The Musculoskeletal Consequences of Breast Reconstruction using the Latissimus Dorsi Muscle for Women following Mastectomy for Breast Cancer: A Critical Review

Nicole Blackburn, Joseph D McVeigh, Eilis McCaughan, Iseult M. Wilson

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Breast reconstruction using the Latissimus Dorsi (LD) flap following mastectomy is an important management option in breast cancer. However, one common, but often ignored, complication following LD flap is shoulder dysfunction. The aim of this critical review was to comprehensively assess the musculoskeletal impact of LD breast reconstruction and evaluate the functional outcome following surgery. Five electronic databases were searched including; Medline, Embase, CINAHL Plus (Cumulative Index to Nursing and Allied Health), PubMed and Web of Science. Databases were searched from 2006 – 2016, and only full text, English language articles were included. Twenty-two observational studies and two surveys were reviewed with sample sizes ranging from six to 206 participants. The majority of studies had small sample sizes and were retrospective in nature. Nevertheless, there is evidence to suggest that there is some degree of weakness and reduced mobility at the shoulder following LD muscle transfer. The literature demonstrates that there is considerable morbidity in the immediate postoperative period with functional recovery varying between studies. The majority of work tends to be limited and often gives conflicting results; therefore, further investigation is required in order to determine underlying factors that contribute to a reduction in function and activities of daily living.
LanguageEnglish
Pages1-10
JournalEuropean Journal of Cancer Care
VolumeTBC
Early online date10 Feb 2017
DOIs
Publication statusE-pub ahead of print - 10 Feb 2017

Fingerprint

Superficial Back Muscles
Mammaplasty
Mastectomy
Breast Neoplasms
Muscles
Sample Size
Databases
Activities of Daily Living
Postoperative Period
PubMed
Observational Studies
Nursing
Language
Morbidity
Health

Keywords

  • Breast reconstruction
  • mastectomy
  • LD flap
  • Latissimus Dorsi flap reconstruction
  • breast cancer

Cite this

@article{4fec61a336a8403481577e651e257029,
title = "The Musculoskeletal Consequences of Breast Reconstruction using the Latissimus Dorsi Muscle for Women following Mastectomy for Breast Cancer: A Critical Review",
abstract = "Breast reconstruction using the Latissimus Dorsi (LD) flap following mastectomy is an important management option in breast cancer. However, one common, but often ignored, complication following LD flap is shoulder dysfunction. The aim of this critical review was to comprehensively assess the musculoskeletal impact of LD breast reconstruction and evaluate the functional outcome following surgery. Five electronic databases were searched including; Medline, Embase, CINAHL Plus (Cumulative Index to Nursing and Allied Health), PubMed and Web of Science. Databases were searched from 2006 – 2016, and only full text, English language articles were included. Twenty-two observational studies and two surveys were reviewed with sample sizes ranging from six to 206 participants. The majority of studies had small sample sizes and were retrospective in nature. Nevertheless, there is evidence to suggest that there is some degree of weakness and reduced mobility at the shoulder following LD muscle transfer. The literature demonstrates that there is considerable morbidity in the immediate postoperative period with functional recovery varying between studies. The majority of work tends to be limited and often gives conflicting results; therefore, further investigation is required in order to determine underlying factors that contribute to a reduction in function and activities of daily living.",
keywords = "Breast reconstruction, mastectomy, LD flap, Latissimus Dorsi flap reconstruction, breast cancer",
author = "Nicole Blackburn and McVeigh, {Joseph D} and Eilis McCaughan and Wilson, {Iseult M.}",
note = "Compliant in the UIR (see evidence in other files '36636 Evidence of Compliance in UIR'). This paper was accepted on 4 Jan 2017. Further details re doi etc. will follow Reference text: The Association of Breast Surgery (ABS) and The British Association of Plastic Reconstruction and Aesthetic Surgeons (BAPRAS) Oncoplastic Breast Reconstruction: Guidelines for Best Practice (2012) Available: http://www.associationofbreastsurgery.org.uk/media/23851/final_oncoplastic_guidelines_for_use.pdf Accessed: [July, 2016]. Bhatt, C,R., Prajapati, B., Patil, D,S., Patel, V,D., Singh, B,G,P. and Mehta, C,D. (2013) Variation in the insertion of the Latissimus Dorsi and its clinical importance. Journal of Orthopedics, 10: 25-28. Bonomi, S., Settembrini, F., Salval, A., Gregorelli, C., Musumarra, G. and Rapisarda, V. (2012) Current indications for and comparative analysis of three different types of Latissimus Dorsi flaps. Aesthetic Surgery Journal, 32 (3): 294-302. Brackley, P,T,H., Mishra, A., Sigaroudina, M. and Iqbal, A. (2010) Modified muscle sparing Latissimus Dorsi with implant for total breast reconstruction - Extending the boundaries. Journal of Plastic, Reconstructive and Aesthetic Surgery, 63 (9): 1495-1502. Button, J., Scott, J., Taghizadeh, R., Weiler-Mithoff, E. and Hart, A,M. (2010) Shoulder function following autologous LD breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques. Journal of Plastic, Reconstructive and Aesthetic Surgery, 63 (9): 1505-1512. Chan, D, N., Lui, L,Y. and So, W,K. (2010) Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. Journal of Advanced Nursing, 66 (9): 1902-1914. Cho, J., Yung, S-Y., Lee, J, E., Shim, E-J., Kim, N, H., Kim, Z., Sohn, G., Youn, H, J., Kim, K, S., Kim, h., Lee, J, W. and Lee, M, H. (2014) A review of breast cancer survivorship issues from survivors perspectives. Journal of Breast Cancer, 17 (3): 189-199. Chow, T,L., Tung-Fei Chan, T., Wing-Wai Chan, S. and Lam, S,H. (2008) Postmastectomy reconstruction with extended Latissimus Dorsi myocutaneous flap for Hong Kong Chinese. Surgical Practice, 12: 35-38. Ciesla, S. and Bak, M. (2012) The effect of breast reconstruction on maintaining a proper body posture in patients after mastectomy. Available: www.intechopen.com Accessed: [October, 2013]. Clough, K.B., Louis-Sylvestre, C., Fitoussi, A., Couturaud, B. and Nos, C. (2002) Donor site sequelae after autologous breast reconstruction with an extended Latissimus Dorsi flap. Plastic and Reconstructive Surgery, 109 (6): 1904-1911. CRUK. Cancer Research UK 2014, Cancer Stats Briefing. Available: http://www.cancerresearchuk.org/cancer-info/cancerstats/ Accessed: [January, 2016]. De Gournay, E., Bonnetain, F., Tixier, H., Loustalot, C., Dabakuyo, S. and Cuisenier, J. (2010) Evaluation of quality of life after breast reconstruction using an autologous LD myocutaneous flap. European Journal of Surgical Oncology, 36: 520-527. De Oliveira, R,R., do Nascimento, S,L., Derchain, S,F. and Sarian, L,O. (2013) Immediate breast reconstruction with a Latissimus Dorsi flap has no detrimental effects on shoulder motion or postsurgical complications up to 1 year after surgery. Plastic and Reconstructive Surgery, 131 (5): 673e-680e. De Oliveira, R,R., Pinto e Silva, M,P., Gurgel, M,S., Pastori-Filho, L. and Sarian, L,O. (2010) Immediate breast reconstruction with transverse Latissimus Dorsi flap does not affect the short-term recovery of shoulder range of motion after mastectomy. Annals of Plastic Surgery, 64 (4): 402-408. Ditsch, N., Bauerfeind, I., Vodermaier, A., Tripp, C., Lohrs, B., Toth, B., Himsl, I., Graeser, M., Harbeck, N. and Lenhard, M. (2013) A retrospective investigation of women's experience with breast reconstruction after mastectomy. Archives of Gynecology and Obstetrics, 287 (3): 555-561. Eyjolfsdottie, H., Haraldsdottir, B., Ragnarsdottir, M. & Asgeirsson, K,S. (2016) A prospective analysis on functional outcomes following extended latissimus dorsi flap breast reconstruction. Scandinavian Journal of Surgery: 1-6. Fodor, L., Bota, I,O., Filip, C,I., Grecea, D., Fodor, M., Dindelegan, G., Motocu, R. and Ciuce, C. (2011) New trends in breast reconstruction. Chirurgia (Bucar), 106 (4): 485-489. Forthomme, B., Croisier, J,L., Heymans, O., Jacquemin, D., Klinkenberg, S., Hoffmann, S., Grandjean, F,X. and Creilaard, J,M. (2010) Shoulder function after Latissimus Dorsi transfer in breast reconstruction. Clinical Physiology Functional Imaging, 30: 406-412. Fraser, S,M., Fayater, H. and Achuthan, R. (2013) Lumbar herniation following extended autologous Latissimus Dorsi breast reconstruction. BMC Surgery, 13 (16). Garusi, C., Manconi, A., Lanni, G., Lomeo, G., Loschi, P., Simmoncini, M,C., Santoro, L., Rietjens, M. & Petit, J,Y. (2016) Shoulder function after breast reconstruction with the latissimus dorsi flap: A prospective cohort study – Combining DASH score and objective evaluation. Breast, 27: 78-86. Giordano, S., Kaariainen, M., Alavaikko, J., Kaistila, T. and Kuokkanen, H. (2011) LD free flap harvesting may affect the shoulder joint in long run. Scandinavian Journal of Surgery, 100 (3): 202-207. Glassey, N., Perks, G,B. and McCulley, S,J. (2008) A prospective assessment of shoulder morbidity and recovery time scales following Latissimus Dorsi breast reconstruction. Plastic and Reconstructive Surgery, 122 (5): 1334-1340. Hamdi, M., Decorte, T., Demuynck, M., Defrene, B., Fredrickx, A., Van Maele, G., De Pypere, H., Van Landuyt, K., Blondeel, P., Vanderstraeten, G. and Monstrey, S. (2008) Shoulder Function after Harvesting a Thoracodorsal Artery Perforator Flap. Plastic and Reconstructive Surgery, 122 (4): 1111-1117. Hoving, J,L., Broekhuizen, M,L,A. and Frings-Dresen, M,H,W. (2009) Return to work of breast cancer survivors: a systematic review of intervention studies. BMC Cancer, 9: 117. Jeevan, R., Cromwell, D,A., Browne, J,P., Caddy, C,M., Pereira, J., Sheppard, C., Greenaway, K. and Van der Meulen, J, H, P. (2014) Findings of a national comparative audit of mastectomy and breast reconstruction survey in England. Journal of Plastic, Reconstructive and Aesthetic Surgery, 67: 1333-1344. Kilbreath, S. (2011) Early postoperative exercises improves shoulder range of motion in women with breast cancer compared with delayed exercise, but increases wound drainage volume and duration. Evidence based Nursing, 14 (2). Kim, Z., Kang, S,G., Lee, M,H., Roh, J,H., Park, J,H., Lee, J., Kim, S. and Lim, C,W. (2012) Skin-sparing mastectomy and immediate Latissimus Dorsi flap reconstruction: a retrospective analysis of the surgical and patient-reported outcomes. World Journal of Surgical Oncology, 10: 259. Kim, H., Wiraatmadja, E,S., Lim, S., Pyon, J., Bang, S., Oh, K,S., Lee, J,E., Nam, S,J. and Mun, G. (2013) Comparison of morbidity of donor site following pedicled muscle-sparing Latissimus Dorsi flap versus extended Latissimus Dorsi flap breast reconstruction. Journal of Plastic, Reconstructive and Aesthetic Surgery, 66 (5): 640-646. Koh, C,E. and Morrison, W,A. (2009) Functional impairment after Latissimus Dorsi flap. ANZ Journal of Surgery, 79 (1-2): 42-47. Lee, K,T. and Mun, G,H. (2014) A Systematic Review of Functional Donor-Site Morbidity after Latissimus Dorsi Muscle Transfer. Plastic and Reconstructive Surgery, 134 (2): 303-314. Liberati, A., Altman, D,G., Tetzlaff, J., Mulrow, C., Gotzche, P,C., Ioannidid, J,P., Clarke, M., Devereaux, P,J., Kleijnen, J. and Moher, D. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. British Medical Journal, 339: b2700. Loh, S,Y. and Musa, A,N. (2015) Methods to improve rehabilitation of patients following breast cancer surgery: a review of systematic reviews. Breast Cancer, 7: 81-98. Losken, A., Nicholas, C,S., Pinell, X,A. and Carlson, G,W. (2010) Outcomes evaluation following bilateral breast reconstruction using Latissimus Dorsi myocutaneous flaps. Annals of Plastic Surgery, 65 (1): 17-22. Lutringer, J., Flipo, B., Carles, M., Gal, J. and Chignon-Sicard, B. (2012) [Functional impairment and its impact on sporting activities after Latissimus Dorsi flap breast reconstruction], Annales de Chirurgie Plastique et Esthetique, 57 (6): 567-574. McNeely, M,L., Binkley, J,M., Pusic, A,L., Campbell, K,L., Gabram, S. and Soballe, P, W. (2012) A prospective model of care for breast cancer rehabilitation: Postoperative and postreconstructive issues. Cancer, 118 (S8): 2226-2236. NMBRA National Mastectomy and Breast Reconstruction Audit, Fourth Annual Report (2011) The NHS Information Centre, National Mastectomy and Breast Reconstruction Audit. Available: http://data.gov.uk/dataset/national-mastectomy-and-breast-reconstruction-audit Accessed: [October, 2013]. Paolini, G., Amoroso, M., Pugliese, P., Longo, B. and Santanelli, F. (2014) Functional sequelae following bilateral mastectomy and immediate reconstruction with Latissimus Dorsi flap: medium term follow up. Journal of Plastic Surgery and Hand Surgery, 48 (2): 99-103. Perdikis, G., Koonce, S., Collis, G. and Eck, D. (2011) Latissimus Dorsi myocutaneous flap for breast reconstruction: bad rap or good flap? ePlasty, 11: 411-416. Pinto, B,M., Clark, M,M., Maruyama, N,C. and Feder, S,I. (2003) Psychological and fitness changes associated with exercise participation among women with breast cancer. Psycho-oncology, 12: 118-126. Reefy, S., Patani, N., Anderson, A., Burgoyne, G., Osman, H. and Mokbel, K. (2010) Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study. BMC Cancer, 10: 171. Rifaat, M., Amin, A., Bassiouny, M., Nabawi, A. and Monib, S. (2008) The extended Latissimus Dorsi flap option in autologous breast reconstruction: A report of 14 cases and review of the literature. Indian Journal of Plastic Surgery, 41 (1): 24-33. Saint-Cyr, M., Nagarkar, P., Schaverien, M., Dauwe, P., Wong, C. and Rohrich, R,J. (2009) The Pedicled Descending Branch Muscle-Sparing Latissimus Dorsi Flap for Breast Reconstruction. Plastic and Reconstructive Surgery, 123 (1): 13-24. Sajid, M,S., Betal, D., Akhter, N., Rapisarda, I,F. and Bonomi, R. (2011) Prevention of postoperative seroma-related morbidity by quilting of Latissimus Dorsi flap donor site: a systematic review. Clinical Breast Cancer, 11 (6): 357-363. Senkus, E., Kyriakides, S., Penault-Llorca, F., Poortmans, P., Thompson, A., Zackrisson, S. and Cardoso, F. (2013) Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 24 (6). Smith, S,L. (2014) Functional Morbidity following Latissimus Dorsi flap breast reconstruction. Advanced Practitioner, 5 (3): 181-187. Sowa, Y., Morihara, T., Kushida, R., Sakaguchi, K., Taguchi, T. & Numajiri, T. (2016) Long-term prospective assessment of shoulder function after breast reconstruction involving a latissimus dorsi muscle flap transfer and postoperative radiotherapy. Breast Cancer, [Epud ahead of print]. Spear, S,L. and Hess, C,L. (2004) A review of the biomechanical and functional changes in shoulder following transfer of the Latissimus Dorsi muscles. Plastic Reconstructive Surgery, 115: 2070. Spector, D,J., Mayer, D,K., Knafi, K. and Pusic, A. (2011) Women’s recovery experiences after breast cancer reconstruction surgery. Journal of Psychosocial Oncology, 29 (6): 664-676. Spence, R,R., Heesch, K,C. and Brown, W,J. (2010) Exercise and cancer rehabilitation: A systematic review. Cancer Treatment Reviews, 36 (2): 185-194. Szychta, P., Butterworth, M., Dixon, M., Kulkami, D., Raine, C. and Stewart, K. (2013) Breast reconstruction with the denervated Latissimus Dorsi musculocutaneous flap. The Breast, 22: 667-672. Tarantino, I., Banic, A. and Fischer, T. (2006) Evaluation of Late Results in Breast Reconstruction by Latissimus Dorsi Flap and Prosthesis Implantation. Plastic and Reconstructive Surgery, 117 (5): 1387-1394. Teymouri, H,R., Stergioula, S., Eder, M., Kovacs, L., Biemer, E. and Papadopulos, N,A. (2006) Breast reconstruction with autologous tissue following mastectomy. Hippokratia, 10 (4): 153-162. Thiruchelvam, P,T,R., McNeill, F., Jallali, N., Harris, P. and Hogben, K. (2013) Post-mastectomy breast reconstruction. British Medical Journal, 347: f5903. Tomita, K., Yano, K., Nishibayashi, A., Fukai, M., Miyasaka, M. and Hosokawa, K. (2013) The role of Latissimus Dorsi myocutaneous flaps in secondary breast reconstruction after breast-conserving surgery. ePlasty, 13: 206-214. Van Huizum, M,A., Hoornweg, M,J., de Ruiter, N., Oudenhoven, E., Joris Hage, J. & Veeger, D,J. (2016) Effect of latissimus dorsi flap breast reconstruction on the strength profile of the upper extremity. Journal of Plastic Surgery and Hand Surgery, 50(4): 202-207. Winters, Z,E., Afzal, M., Balta, V., Freeman, J., Llewellyn-Bennett, R., Rayter, Z., Cook, J., Greenwood, R., King, M,T. & Prospective Trial Management Group (2016) Patient-reported outcomes and their predictors at 2- and 3-year follow-up after immediate latissimus dorsi breast reconstruction and adjuvant treatment. The British Journal of Surgery, 103(5): 524-536. Winters, Z,E., Haviland, J., Blata, V., Benson, J., Reece-Smith, A. and Betambeau, N. (2012) Integration of patient-reported outcome measures with key clinical outcomes after Latissimus Dorsi breast reconstruction and adjuvant treatment. British Journal of Surgery, 100: 240-251. Winters, Z.E., Haviland, J., Balta, V., Benson, J., Reece-Smith, A., Betambeau, N. and Prospective Trial Management, G. (2013) Integration of patient-reported outcome measures with key clinical outcomes after immediate Latissimus Dorsi breast reconstruction and adjuvant treatment. British Journal of Surgery, 100 (2): 240-251. Yang, J,D., Huh, J,S. Min, Y,S., Kim, H,J., Park, H,Y. and Jung, T. (2015) Physical and Functional Ability Recovery Patterns and Quality of life after Immediate Autologous Latissimus Dorsi Breast Reconstruction: a 1 year Prospective Observational Study. Plastic and Reconstructive Surgery, 136 (6): 1146-54.",
year = "2017",
month = "2",
day = "10",
doi = "10.1111/ecc.12664",
language = "English",
volume = "TBC",
pages = "1--10",
journal = "European Journal of Cancer Care",
issn = "0961-5423",

}

TY - JOUR

T1 - The Musculoskeletal Consequences of Breast Reconstruction using the Latissimus Dorsi Muscle for Women following Mastectomy for Breast Cancer: A Critical Review

AU - Blackburn, Nicole

AU - McVeigh, Joseph D

AU - McCaughan, Eilis

AU - Wilson, Iseult M.

N1 - Compliant in the UIR (see evidence in other files '36636 Evidence of Compliance in UIR'). This paper was accepted on 4 Jan 2017. Further details re doi etc. will follow Reference text: The Association of Breast Surgery (ABS) and The British Association of Plastic Reconstruction and Aesthetic Surgeons (BAPRAS) Oncoplastic Breast Reconstruction: Guidelines for Best Practice (2012) Available: http://www.associationofbreastsurgery.org.uk/media/23851/final_oncoplastic_guidelines_for_use.pdf Accessed: [July, 2016]. Bhatt, C,R., Prajapati, B., Patil, D,S., Patel, V,D., Singh, B,G,P. and Mehta, C,D. (2013) Variation in the insertion of the Latissimus Dorsi and its clinical importance. Journal of Orthopedics, 10: 25-28. Bonomi, S., Settembrini, F., Salval, A., Gregorelli, C., Musumarra, G. and Rapisarda, V. (2012) Current indications for and comparative analysis of three different types of Latissimus Dorsi flaps. Aesthetic Surgery Journal, 32 (3): 294-302. Brackley, P,T,H., Mishra, A., Sigaroudina, M. and Iqbal, A. (2010) Modified muscle sparing Latissimus Dorsi with implant for total breast reconstruction - Extending the boundaries. Journal of Plastic, Reconstructive and Aesthetic Surgery, 63 (9): 1495-1502. Button, J., Scott, J., Taghizadeh, R., Weiler-Mithoff, E. and Hart, A,M. (2010) Shoulder function following autologous LD breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques. Journal of Plastic, Reconstructive and Aesthetic Surgery, 63 (9): 1505-1512. Chan, D, N., Lui, L,Y. and So, W,K. (2010) Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. Journal of Advanced Nursing, 66 (9): 1902-1914. Cho, J., Yung, S-Y., Lee, J, E., Shim, E-J., Kim, N, H., Kim, Z., Sohn, G., Youn, H, J., Kim, K, S., Kim, h., Lee, J, W. and Lee, M, H. (2014) A review of breast cancer survivorship issues from survivors perspectives. Journal of Breast Cancer, 17 (3): 189-199. Chow, T,L., Tung-Fei Chan, T., Wing-Wai Chan, S. and Lam, S,H. (2008) Postmastectomy reconstruction with extended Latissimus Dorsi myocutaneous flap for Hong Kong Chinese. Surgical Practice, 12: 35-38. Ciesla, S. and Bak, M. (2012) The effect of breast reconstruction on maintaining a proper body posture in patients after mastectomy. Available: www.intechopen.com Accessed: [October, 2013]. Clough, K.B., Louis-Sylvestre, C., Fitoussi, A., Couturaud, B. and Nos, C. (2002) Donor site sequelae after autologous breast reconstruction with an extended Latissimus Dorsi flap. Plastic and Reconstructive Surgery, 109 (6): 1904-1911. CRUK. Cancer Research UK 2014, Cancer Stats Briefing. Available: http://www.cancerresearchuk.org/cancer-info/cancerstats/ Accessed: [January, 2016]. De Gournay, E., Bonnetain, F., Tixier, H., Loustalot, C., Dabakuyo, S. and Cuisenier, J. (2010) Evaluation of quality of life after breast reconstruction using an autologous LD myocutaneous flap. European Journal of Surgical Oncology, 36: 520-527. De Oliveira, R,R., do Nascimento, S,L., Derchain, S,F. and Sarian, L,O. (2013) Immediate breast reconstruction with a Latissimus Dorsi flap has no detrimental effects on shoulder motion or postsurgical complications up to 1 year after surgery. Plastic and Reconstructive Surgery, 131 (5): 673e-680e. De Oliveira, R,R., Pinto e Silva, M,P., Gurgel, M,S., Pastori-Filho, L. and Sarian, L,O. (2010) Immediate breast reconstruction with transverse Latissimus Dorsi flap does not affect the short-term recovery of shoulder range of motion after mastectomy. Annals of Plastic Surgery, 64 (4): 402-408. Ditsch, N., Bauerfeind, I., Vodermaier, A., Tripp, C., Lohrs, B., Toth, B., Himsl, I., Graeser, M., Harbeck, N. and Lenhard, M. (2013) A retrospective investigation of women's experience with breast reconstruction after mastectomy. Archives of Gynecology and Obstetrics, 287 (3): 555-561. Eyjolfsdottie, H., Haraldsdottir, B., Ragnarsdottir, M. & Asgeirsson, K,S. (2016) A prospective analysis on functional outcomes following extended latissimus dorsi flap breast reconstruction. Scandinavian Journal of Surgery: 1-6. Fodor, L., Bota, I,O., Filip, C,I., Grecea, D., Fodor, M., Dindelegan, G., Motocu, R. and Ciuce, C. (2011) New trends in breast reconstruction. Chirurgia (Bucar), 106 (4): 485-489. Forthomme, B., Croisier, J,L., Heymans, O., Jacquemin, D., Klinkenberg, S., Hoffmann, S., Grandjean, F,X. and Creilaard, J,M. (2010) Shoulder function after Latissimus Dorsi transfer in breast reconstruction. Clinical Physiology Functional Imaging, 30: 406-412. Fraser, S,M., Fayater, H. and Achuthan, R. (2013) Lumbar herniation following extended autologous Latissimus Dorsi breast reconstruction. BMC Surgery, 13 (16). Garusi, C., Manconi, A., Lanni, G., Lomeo, G., Loschi, P., Simmoncini, M,C., Santoro, L., Rietjens, M. & Petit, J,Y. (2016) Shoulder function after breast reconstruction with the latissimus dorsi flap: A prospective cohort study – Combining DASH score and objective evaluation. Breast, 27: 78-86. Giordano, S., Kaariainen, M., Alavaikko, J., Kaistila, T. and Kuokkanen, H. (2011) LD free flap harvesting may affect the shoulder joint in long run. Scandinavian Journal of Surgery, 100 (3): 202-207. Glassey, N., Perks, G,B. and McCulley, S,J. (2008) A prospective assessment of shoulder morbidity and recovery time scales following Latissimus Dorsi breast reconstruction. Plastic and Reconstructive Surgery, 122 (5): 1334-1340. Hamdi, M., Decorte, T., Demuynck, M., Defrene, B., Fredrickx, A., Van Maele, G., De Pypere, H., Van Landuyt, K., Blondeel, P., Vanderstraeten, G. and Monstrey, S. (2008) Shoulder Function after Harvesting a Thoracodorsal Artery Perforator Flap. Plastic and Reconstructive Surgery, 122 (4): 1111-1117. Hoving, J,L., Broekhuizen, M,L,A. and Frings-Dresen, M,H,W. (2009) Return to work of breast cancer survivors: a systematic review of intervention studies. BMC Cancer, 9: 117. Jeevan, R., Cromwell, D,A., Browne, J,P., Caddy, C,M., Pereira, J., Sheppard, C., Greenaway, K. and Van der Meulen, J, H, P. (2014) Findings of a national comparative audit of mastectomy and breast reconstruction survey in England. Journal of Plastic, Reconstructive and Aesthetic Surgery, 67: 1333-1344. Kilbreath, S. (2011) Early postoperative exercises improves shoulder range of motion in women with breast cancer compared with delayed exercise, but increases wound drainage volume and duration. Evidence based Nursing, 14 (2). Kim, Z., Kang, S,G., Lee, M,H., Roh, J,H., Park, J,H., Lee, J., Kim, S. and Lim, C,W. (2012) Skin-sparing mastectomy and immediate Latissimus Dorsi flap reconstruction: a retrospective analysis of the surgical and patient-reported outcomes. World Journal of Surgical Oncology, 10: 259. Kim, H., Wiraatmadja, E,S., Lim, S., Pyon, J., Bang, S., Oh, K,S., Lee, J,E., Nam, S,J. and Mun, G. (2013) Comparison of morbidity of donor site following pedicled muscle-sparing Latissimus Dorsi flap versus extended Latissimus Dorsi flap breast reconstruction. Journal of Plastic, Reconstructive and Aesthetic Surgery, 66 (5): 640-646. Koh, C,E. and Morrison, W,A. (2009) Functional impairment after Latissimus Dorsi flap. ANZ Journal of Surgery, 79 (1-2): 42-47. Lee, K,T. and Mun, G,H. (2014) A Systematic Review of Functional Donor-Site Morbidity after Latissimus Dorsi Muscle Transfer. Plastic and Reconstructive Surgery, 134 (2): 303-314. Liberati, A., Altman, D,G., Tetzlaff, J., Mulrow, C., Gotzche, P,C., Ioannidid, J,P., Clarke, M., Devereaux, P,J., Kleijnen, J. and Moher, D. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. British Medical Journal, 339: b2700. Loh, S,Y. and Musa, A,N. (2015) Methods to improve rehabilitation of patients following breast cancer surgery: a review of systematic reviews. Breast Cancer, 7: 81-98. Losken, A., Nicholas, C,S., Pinell, X,A. and Carlson, G,W. (2010) Outcomes evaluation following bilateral breast reconstruction using Latissimus Dorsi myocutaneous flaps. Annals of Plastic Surgery, 65 (1): 17-22. Lutringer, J., Flipo, B., Carles, M., Gal, J. and Chignon-Sicard, B. (2012) [Functional impairment and its impact on sporting activities after Latissimus Dorsi flap breast reconstruction], Annales de Chirurgie Plastique et Esthetique, 57 (6): 567-574. McNeely, M,L., Binkley, J,M., Pusic, A,L., Campbell, K,L., Gabram, S. and Soballe, P, W. (2012) A prospective model of care for breast cancer rehabilitation: Postoperative and postreconstructive issues. Cancer, 118 (S8): 2226-2236. NMBRA National Mastectomy and Breast Reconstruction Audit, Fourth Annual Report (2011) The NHS Information Centre, National Mastectomy and Breast Reconstruction Audit. Available: http://data.gov.uk/dataset/national-mastectomy-and-breast-reconstruction-audit Accessed: [October, 2013]. Paolini, G., Amoroso, M., Pugliese, P., Longo, B. and Santanelli, F. (2014) Functional sequelae following bilateral mastectomy and immediate reconstruction with Latissimus Dorsi flap: medium term follow up. Journal of Plastic Surgery and Hand Surgery, 48 (2): 99-103. Perdikis, G., Koonce, S., Collis, G. and Eck, D. (2011) Latissimus Dorsi myocutaneous flap for breast reconstruction: bad rap or good flap? ePlasty, 11: 411-416. Pinto, B,M., Clark, M,M., Maruyama, N,C. and Feder, S,I. (2003) Psychological and fitness changes associated with exercise participation among women with breast cancer. Psycho-oncology, 12: 118-126. Reefy, S., Patani, N., Anderson, A., Burgoyne, G., Osman, H. and Mokbel, K. (2010) Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study. BMC Cancer, 10: 171. Rifaat, M., Amin, A., Bassiouny, M., Nabawi, A. and Monib, S. (2008) The extended Latissimus Dorsi flap option in autologous breast reconstruction: A report of 14 cases and review of the literature. Indian Journal of Plastic Surgery, 41 (1): 24-33. Saint-Cyr, M., Nagarkar, P., Schaverien, M., Dauwe, P., Wong, C. and Rohrich, R,J. (2009) The Pedicled Descending Branch Muscle-Sparing Latissimus Dorsi Flap for Breast Reconstruction. Plastic and Reconstructive Surgery, 123 (1): 13-24. Sajid, M,S., Betal, D., Akhter, N., Rapisarda, I,F. and Bonomi, R. (2011) Prevention of postoperative seroma-related morbidity by quilting of Latissimus Dorsi flap donor site: a systematic review. Clinical Breast Cancer, 11 (6): 357-363. Senkus, E., Kyriakides, S., Penault-Llorca, F., Poortmans, P., Thompson, A., Zackrisson, S. and Cardoso, F. (2013) Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 24 (6). Smith, S,L. (2014) Functional Morbidity following Latissimus Dorsi flap breast reconstruction. Advanced Practitioner, 5 (3): 181-187. Sowa, Y., Morihara, T., Kushida, R., Sakaguchi, K., Taguchi, T. & Numajiri, T. (2016) Long-term prospective assessment of shoulder function after breast reconstruction involving a latissimus dorsi muscle flap transfer and postoperative radiotherapy. Breast Cancer, [Epud ahead of print]. Spear, S,L. and Hess, C,L. (2004) A review of the biomechanical and functional changes in shoulder following transfer of the Latissimus Dorsi muscles. Plastic Reconstructive Surgery, 115: 2070. Spector, D,J., Mayer, D,K., Knafi, K. and Pusic, A. (2011) Women’s recovery experiences after breast cancer reconstruction surgery. Journal of Psychosocial Oncology, 29 (6): 664-676. Spence, R,R., Heesch, K,C. and Brown, W,J. (2010) Exercise and cancer rehabilitation: A systematic review. Cancer Treatment Reviews, 36 (2): 185-194. Szychta, P., Butterworth, M., Dixon, M., Kulkami, D., Raine, C. and Stewart, K. (2013) Breast reconstruction with the denervated Latissimus Dorsi musculocutaneous flap. The Breast, 22: 667-672. Tarantino, I., Banic, A. and Fischer, T. (2006) Evaluation of Late Results in Breast Reconstruction by Latissimus Dorsi Flap and Prosthesis Implantation. Plastic and Reconstructive Surgery, 117 (5): 1387-1394. Teymouri, H,R., Stergioula, S., Eder, M., Kovacs, L., Biemer, E. and Papadopulos, N,A. (2006) Breast reconstruction with autologous tissue following mastectomy. Hippokratia, 10 (4): 153-162. Thiruchelvam, P,T,R., McNeill, F., Jallali, N., Harris, P. and Hogben, K. (2013) Post-mastectomy breast reconstruction. British Medical Journal, 347: f5903. Tomita, K., Yano, K., Nishibayashi, A., Fukai, M., Miyasaka, M. and Hosokawa, K. (2013) The role of Latissimus Dorsi myocutaneous flaps in secondary breast reconstruction after breast-conserving surgery. ePlasty, 13: 206-214. Van Huizum, M,A., Hoornweg, M,J., de Ruiter, N., Oudenhoven, E., Joris Hage, J. & Veeger, D,J. (2016) Effect of latissimus dorsi flap breast reconstruction on the strength profile of the upper extremity. Journal of Plastic Surgery and Hand Surgery, 50(4): 202-207. Winters, Z,E., Afzal, M., Balta, V., Freeman, J., Llewellyn-Bennett, R., Rayter, Z., Cook, J., Greenwood, R., King, M,T. & Prospective Trial Management Group (2016) Patient-reported outcomes and their predictors at 2- and 3-year follow-up after immediate latissimus dorsi breast reconstruction and adjuvant treatment. The British Journal of Surgery, 103(5): 524-536. Winters, Z,E., Haviland, J., Blata, V., Benson, J., Reece-Smith, A. and Betambeau, N. (2012) Integration of patient-reported outcome measures with key clinical outcomes after Latissimus Dorsi breast reconstruction and adjuvant treatment. British Journal of Surgery, 100: 240-251. Winters, Z.E., Haviland, J., Balta, V., Benson, J., Reece-Smith, A., Betambeau, N. and Prospective Trial Management, G. (2013) Integration of patient-reported outcome measures with key clinical outcomes after immediate Latissimus Dorsi breast reconstruction and adjuvant treatment. British Journal of Surgery, 100 (2): 240-251. Yang, J,D., Huh, J,S. Min, Y,S., Kim, H,J., Park, H,Y. and Jung, T. (2015) Physical and Functional Ability Recovery Patterns and Quality of life after Immediate Autologous Latissimus Dorsi Breast Reconstruction: a 1 year Prospective Observational Study. Plastic and Reconstructive Surgery, 136 (6): 1146-54.

PY - 2017/2/10

Y1 - 2017/2/10

N2 - Breast reconstruction using the Latissimus Dorsi (LD) flap following mastectomy is an important management option in breast cancer. However, one common, but often ignored, complication following LD flap is shoulder dysfunction. The aim of this critical review was to comprehensively assess the musculoskeletal impact of LD breast reconstruction and evaluate the functional outcome following surgery. Five electronic databases were searched including; Medline, Embase, CINAHL Plus (Cumulative Index to Nursing and Allied Health), PubMed and Web of Science. Databases were searched from 2006 – 2016, and only full text, English language articles were included. Twenty-two observational studies and two surveys were reviewed with sample sizes ranging from six to 206 participants. The majority of studies had small sample sizes and were retrospective in nature. Nevertheless, there is evidence to suggest that there is some degree of weakness and reduced mobility at the shoulder following LD muscle transfer. The literature demonstrates that there is considerable morbidity in the immediate postoperative period with functional recovery varying between studies. The majority of work tends to be limited and often gives conflicting results; therefore, further investigation is required in order to determine underlying factors that contribute to a reduction in function and activities of daily living.

AB - Breast reconstruction using the Latissimus Dorsi (LD) flap following mastectomy is an important management option in breast cancer. However, one common, but often ignored, complication following LD flap is shoulder dysfunction. The aim of this critical review was to comprehensively assess the musculoskeletal impact of LD breast reconstruction and evaluate the functional outcome following surgery. Five electronic databases were searched including; Medline, Embase, CINAHL Plus (Cumulative Index to Nursing and Allied Health), PubMed and Web of Science. Databases were searched from 2006 – 2016, and only full text, English language articles were included. Twenty-two observational studies and two surveys were reviewed with sample sizes ranging from six to 206 participants. The majority of studies had small sample sizes and were retrospective in nature. Nevertheless, there is evidence to suggest that there is some degree of weakness and reduced mobility at the shoulder following LD muscle transfer. The literature demonstrates that there is considerable morbidity in the immediate postoperative period with functional recovery varying between studies. The majority of work tends to be limited and often gives conflicting results; therefore, further investigation is required in order to determine underlying factors that contribute to a reduction in function and activities of daily living.

KW - Breast reconstruction

KW - mastectomy

KW - LD flap

KW - Latissimus Dorsi flap reconstruction

KW - breast cancer

U2 - 10.1111/ecc.12664

DO - 10.1111/ecc.12664

M3 - Article

VL - TBC

SP - 1

EP - 10

JO - European Journal of Cancer Care

T2 - European Journal of Cancer Care

JF - European Journal of Cancer Care

SN - 0961-5423

ER -