Effect of breast reconstruction modality on the development of postmastectomy shoulder morbidity
- 주제(키워드) Breast reconstruction , Shoulder morbidity , Expander-implant , Latissimus dorsi flap , Deep inferior epigastric artery perforator flap , Rehabilitation
- 주제(기타) Surgery
- 설명문(일반) [Woo, Kyong-Je] Ewha Womans Univ, Coll Med, Dept Plast Surg, 1071 Anyangchen Ro, Seoul, South Korea; [Lee, Kyeong-Tae; Mun, Goo-Hyun; Pyon, Jai-Kyong; Bang, Sa Ik] Sungkyunkwan Univ, Samsung Med Ctr, Dept Plast Surg, Sch Med, Irwon Ro 81, Seoul, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 ELSEVIER SCI LTD
- 발행년도 2018
- URI http://www.dcollection.net/handler/ewha/000000156878
- 본문언어 영어
- Published As http://dx.doi.org/10.1016/j.bjps.2018.07.033
초록/요약
Background: The aim of this study was to evaluate the impact of breast reconstruction modality on the incidence of shoulder morbidity. Methods: Breast cancer patients who underwent immediate reconstructions using three modalities, namely, tissue expander-implant, latissimus dorsi (LD) pedicled flap, and deep inferior epigastric artery perforator (DIEP) flap, from 2008 to 2013 were examined. The cumulative incidence of shoulder morbidity was compared among the reconstruction modalities, and risk factor analysis was performed using multivariable analysis. Results: A total of 430 reconstructions (223 expander-implant, 44 LD flap, and 163 DIEP flap) in 420 patients were analyzed in this study. Shoulder morbidity developed in 95 patients (22.1%) and was most common in the LD group (43.2%) followed by the expander-implant (23.8%) and the DIEP (14.1%) groups over a mean follow-up of 52 (range: 24-120) months. The multivariable analysis showed that the expander-implant (odds ratio (OR) 2.15, p = 0.010) and the LD flap (OR 6.27, p < 0001) were significant risk factors for shoulder morbidity, compared to the DIEP flap. Old age (p = 0.041), presence of tumor-positive lymph nodes (p = 0.014), and receiving neoadjuvant chemotherapy (p = 0.002) were independent risk factors for the development of shoulder morbidity. Early rehabilitation within 2 postoperative-months reduced the risk of sustained shoulder morbidity.
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