The functional impact of breast reconstruction: An overview and update Journal Article

Authors: Nelson, J. A.; Lee, I. T.; Disa, J. J.
Article Title: The functional impact of breast reconstruction: An overview and update
Abstract: As rates of bilateral mastectomy and immediate reconstruction rise, the aesthetic and psychosocial benefits of breast reconstruction are increasingly well understood. However, an understanding of functional outcome and its optimization is still lacking. This endpoint is critical to maximizing postoperative quality of life. All reconstructive modalities have possible functional consequences. Studies demonstrate that implant-based reconstruction impacts subjective movement, but patients' day-to-day function may not be objectively hindered despite self-reported disability. For latissimus dorsi flap reconstruction, patients also report some dysfunction at the donor site, but this does not seem to result in significant, long-lasting limitation of daily activity. Athletic and other vigorous activities are most affected. For abdominal free flaps, patient perception of postoperative disability is generally not significant, despite the varying degrees of objective disadvantage that have been identified depending on the extent of rectus muscle sacrifice. With these functional repercussions in mind, a broader perspective on the attempt to ensure minimal functional decline after breast surgery should focus not only on surgical technique but also on postoperative rehabilitation. Early directed physical therapy may be an instrumental element in facilitating return to baseline function. With the patient's optimal quality of life as an overarching objective, a multifaceted approach to functional preservation may be the answer to this continued challenge. This review will examine these issues in depth in an effort to better understand postoperative functional outcomes with a focus on the younger, active breast reconstruction patient.
Keywords: patient-reported outcomes; skin-sparing mastectomy; quality-of-life; free tram flaps; donor-site morbidity; latissimus-dorsi flap; diminishing relative contraindications; abdominis musculocutaneous flap; pectoralis; major muscle; upper-body morbidity
Journal Title: Plastic and Reconstructive Surgery-Global Open
Volume: 6
Issue: 3
ISSN: 2169-7574
Publisher: Lippincott Williams & Wilkins  
Date Published: 2018-03-01
Start Page: e1640
Language: English
ACCESSION: WOS:000435737900004
DOI: 10.1097/gox.0000000000001640
PMCID: PMC5908499
PUBMED: 29707442
Notes: Article -- Source: Wos
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MSK Authors
  1. Joseph Disa
    206 Disa
  2. Jonas Allan Nelson
    15 Nelson