The musculoskeletal consequences of breast reconstruction using the latissimus dorsi muscle in women following mastectomy for breast cancer

Abstract

Background
There is evidence to suggest some degree of shoulder restriction and loss of strength in patients following Latissimus Dorsi (LD) breast reconstruction. However, due to there being no standardised assessment or follow-up period within the literature there are conflicting findings. Therefore, the overall aim of this research was to investigate the functional impact of LD breast reconstruction in women following mastectomy for breast cancer.

Methods
A focus group study explored the musculoskeletal (MSk) consequences of breast reconstruction using the LD muscle as perceived by the women (n=15) and their healthcare professionals (n=11). A questionnaire survey was then administered to all women in Northern Ireland who had undergone LD breast reconstruction (n=159). Finally, dyad interviews were 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
Findings from the studies indicated low to moderate dysfunction among the group (n=159), however, node removal significantly impacted certain aspects of quality of life (p<0.05) and disability (p=0.04). 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 healthcare professionals demonstrated a varying awareness of the MSk impact of surgery, with inconsistencies in the support provided apparent across studies. The results from the dyad interviews supported that presented in the previous studies, highlighting the lack of preparedness and unrealistic expectations regarding functional recovery.

Conclusions and Implications
There is evidence that LD breast reconstruction has an impact on shoulder function and certain ADL. This impact can extend beyond that of the woman, impacting roles and behaviours, dependent on individual circumstances and preparedness. This impact has greater bearing in the immediate postoperative period with the severity of the impact varying among patients. Women demonstrate resilience in how they cope with the after effects of surgery, promoting a positive message for this patient group.

Date of Award	Mar 2017
Original language	English
Sponsors	Cancer Focus & Department of Employment and Learning
Supervisor	Iseult Wilson (Supervisor), Joseph Mc Veigh (Supervisor) & Eilis Mc Caughan (Supervisor)