The musculoskeletal consequences of latissmus dorsi breast reconstruction in women following mastectomy for breast cancer

Nicole Blackburn, Joe mcveigh, Eilis McCaughan, Richard Kennedy, Stuart McIntosh, IM Wilson

Research output: Contribution to journalArticle

Abstract

Introduction: Current evidence suggests that patients who have latissimus dorsi (LD) breast reconstruction following mastectomy for breast cancer can experience long-term shoulder dysfunction. However, as there is no standardised assessment or follow-up period within the literature, findings are conflicting. This research aimed to investigate the impact on daily living of immediate and delayed LD breast reconstruction in women following mastectomy for breast cancer.Methods: Both qualitative and quantitative methods of enquiry were used. A focus group study explored the musculoskeletal consequences of surgery as perceived by the women (n=15) and their healthcare professionals (n=11). A questionnaire survey was administered (n=159), including a range of outcome measures to quantify both the physical and psychosocial impact of LD breast reconstruction. Dyad interviews were also conducted in order to determine the impact of surgery on function and activities of daily living (ADL) from the woman's perspective and that of her significant other (n=8). Results: The qualitative studies highlighted a lack of preparedness and unrealistic expectations regarding functional recovery among women and their significant others'. Post-surgery it was apparent that women weighed up reduced shoulder function against survival, demonstrating resilience in their approach to coping with this adaptive way of living. The survey identified low to moderate effect on the outcomes assessed (n=159), however, node removal significantly impacted certain aspects of quality of life (p<0.05) and disability (p=0.04). Conclusions: Breast reconstruction using the LD had an impact on shoulder function and some ADL, which impacted not only on the women but also family and significant others. Despite the functional implications associated with surgery, findings would suggest that shoulder dysfunction is not their main concern. This work identified that women and their significant other require further information to clarify expectation regarding recovery, highlighting the changing priorities of women throughout their journey from diagnosis into long-term recovery. 
LanguageEnglish
Article numberPONE-D-18-00316R3
Number of pages17
JournalPLoS ONE
Volume13
Issue number8
Early online date28 Aug 2018
DOIs
Publication statusE-pub ahead of print - 28 Aug 2018

Fingerprint

Mammaplasty
Mastectomy
breast neoplasms
Surgery
breasts
Breast Neoplasms
Superficial Back Muscles
shoulders
Recovery
surgery
Activities of Daily Living
focus groups
health care workers
qualitative analysis
Focus Groups
quality of life
quantitative analysis
interviews
questionnaires
Quality of Life

Keywords

  • Breast reconstruction
  • Musculoskeletal consequences
  • mastectomy
  • Latissimus Dorsi flap reconstruction

Cite this

@article{5b179220fac9434a9b4d4da90b0f2717,
title = "The musculoskeletal consequences of latissmus dorsi breast reconstruction in women following mastectomy for breast cancer",
abstract = "Introduction: Current evidence suggests that patients who have latissimus dorsi (LD) breast reconstruction following mastectomy for breast cancer can experience long-term shoulder dysfunction. However, as there is no standardised assessment or follow-up period within the literature, findings are conflicting. This research aimed to investigate the impact on daily living of immediate and delayed LD breast reconstruction in women following mastectomy for breast cancer.Methods: Both qualitative and quantitative methods of enquiry were used. A focus group study explored the musculoskeletal consequences of surgery as perceived by the women (n=15) and their healthcare professionals (n=11). A questionnaire survey was administered (n=159), including a range of outcome measures to quantify both the physical and psychosocial impact of LD breast reconstruction. Dyad interviews were also conducted in order to determine the impact of surgery on function and activities of daily living (ADL) from the woman's perspective and that of her significant other (n=8). Results: The qualitative studies highlighted a lack of preparedness and unrealistic expectations regarding functional recovery among women and their significant others'. Post-surgery it was apparent that women weighed up reduced shoulder function against survival, demonstrating resilience in their approach to coping with this adaptive way of living. The survey identified low to moderate effect on the outcomes assessed (n=159), however, node removal significantly impacted certain aspects of quality of life (p<0.05) and disability (p=0.04). Conclusions: Breast reconstruction using the LD had an impact on shoulder function and some ADL, which impacted not only on the women but also family and significant others. Despite the functional implications associated with surgery, findings would suggest that shoulder dysfunction is not their main concern. This work identified that women and their significant other require further information to clarify expectation regarding recovery, highlighting the changing priorities of women throughout their journey from diagnosis into long-term recovery. ",
keywords = "Breast reconstruction, Musculoskeletal consequences, mastectomy, Latissimus Dorsi flap reconstruction",
author = "Nicole Blackburn and Joe mcveigh and Eilis McCaughan and Richard Kennedy and Stuart McIntosh and IM Wilson",
year = "2018",
month = "8",
day = "28",
doi = "10.1371/journal.pone.0202859",
language = "English",
volume = "13",
journal = "PLoS ONE",
issn = "1932-6203",
number = "8",

}

The musculoskeletal consequences of latissmus dorsi breast reconstruction in women following mastectomy for breast cancer. / Blackburn, Nicole; mcveigh, Joe; McCaughan, Eilis; Kennedy, Richard; McIntosh, Stuart; Wilson, IM.

In: PLoS ONE, Vol. 13, No. 8, PONE-D-18-00316R3, 28.08.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The musculoskeletal consequences of latissmus dorsi breast reconstruction in women following mastectomy for breast cancer

AU - Blackburn, Nicole

AU - mcveigh, Joe

AU - McCaughan, Eilis

AU - Kennedy, Richard

AU - McIntosh, Stuart

AU - Wilson, IM

PY - 2018/8/28

Y1 - 2018/8/28

N2 - Introduction: Current evidence suggests that patients who have latissimus dorsi (LD) breast reconstruction following mastectomy for breast cancer can experience long-term shoulder dysfunction. However, as there is no standardised assessment or follow-up period within the literature, findings are conflicting. This research aimed to investigate the impact on daily living of immediate and delayed LD breast reconstruction in women following mastectomy for breast cancer.Methods: Both qualitative and quantitative methods of enquiry were used. A focus group study explored the musculoskeletal consequences of surgery as perceived by the women (n=15) and their healthcare professionals (n=11). A questionnaire survey was administered (n=159), including a range of outcome measures to quantify both the physical and psychosocial impact of LD breast reconstruction. Dyad interviews were also conducted in order to determine the impact of surgery on function and activities of daily living (ADL) from the woman's perspective and that of her significant other (n=8). Results: The qualitative studies highlighted a lack of preparedness and unrealistic expectations regarding functional recovery among women and their significant others'. Post-surgery it was apparent that women weighed up reduced shoulder function against survival, demonstrating resilience in their approach to coping with this adaptive way of living. The survey identified low to moderate effect on the outcomes assessed (n=159), however, node removal significantly impacted certain aspects of quality of life (p<0.05) and disability (p=0.04). Conclusions: Breast reconstruction using the LD had an impact on shoulder function and some ADL, which impacted not only on the women but also family and significant others. Despite the functional implications associated with surgery, findings would suggest that shoulder dysfunction is not their main concern. This work identified that women and their significant other require further information to clarify expectation regarding recovery, highlighting the changing priorities of women throughout their journey from diagnosis into long-term recovery. 

AB - Introduction: Current evidence suggests that patients who have latissimus dorsi (LD) breast reconstruction following mastectomy for breast cancer can experience long-term shoulder dysfunction. However, as there is no standardised assessment or follow-up period within the literature, findings are conflicting. This research aimed to investigate the impact on daily living of immediate and delayed LD breast reconstruction in women following mastectomy for breast cancer.Methods: Both qualitative and quantitative methods of enquiry were used. A focus group study explored the musculoskeletal consequences of surgery as perceived by the women (n=15) and their healthcare professionals (n=11). A questionnaire survey was administered (n=159), including a range of outcome measures to quantify both the physical and psychosocial impact of LD breast reconstruction. Dyad interviews were also conducted in order to determine the impact of surgery on function and activities of daily living (ADL) from the woman's perspective and that of her significant other (n=8). Results: The qualitative studies highlighted a lack of preparedness and unrealistic expectations regarding functional recovery among women and their significant others'. Post-surgery it was apparent that women weighed up reduced shoulder function against survival, demonstrating resilience in their approach to coping with this adaptive way of living. The survey identified low to moderate effect on the outcomes assessed (n=159), however, node removal significantly impacted certain aspects of quality of life (p<0.05) and disability (p=0.04). Conclusions: Breast reconstruction using the LD had an impact on shoulder function and some ADL, which impacted not only on the women but also family and significant others. Despite the functional implications associated with surgery, findings would suggest that shoulder dysfunction is not their main concern. This work identified that women and their significant other require further information to clarify expectation regarding recovery, highlighting the changing priorities of women throughout their journey from diagnosis into long-term recovery. 

KW - Breast reconstruction

KW - Musculoskeletal consequences

KW - mastectomy

KW - Latissimus Dorsi flap reconstruction

U2 - 10.1371/journal.pone.0202859

DO - 10.1371/journal.pone.0202859

M3 - Article

VL - 13

JO - PLoS ONE

T2 - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 8

M1 - PONE-D-18-00316R3

ER -