Latissimus dorsi flap breast reconstruction weakens shoulder strength

Breast reconstruction with latissimus dorsi (LD) flap appears to impair shoulder strength, a recent study has found. Activities of daily living (ADLs) remain unhindered after LD procedures.

The researchers conducted a prospective observational study of 20 women undergoing delayed breast reconstruction with an LD flap. Shoulder strength, the primary outcome, was measured using a dynamometer after the operation. Other outcomes included range of motion (ROM), self-reported pain, lymphoedema, sensory disturbances, and capacity for ADLs.

Seventeen participants successfully completed follow-up. At 12 months, there was a significant 17-percent drop in isometric shoulder adduction strength, accompanied by a 21-percent reduction in extension strength (p<0.001 for both). No such change was reported for isokinetic adduction and extension at different degrees

ROM was likewise unaffected by the LD procedure, with adduction/abduction dropping only slightly from 156° at baseline to 155° at 12 months (p=0.8). Extension ROM likewise did not significantly change (52° to 49°; p=0.3).

Similarly, patient-reported outcomes were mostly unaffected by the reconstruction, including pain, lymphoedema, and ADLs. There were nevertheless slight changes that failed to satisfy statistical muster. Sensory disturbances, for example, was reported by three patients at baseline and by eight at 12 months; the number of patients with lymphoedema, meanwhile, dropped from 10 to seven over the same time.

“The LD flap remains a reliable alternative for breast reconstruction and is an excellent choice for salvage reconstruction,” the researchers said, adding that further research is still needed to more comprehensively compare LD with other reconstruction techniques.