The Musculoskeletal Consequences of Breast Reconstruction using the Latissimus Dorsi Muscle:A Focus Group Study

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

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Background: 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 reconstruction is shoulder dysfunction. The aim of the study, therefore, was to explore the musculoskeletal consequences of this surgery and their impact on function and quality of life as perceived by patients and the healthcare professionals who manage this client group.Materials and Methods: An integrated methodology was used in this study. Five focus groups were conducted; three with women who had undergone reconstructive surgery (n = 15) and two with the healthcare professionals (n = 11). The women also completed a demographics questionnaire, and their shoulder movement was assessed. All focus groups were audio and video recorded. Inductive content analysis was used to analyse transcripts and to develop core themes and sub-themes.Results: The over-arching theme to emerge from the women's focus groups was ‘Resilience’, sub-themes were ‘preparation and awareness’, ‘coping’ and ‘self-management’. Women reported a change in their musculoskeletal ability post-surgery but gradually returned to ‘new normal’ function, stating that they could now carry out their daily activities albeit for shorter periods of time, with assistance, or by adapting how they performed the task. The women recognised their lack of awareness regarding the potential long-term musculoskeletal implications of surgery, acknowledging pre and post-operative care to be mainly concerning wound healing and aesthetic outcome. This was reflected in the healthcare professionals group, whereby the breast care nurses demonstrated a varying awareness of the musculoskeletal impact of surgery, anticipating full recovery between three to twelve months. It was evident from the groups that the relative importance of overcoming the cancer and recovering from the adjuvant treatments was of higher priority than the potential of reduced function of the shoulder, following surgery.Conclusions: LD breast reconstruction has an impact on function and activities of daily living to varying extents, with women facing on-going challenges at least one year post-operative. As a result of the musculoskeletal implications of surgery women are adjusting to a ‘new normal’, demonstrating resilience in their approach to coping with this adaptive way of living. There is a lack of awareness regarding the long-term musculoskeletal consequences of surgery, with short-term follow up mainly regarding wound healing and aesthetic outcome, this has clinical implications for physiotherapists and breast care nurses in this area.
LanguageEnglish
Title of host publicationUnknown Host Publication
Number of pages1
Publication statusPublished - 9 Mar 2016
EventEuropean Breast Cancer Conference - Amsterdam, The Netherlands
Duration: 9 Mar 2016 → …

Conference

ConferenceEuropean Breast Cancer Conference
Period9/03/16 → …

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Superficial Back Muscles
Mammaplasty
Focus Groups
Muscles
Delivery of Health Care
Esthetics
Wound Healing
Reconstructive Surgical Procedures
Breast
Nurses
Aptitude
Physical Therapists
Mastectomy
Activities of Daily Living
Self Care
Quality of Life
Demography
Breast Neoplasms
Neoplasms

Keywords

  • Survivorship
  • Quality of life
  • Function

Cite this

@inproceedings{1662f47282f14127bde98a444efa9189,
title = "The Musculoskeletal Consequences of Breast Reconstruction using the Latissimus Dorsi Muscle:A Focus Group Study",
abstract = "Background: 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 reconstruction is shoulder dysfunction. The aim of the study, therefore, was to explore the musculoskeletal consequences of this surgery and their impact on function and quality of life as perceived by patients and the healthcare professionals who manage this client group.Materials and Methods: An integrated methodology was used in this study. Five focus groups were conducted; three with women who had undergone reconstructive surgery (n = 15) and two with the healthcare professionals (n = 11). The women also completed a demographics questionnaire, and their shoulder movement was assessed. All focus groups were audio and video recorded. Inductive content analysis was used to analyse transcripts and to develop core themes and sub-themes.Results: The over-arching theme to emerge from the women's focus groups was ‘Resilience’, sub-themes were ‘preparation and awareness’, ‘coping’ and ‘self-management’. Women reported a change in their musculoskeletal ability post-surgery but gradually returned to ‘new normal’ function, stating that they could now carry out their daily activities albeit for shorter periods of time, with assistance, or by adapting how they performed the task. The women recognised their lack of awareness regarding the potential long-term musculoskeletal implications of surgery, acknowledging pre and post-operative care to be mainly concerning wound healing and aesthetic outcome. This was reflected in the healthcare professionals group, whereby the breast care nurses demonstrated a varying awareness of the musculoskeletal impact of surgery, anticipating full recovery between three to twelve months. It was evident from the groups that the relative importance of overcoming the cancer and recovering from the adjuvant treatments was of higher priority than the potential of reduced function of the shoulder, following surgery.Conclusions: LD breast reconstruction has an impact on function and activities of daily living to varying extents, with women facing on-going challenges at least one year post-operative. As a result of the musculoskeletal implications of surgery women are adjusting to a ‘new normal’, demonstrating resilience in their approach to coping with this adaptive way of living. There is a lack of awareness regarding the long-term musculoskeletal consequences of surgery, with short-term follow up mainly regarding wound healing and aesthetic outcome, this has clinical implications for physiotherapists and breast care nurses in this area.",
keywords = "Survivorship, Quality of life, Function",
author = "Nicole Blackburn and McVeigh, {Joseph G} and Eilis McCaughan and Wilson, {Iseult M.}",
note = "Reference text: [1] Senkus, E., Kyriakides, S., Penault-Llorca, F., Poortmans, P., Thompson, A., Zackrisson, S. & Cardoso, F. (2013) Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 24 (6). [2] Ditsch, N., Bauerfeind, I., Vodermaier, A., Tripp, C., Lohrs, B., Toth, B., Himsl, I., Graeser, M., Harbeck, N. & Lenhard, M. (2013) A retrospective investigation of women’s experience with breast reconstruction after mastectomy. Gynecologic Oncology, 287: 555-561. [3] Reefy, S., Patani, N., Anderson, A., Burgoyne, G., Osman, H. & Mokbel, K. (2010) Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study. BMC Cancer, 10: 171 [4] Glassey et al 2008 Glassey, N., Perks, G.B. & 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. [5] Giordani et al 2010 Giordano, S., Kaariainen, M., Alavaikko, J., Kaistila, T. & Kuokkanen, H. (2011) LD free flap harvesting may affect the shoulder joint in long run. Scandinavian Journal of Surgery, 100(3): 202-207. [6] Forthomme, B., Croisier, J,L., Heymans, O., Jacquemin, D., Klinkenberg, S., Hoffmann, S., Grandjean, F,X. & Creilaard, J,M. (2010) Shoulder function after latissimus dorsi transfer in breast reconstruction. Clinical Physiology Functional Imaging, 30: 406-412. [7] Smith, S.L. 2014, {"}Functional morbidity following latissimus dorsi flap breast reconstruction.{"}, Journal of the advanced practitioner in oncology, vol. 5, no. 3, pp. 181-7.",
year = "2016",
month = "3",
day = "9",
language = "English",
booktitle = "Unknown Host Publication",

}

Blackburn, N, McVeigh, JG, McCaughan, E & Wilson, IM 2016, The Musculoskeletal Consequences of Breast Reconstruction using the Latissimus Dorsi Muscle:A Focus Group Study. in Unknown Host Publication. European Breast Cancer Conference, 9/03/16.

The Musculoskeletal Consequences of Breast Reconstruction using the Latissimus Dorsi Muscle:A Focus Group Study. / Blackburn, Nicole; McVeigh, Joseph G; McCaughan, Eilis; Wilson, Iseult M.

Unknown Host Publication. 2016.

Research output: Chapter in Book/Report/Conference proceedingConference contribution

TY - GEN

T1 - The Musculoskeletal Consequences of Breast Reconstruction using the Latissimus Dorsi Muscle:A Focus Group Study

AU - Blackburn, Nicole

AU - McVeigh, Joseph G

AU - McCaughan, Eilis

AU - Wilson, Iseult M.

N1 - Reference text: [1] Senkus, E., Kyriakides, S., Penault-Llorca, F., Poortmans, P., Thompson, A., Zackrisson, S. & Cardoso, F. (2013) Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 24 (6). [2] Ditsch, N., Bauerfeind, I., Vodermaier, A., Tripp, C., Lohrs, B., Toth, B., Himsl, I., Graeser, M., Harbeck, N. & Lenhard, M. (2013) A retrospective investigation of women’s experience with breast reconstruction after mastectomy. Gynecologic Oncology, 287: 555-561. [3] Reefy, S., Patani, N., Anderson, A., Burgoyne, G., Osman, H. & Mokbel, K. (2010) Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study. BMC Cancer, 10: 171 [4] Glassey et al 2008 Glassey, N., Perks, G.B. & 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. [5] Giordani et al 2010 Giordano, S., Kaariainen, M., Alavaikko, J., Kaistila, T. & Kuokkanen, H. (2011) LD free flap harvesting may affect the shoulder joint in long run. Scandinavian Journal of Surgery, 100(3): 202-207. [6] Forthomme, B., Croisier, J,L., Heymans, O., Jacquemin, D., Klinkenberg, S., Hoffmann, S., Grandjean, F,X. & Creilaard, J,M. (2010) Shoulder function after latissimus dorsi transfer in breast reconstruction. Clinical Physiology Functional Imaging, 30: 406-412. [7] Smith, S.L. 2014, "Functional morbidity following latissimus dorsi flap breast reconstruction.", Journal of the advanced practitioner in oncology, vol. 5, no. 3, pp. 181-7.

PY - 2016/3/9

Y1 - 2016/3/9

N2 - Background: 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 reconstruction is shoulder dysfunction. The aim of the study, therefore, was to explore the musculoskeletal consequences of this surgery and their impact on function and quality of life as perceived by patients and the healthcare professionals who manage this client group.Materials and Methods: An integrated methodology was used in this study. Five focus groups were conducted; three with women who had undergone reconstructive surgery (n = 15) and two with the healthcare professionals (n = 11). The women also completed a demographics questionnaire, and their shoulder movement was assessed. All focus groups were audio and video recorded. Inductive content analysis was used to analyse transcripts and to develop core themes and sub-themes.Results: The over-arching theme to emerge from the women's focus groups was ‘Resilience’, sub-themes were ‘preparation and awareness’, ‘coping’ and ‘self-management’. Women reported a change in their musculoskeletal ability post-surgery but gradually returned to ‘new normal’ function, stating that they could now carry out their daily activities albeit for shorter periods of time, with assistance, or by adapting how they performed the task. The women recognised their lack of awareness regarding the potential long-term musculoskeletal implications of surgery, acknowledging pre and post-operative care to be mainly concerning wound healing and aesthetic outcome. This was reflected in the healthcare professionals group, whereby the breast care nurses demonstrated a varying awareness of the musculoskeletal impact of surgery, anticipating full recovery between three to twelve months. It was evident from the groups that the relative importance of overcoming the cancer and recovering from the adjuvant treatments was of higher priority than the potential of reduced function of the shoulder, following surgery.Conclusions: LD breast reconstruction has an impact on function and activities of daily living to varying extents, with women facing on-going challenges at least one year post-operative. As a result of the musculoskeletal implications of surgery women are adjusting to a ‘new normal’, demonstrating resilience in their approach to coping with this adaptive way of living. There is a lack of awareness regarding the long-term musculoskeletal consequences of surgery, with short-term follow up mainly regarding wound healing and aesthetic outcome, this has clinical implications for physiotherapists and breast care nurses in this area.

AB - Background: 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 reconstruction is shoulder dysfunction. The aim of the study, therefore, was to explore the musculoskeletal consequences of this surgery and their impact on function and quality of life as perceived by patients and the healthcare professionals who manage this client group.Materials and Methods: An integrated methodology was used in this study. Five focus groups were conducted; three with women who had undergone reconstructive surgery (n = 15) and two with the healthcare professionals (n = 11). The women also completed a demographics questionnaire, and their shoulder movement was assessed. All focus groups were audio and video recorded. Inductive content analysis was used to analyse transcripts and to develop core themes and sub-themes.Results: The over-arching theme to emerge from the women's focus groups was ‘Resilience’, sub-themes were ‘preparation and awareness’, ‘coping’ and ‘self-management’. Women reported a change in their musculoskeletal ability post-surgery but gradually returned to ‘new normal’ function, stating that they could now carry out their daily activities albeit for shorter periods of time, with assistance, or by adapting how they performed the task. The women recognised their lack of awareness regarding the potential long-term musculoskeletal implications of surgery, acknowledging pre and post-operative care to be mainly concerning wound healing and aesthetic outcome. This was reflected in the healthcare professionals group, whereby the breast care nurses demonstrated a varying awareness of the musculoskeletal impact of surgery, anticipating full recovery between three to twelve months. It was evident from the groups that the relative importance of overcoming the cancer and recovering from the adjuvant treatments was of higher priority than the potential of reduced function of the shoulder, following surgery.Conclusions: LD breast reconstruction has an impact on function and activities of daily living to varying extents, with women facing on-going challenges at least one year post-operative. As a result of the musculoskeletal implications of surgery women are adjusting to a ‘new normal’, demonstrating resilience in their approach to coping with this adaptive way of living. There is a lack of awareness regarding the long-term musculoskeletal consequences of surgery, with short-term follow up mainly regarding wound healing and aesthetic outcome, this has clinical implications for physiotherapists and breast care nurses in this area.

KW - Survivorship

KW - Quality of life

KW - Function

M3 - Conference contribution

BT - Unknown Host Publication

ER -