Immediate Breast Reconstruction With Transverse Latissimus Dorsi Flap Does Not Affect the Short-term Recovery of Shoulder Range of Motion After Mastectomy

Immediate breast reconstruction, depending on the surgical strategy, can result in anatomic modifications that may affect the shoulder apparatus. This study compares the recovery of shoulder range of motion (ROM), after mastectomy, in women with and without immediate breast reconstruction with latssimus dorsi flap (LDF). This was a prospective study with 87 women who underwent mastectomy (41 with LDF). Shoulder ROM was assessed with goniometry, with a universal full-circle manual goniometer, prior to surgery, and on a weekly basis during the first 4 weeks postoperatively. Reconstruction with LDF was not associated with a decrease in shoulder ROM (P = 0.84). By the end of the 4-week assessment program, women in both groups still had an average reduction of 30 degrees in their shoulder ROM compared with baseline. Factors significantly associated with a reduction in shoulder ROM during the recovery period were complete dissection of the axilla, current smoking behavior, and presence of painful axillary cords. It is likely that breast reconstruction with LDF has little or no effect on shoulder ROM in the immediate postoperative period. It is also possible that LDF effects (if any) are overridden by the major reduction (over 30% in the immediate postoperative period, subsiding partially during the first weeks postoperatively) in shoulder ROM caused by mastectomy.