What the research says about how latissimus dorsi flap reconstruction affects shoulder function and the benefits of breast cancer rehabilitation...
As an educator in breast cancer rehabilitation, it’s my job to scour the research. While reading articles on reconstruction after breast cancer, I was surprised to see plastic surgeons giving minimal consequence to shoulder function after resection of the latissimus dorsi muscle.
This left me in a quandary, “Really? Harvesting a portion of the broadest muscle of the back then threading it through the axilla to recreate the breast mound won’t have an impact on shoulder function or back pain? Impressive!”
But, this observation does not always correlate with my clinical findings. Post-operatively, sometimes I see changes in scapulohumeral rhythm, range of motion restrictions, and limitations in activity due to pain and fatigue.
Here is a quick summary of two systematic reviews published in 2014 addressing shoulder function after ‘lat flap’ reconstruction:
Patient impressions:
Strength:
Range of Motion:
Other reported complications that may impact function:
Is it feasible to say that the latissimus dorsi muscle bears little consequence to function after reconstruction? I’m going to trust what the researchers performing the systematic reviews say:
No doubt, it is time we start talking with our surgical oncologists and
plastic surgeons about how rehabilitation can help improve surgical
outcomes for their patients.
If you would like to learn more about breast cancer rehabilitation consider taking the online course ‘Breast Cancer Rehabilitation; Comprehensive Evaluation & Treatment.’ This course teaches rehab and medical practitioners how to assess and conservatively treat all side effects of breast cancer treatment (surgeries is just one of 4 modules)!
Thank you for reading and sharing!
Article written by Susannah Haarmann, PT, WCS, CLT
References:
1. Adams, Jr., W., Lipschitz, A., Ansari, M., Kenkel, J., & Rohrich, R. J. (2004). Functional donor site morbidity following LD muscle flap transfer. Annals of Plastic Surgery, 53(1), 6–11.
2. de Oliveira, R., Nascimento, S., Derchain, S. & Sarian, L. (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.
3. de Oliveira, R. R., Pinto e Silva, M. P., Costa Gurgel, M. S., Pastori-Filho, L., & 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.
4. Forthomme, B., Heymans, O., Jacquemin, D., Klinkenberg, S., Hoffmann, S., Grandjean, F. X.,...Croisier, J. L. (2010). Shoulder function after latissimus dorsi transfer in breast reconstruction. Clinical Physiology and Functional Imaging, 30, 406– 412.
5. Giordano, S., Kääriäinen, M., Alavaikko, J., Kaistila, T. & Kuokkanen, H. (2011). Latissimus dorsi free flap harvesting may affect the shoulder joint in long run. Scandinavian Journal of Surgery, 100, 202–207.
6. Hamdi, M., Decorte, T., Demuynck, M., Defrene, B., Fredricks, A., VanMaele, G.,...Monstrey, S. (2008). Shoulder function after harvesting a thoracodorsal artery perforator flap. Plastic and Reconstructive Surgery, 122(4), 1111–1117.
7. Koh, C. E., & Morrison, W. A. (2009). Functional impairment after latissimus dorsi flap. Australian Journal of Surgery, 79, 42–47. http://dx.doi.org/10.1111/j.1445-2197.2008.04797.x
8. Lee, K.T., Mun, G.H., (2014).A systematic review of functional donor-site morbidity after latissimus dorsi muscle transfer, Plast. Reconstr. Surg. 134: 303.
9. Smith, S., (2014). Functional morbidity following latissimus dorsi flap breast reconstruction. J Adv Pract Oncol, 5, 181–187.
10. Tarantino, I., Banic, A., & 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.