Impact of Combined Skin Sparing Mastectomy and Immediate Subpectoral Prosthetic Reconstruction on the Pectoralis Major Muscle Function

Hage, J. Joris; Heeden, Jorine F. van der; Lankhorst, Kristel M.; Romviel, Suzanne M.G.; Vluttters, Maaike E.; Woerdeman, Leonie A. E.; Visser, Bart; Veeger, H.E.J.

doi:10.1097/sap.0b013e318269e4ee

Cited by 31 publications

(29 citation statements)

References 15 publications

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“…However, both fiber regions of the pectoralis major are being underutilized in subpectoral implant patients when compared to healthy controls. These findings contrast previous data that showed increased activity in the clavicular fiber region post‐reconstruction when compared to pre‐reconstruction levels during maximal voluntary contractions . Future work should further investigate the long‐term neuromuscular adaption of shoulder musculature to subpectoral implant breast reconstruction.…”

Section: Discussioncontrasting

confidence: 97%

Functional integrity of the shoulder joint and pectoralis major following subpectoral implant breast reconstruction

Leonardis

Lyons

Giladi

et al. 2019

Journal Orthopaedic Research

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Subpectoral implants for breast reconstruction after mastectomy requires the surgical disinsertion of the sternocostal fiber region of the pectoralis major. This technique is associated with significant shoulder strength and range of motion deficits, but it is unknown how it affects the underlying integrity of the shoulder joint or pectoralis major. The aim of this study was to characterize the long-term effects of this reconstruction approach on shoulder joint stiffness and pectoralis major material properties. Robot-assisted measures of shoulder strength and stiffness and ultrasound shear wave elastography images from the pectoralis major were acquired from 14 women an average of 549 days (range: 313-795 days) post reconstruction and 14 healthy, age-matched controls. Subpectoral implant patients were significantly weaker in shoulder adduction (p < 0.001) and exhibited lower shoulder stiffness when producing submaximal adduction torques (p ¼ 0.004). The underlying material properties of the clavicular fiber region of the pectoralis major were altered in subpectoral implant patients, with significantly reduced shear wave velocities in the clavicular fiber region of the pectoralis major when generating adduction torques (p ¼ 0.023). The clinical significance of these findings are that subpectoral implant patients do not fully recover shoulder strength or stability in the long-term, despite significant recovery time, and substantial shoulder musculature left intact. The impact of these procedures extends to the remaining, intact volume of the pectoralis major. Optimization of shoulder function should be a key aspect of the post-reconstruction standard of care. ß

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Section: Discussioncontrasting

confidence: 97%

Functional integrity of the shoulder joint and pectoralis major following subpectoral implant breast reconstruction

Leonardis

Lyons

Giladi

et al. 2019

Journal Orthopaedic Research

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“…This can be explained because all the women had undergone or were undergoing physical therapy as a follow-up to cancer treatment; also, the women with lymphedema, which is known to be a comorbidity that interferes with functionality 28 , were excluded from the research. Previous studies have reported that after breast reconstruction women may experience decreased functionality 29,30 , however, one study reported no association between breast reconstruction and functionality 3 , which corroborates the results of this research. Such findings can be explained by the fact that the sample studied had an almost two-year long postoperative period, which could have minimized the treatment's effects.…”

Section: Discussionsupporting

confidence: 82%

Reconstrução mamária imediata versus não reconstrução pós-mastectomia: estudo sobre qualidade de vida, dor e funcionalidade

et al. 2017

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This study derives from the project Funcionalidade do membro superior de mulheres pós-mastectomia radical modificada com e sem reconstrução mamária (Functionality of the upper limb of women after modified radical mastectomy without breast reconstruction), developed at Universidade Federal de Santa Maria -Santa Maria (RS), Brazil. RESUMEN | Con la evolución de las técnicas oncoplásticas que permiten la reconstrucción de la mama en el mismo instante de la mastectomía, sin comprometer la seguridad oncológica, resulta pertinente investigar las implicaciones de la reconstrucción inmediata con expansor o prótesis de silicona sobre el dolor, la funcionalidad del miembro superior homolateral a la cirugía y la calidad de vida (CV) de las mujeres. El objetivo de este estudio ha sido comparar el dolor, la funcionalidad y la CV de mujeres sometidas a la mastectomía radical modificada con reconstrucción mamaria inmediata y sin reconstrucción. Se trata de un estudio transversal, comparativo y descriptivo con abordaje cuantitativo, que evaluó 22 voluntarias postmastectomía radical modificada, divididas igualmente en dos grupos, de acuerdo a la realización de la reconstrucción mamaria inmediata (RI) o sin reconstrucción (SR). Las voluntarias han contestado al cuestionario sociodemográfico, clínico y de tratamiento oncológico, la EVA, para medir el dolor, DASH para evaluar la funcionalidad del miembro superior y, para evaluar la CV, se utilizó el cuestionario EORTC QLQ-C30 con su módulo específico para el CA de mama.Hubo alta prevalencia de dolor, moderada limitación funcional y satisfactoria CV. Sin embargo, no se encontraron diferencias significativas intergrupos para el dolor (p=0.586), funcionalidad (p=0.399) y CV (p>0.05). Para la muestra evaluada, hacer o no la reconstrucción de la mama con expansor o implante de silicona en el acto de la mastectomía no implicó sobre el dolor, la funcionalidad y la CV.Palabras clave | Neoplasias de la Mama; Dolor; Extremo Superior; Calidad de Vida; Mastectomía Radical Modificada.

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“…Nevertheless, the better cosmetic is associated with the same loss of muscle function present with the use of expander and physiotherapy sessions are often required after both procedures . About 16% of reconstructed patients experience decreased pectoralis strength during postoperative isometric muscle tests …”

Section: Discussionmentioning

confidence: 99%

“…20 About 16% of reconstructed patients experience decreased pectoralis strength during postoperative isometric muscle tests. 21,22 With the aim of avoiding the pectoralis major impairment, a muscle-sparing breast reconstruction technique has been proposed by with the subcutaneous tissue. 11,12 Despite the prepectoral reconstructive technique was reported by some authors also with other materials, 14,15,23 we performed the study with the Braxon ADM because it is the only matrix approved for this specific indication and its preshaped feature has several advantages.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness of the prepectoral breast reconstruction with Braxon dermal matrix: First multicenter European report on 100 cases

et al. 2017

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We report the outcomes of the European prospective study on prepectoral breast reconstruction using preshaped acellular dermal matrix for complete breast implant coverage. Seventy-nine patients were enrolled between April 2014 and August 2015 all over Europe using a single protocol for patient selection and surgical procedure, according to the Association of Breast Surgery and British Association of Plastic Reconstructive and Aesthetic Surgeons joint guidelines for the use of acellular dermal matrix in breast surgery. The preshaped matrix completely wraps the breast implant, which is placed above the pectoralis major, without detaching the muscle. A total of 100 prepectoral breast reconstructions with complete implant coverage were performed. This series, with mean follow-up of 17.9 months, had two cases of implant loss (2.0%) including one necrosis of the nipple and one wound breakdown (1.0% respectively). No implant rotations were observed. Good cosmetic outcomes were obtained with natural movement of the breasts and softness to the touch; none of the patients reported experiencing pain or reduction in the movements of the pectoralis major muscle postoperatively. The use of preshaped acellular dermal matrix for a complete breast implant coverage in selected patients is safe and gives satisfactory results, both from the aesthetic view point and the low postoperative complication rates. Further studies reporting long-term outcomes are planned.

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Impact of Combined Skin Sparing Mastectomy and Immediate Subpectoral Prosthetic Reconstruction on the Pectoralis Major Muscle Function

Abstract: Daily life consequences of partial detachment of the pectoralis major muscle were acceptable in our patients.

Cited by 31 publications

References 15 publications

Functional integrity of the shoulder joint and pectoralis major following subpectoral implant breast reconstruction

Functional integrity of the shoulder joint and pectoralis major following subpectoral implant breast reconstruction

Reconstrução mamária imediata versus não reconstrução pós-mastectomia: estudo sobre qualidade de vida, dor e funcionalidade

Evaluation of the effectiveness of the prepectoral breast reconstruction with Braxon dermal matrix: First multicenter European report on 100 cases

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