breast augmentation. Aesthetic Plast Surg 2018; 42 (03) 716-724
33 Lentz RB, Piper ML, Gomez-Sanchez C, Sbitany H. Correction of breast animation deformity following prosthetic breast reconstruction. Plast Reconstr Surg 2017; 140 (04) 643e-644e
34 Nahabedian MY, Cocilovo C. Two-stage prosthetic breast reconstruction: a comparison between prepectoral and partial subpectoral techniques. Plast Reconstr Surg 2017; 140 (6S Prepectoral Breast Reconstruction): 22S-30S
35 Storm-Dickerson T, Sigalove N. Prepectoral breast reconstruction: the breast surgeon's perspective. Plast Reconstr Surg 2017; 140 (6S Prepectoral Breast Reconstruction): 43S-48S
36 Luz CMD, Deitos J, Siqueira TC, Palú M, Heck APF. Management of axillary web syndrome after breast cancer: evidence-based practice. Rev Bras Ginecol Obstet 2017; 39 (11) 632-639
37 Lai L, Binkley J, Jones V. , et al. Implementing the prospective surveillance model (PSM) of rehabilitation for breast cancer patients with 1-year postoperative follow-up, a prospective, observational study. Ann Surg Oncol 2016; 23 (10) 3379-3384
38 Sayegh HE, Asdourian MS, Swaroop MN. , et al. Diagnostic methods, risk factors, prevention, and management of breast cancer-related lymphedema: past, present, and future directions. Curr Breast Cancer Rep 2017; 9 (02) 111-121
39 Pinto BM, Maruyama NC. Exercise in the rehabilitation of breast cancer survivors. Psychooncology 1999; 8 (03) 191-206
40 Plastic Surgery Statistics Report 2016. American Society of Plastic Surgeons. Available at: https://www.plasticsurgery.org/documents/News/Statistics/2016/plastic-surgery-statistics-full-report-2016.pdf . Accessed June 1, 2018
41 Cella D, Yount S, Rothrock N. , et al; PROMIS Cooperative Group. The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Med Care 2007; 45 (05) (Suppl. 01) S3-S11