Riza Rute de Oliveira

Immediate breast reconstruction with a Latissimus dorsi flap has no detrimental effects on shoulder motion or postsurgical complications up to 1 year after surgery.

Background: Mastectomy negatively affects scapulothoracic and glenohumeral kinematics. Breast reconstructive methods such as the latissimus dorsi flap can result in anatomical modifications that may in theory further affect the shoulder apparatus. The purpose of this study was to examine the effects of latissimus dorsi flap reconstruction on the recovery of shoulder motion and other postsurgical problems during the first year after mastectomy. Methods: This was a prospective cohort study of 104 consecutive mastectomies (47 with immediate latissimus dorsi flaps). Shoulder range of motion was assessed before and at 1, 3, 6, and 12 months after surgery. Pain, tissue adhesion, scar enlargement, and web syndrome were assessed during follow-up. Results: There was a 30 percent decrease of shoulder range of motion 1 month after surgery, with gradual recovery over time. However, mean abduction and flexion capacities did not reach baseline levels and were on average 5 to 10 percent lower than baseline, even after 1 year. Over time, the latissimus dorsi flap was not associated with restriction of flexion or abduction. Scar enlargement (at the first month, p = 0.009) and tissue adhesion (at month 12, p = 0.032) were significantly less common in the latissimus dorsi flap group. Conclusions: The authors’ study clearly suggests that the additional anatomical manipulation required for the latissimus dorsi flap procedure does not further affect shoulder kinematics and is associated with a lower incidence of tissue adhesion. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

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.

Complicações e condutas fisioterapêuticas após cirurgia por câncer de mama: estudo retrospectivo

After breast cancer surgery, women may develop some physical complications. Thus, the aims of this study were to investigate the outcome of these women, who participated in a rehabilitation program for one month, as well to identify along two years the most frequent complications and adopted physical therapy conducts. It was a descriptive and retrospective study with 707 medical records of women treated for breast cancer at the Womens Hospital Professor Doutor Jose Aristodemo Pinotti, Universidade Estadual de Campinas, between January 2006 and December 2007, admitted in the Division of Physical Therapy. Analysis was performed by means, standard deviation, absolute and relative frequencies. By the end of the program, 55% of women were discharged, 17% required additional treatment, and 26% did not join it. The most frequent complications were: pericicatricial adherence (26%), range of motion (ROM) restriction (24%), and scar dehiscence (17%). In the first year after surgery (n=460), the main complaints were: pain (28.5%), heaviness (21.5%), and restriction of shoulder range of motion (16.7%); in the second year (n=168), they were pain (48.2%), heaviness (42.8%), and lymphedema (23.2%). It was concluded that most women were discharged in the end of the program and, over the years, they presented reduction of shoulder range of motion frequency and lymphedema increase. Care of the arm, home exercises, and self-lymphatic drainage were the most adopted conducts.

Influencia del índice de masa corporal en la frecuencia de linfedema y otras complicaciones después de la cirugía para el cáncer de mama

Objective: this study assessed the influence of pre-operative body mass index (BMI) has upon lymphedema, scar tissue adhesion, pain, and heaviness in the upper limb at two years after surgery for breast cancer. Methods: retrospective analysis of 631 medical records of women who underwent surgery for breast cancer and were referred to the Physiotherapy Program at Prof. Dr. Jose Aristodemo Pinotti Womens Hospital of the Center for Integral Womens Health Care, CAISM/UNICAMP between January 2006 and December 2007. Results: mean age of women was 56.5 years (±13.7 years) and the most part (55%) were overweight or obese, surgical stages II and III were present in 63% of women studied. Radical mastectomy was the most frequent surgery (54.4%), followed by quadrantectomy (32.1%). In the first year after surgery, there was no significant association between BMI categories and incidence of scar tissue adhesion, pain, heaviness and lymphedema. In the second year, overweight and obese women had higher rates of heaviness in the upper limb and lymphedema. For lymphedema, there was a significant difference among BMI categories (p=0.0268). Obese women are 3.6 times more likely to develop lymphedema in the second year after surgery (odds ratio 3.61 95% CI 1.36 to 9.41). Conclusion: BMI ≥25kg/m2 prior to treatment for breast cancer can be considered a risk factor for developing lymphedema in the two years after surgery. There was no association between BMI and the development of other complications.Avaliou-se a influencia do indice de massa corporal (IMC) pre-operatoria na ocorrencia de linfedema, aderencia cicatricial, dor e peso no membro superior nos primeiros dois anos apos cirurgia para câncer de mama. O estudo e uma analise retrospectiva, secundaria de 631 prontuarios de mulheres submetidas a cirurgia para câncer de mama e encaminhadas ao Programa de Fisioterapia do Hospital Professor Dr. Jose Aristodemo Pinotti do Centro de Atencao Integral a Saude da Mulher, CAISM /UNICAMP, entre janeiro de 2006 e dezembro de 2007. Eram mulheres com idade media de 56,5 anos (±13,7 anos), a maioria (55%) com sobrepeso ou obesa. Os estadios clinicos II e III foram encontrados em 63% das mulheres. Mastectomia radical foi a cirurgia mais frequente (54,4%), seguida por quadrantectomia (32,1%). No primeiro ano apos a cirurgia nao houve associacao significativa entre as categorias do indice de massa corporal e incidencia de aderencia cicatricial, dor, peso e linfedema. No segundo ano, mulheres com sobrepeso e obesidade apresentaram maiores taxas de peso no membro superior e linfedema. Para linfedema houve diferenca significativa entre as categorias de indice de massa corporal (p=0,0268). Mulheres obesas tem 3,6 vezes mais chance de desenvolver linfedema no segundo ano apos a cirurgia (odds ratio 3,61 95% IC 1,36-9,41). Concluiu-se que IMC ≥25kg/m2 anterior ao tratamento para câncer de mama pode ser considerado fator de risco para desenvolvimento do linfedema dois anos apos a cirurgia. Nao houve associacao entre IMC e outras complicacoes.

Influência da massa corporal na frequência de linfedema e outras complicações depois de cirurgia para câncer de mama

Objective: this study assessed the influence of pre-operative body mass index (BMI) has upon lymphedema, scar tissue adhesion, pain, and heaviness in the upper limb at two years after surgery for breast cancer. Methods: retrospective analysis of 631 medical records of women who underwent surgery for breast cancer and were referred to the Physiotherapy Program at Prof. Dr. Jose Aristodemo Pinotti Womens Hospital of the Center for Integral Womens Health Care, CAISM/UNICAMP between January 2006 and December 2007. Results: mean age of women was 56.5 years (±13.7 years) and the most part (55%) were overweight or obese, surgical stages II and III were present in 63% of women studied. Radical mastectomy was the most frequent surgery (54.4%), followed by quadrantectomy (32.1%). In the first year after surgery, there was no significant association between BMI categories and incidence of scar tissue adhesion, pain, heaviness and lymphedema. In the second year, overweight and obese women had higher rates of heaviness in the upper limb and lymphedema. For lymphedema, there was a significant difference among BMI categories (p=0.0268). Obese women are 3.6 times more likely to develop lymphedema in the second year after surgery (odds ratio 3.61 95% CI 1.36 to 9.41). Conclusion: BMI ≥25kg/m2 prior to treatment for breast cancer can be considered a risk factor for developing lymphedema in the two years after surgery. There was no association between BMI and the development of other complications.Avaliou-se a influencia do indice de massa corporal (IMC) pre-operatoria na ocorrencia de linfedema, aderencia cicatricial, dor e peso no membro superior nos primeiros dois anos apos cirurgia para câncer de mama. O estudo e uma analise retrospectiva, secundaria de 631 prontuarios de mulheres submetidas a cirurgia para câncer de mama e encaminhadas ao Programa de Fisioterapia do Hospital Professor Dr. Jose Aristodemo Pinotti do Centro de Atencao Integral a Saude da Mulher, CAISM /UNICAMP, entre janeiro de 2006 e dezembro de 2007. Eram mulheres com idade media de 56,5 anos (±13,7 anos), a maioria (55%) com sobrepeso ou obesa. Os estadios clinicos II e III foram encontrados em 63% das mulheres. Mastectomia radical foi a cirurgia mais frequente (54,4%), seguida por quadrantectomia (32,1%). No primeiro ano apos a cirurgia nao houve associacao significativa entre as categorias do indice de massa corporal e incidencia de aderencia cicatricial, dor, peso e linfedema. No segundo ano, mulheres com sobrepeso e obesidade apresentaram maiores taxas de peso no membro superior e linfedema. Para linfedema houve diferenca significativa entre as categorias de indice de massa corporal (p=0,0268). Mulheres obesas tem 3,6 vezes mais chance de desenvolver linfedema no segundo ano apos a cirurgia (odds ratio 3,61 95% IC 1,36-9,41). Concluiu-se que IMC ≥25kg/m2 anterior ao tratamento para câncer de mama pode ser considerado fator de risco para desenvolvimento do linfedema dois anos apos a cirurgia. Nao houve associacao entre IMC e outras complicacoes.

Influence of body mass index on the frequency of lymphedema and other complications after surgery for breast cancer

Objective: this study assessed the influence of pre-operative body mass index (BMI) has upon lymphedema, scar tissue adhesion, pain, and heaviness in the upper limb at two years after surgery for breast cancer. Methods: retrospective analysis of 631 medical records of women who underwent surgery for breast cancer and were referred to the Physiotherapy Program at Prof. Dr. Jose Aristodemo Pinotti Womens Hospital of the Center for Integral Womens Health Care, CAISM/UNICAMP between January 2006 and December 2007. Results: mean age of women was 56.5 years (±13.7 years) and the most part (55%) were overweight or obese, surgical stages II and III were present in 63% of women studied. Radical mastectomy was the most frequent surgery (54.4%), followed by quadrantectomy (32.1%). In the first year after surgery, there was no significant association between BMI categories and incidence of scar tissue adhesion, pain, heaviness and lymphedema. In the second year, overweight and obese women had higher rates of heaviness in the upper limb and lymphedema. For lymphedema, there was a significant difference among BMI categories (p=0.0268). Obese women are 3.6 times more likely to develop lymphedema in the second year after surgery (odds ratio 3.61 95% CI 1.36 to 9.41). Conclusion: BMI ≥25kg/m2 prior to treatment for breast cancer can be considered a risk factor for developing lymphedema in the two years after surgery. There was no association between BMI and the development of other complications.Avaliou-se a influencia do indice de massa corporal (IMC) pre-operatoria na ocorrencia de linfedema, aderencia cicatricial, dor e peso no membro superior nos primeiros dois anos apos cirurgia para câncer de mama. O estudo e uma analise retrospectiva, secundaria de 631 prontuarios de mulheres submetidas a cirurgia para câncer de mama e encaminhadas ao Programa de Fisioterapia do Hospital Professor Dr. Jose Aristodemo Pinotti do Centro de Atencao Integral a Saude da Mulher, CAISM /UNICAMP, entre janeiro de 2006 e dezembro de 2007. Eram mulheres com idade media de 56,5 anos (±13,7 anos), a maioria (55%) com sobrepeso ou obesa. Os estadios clinicos II e III foram encontrados em 63% das mulheres. Mastectomia radical foi a cirurgia mais frequente (54,4%), seguida por quadrantectomia (32,1%). No primeiro ano apos a cirurgia nao houve associacao significativa entre as categorias do indice de massa corporal e incidencia de aderencia cicatricial, dor, peso e linfedema. No segundo ano, mulheres com sobrepeso e obesidade apresentaram maiores taxas de peso no membro superior e linfedema. Para linfedema houve diferenca significativa entre as categorias de indice de massa corporal (p=0,0268). Mulheres obesas tem 3,6 vezes mais chance de desenvolver linfedema no segundo ano apos a cirurgia (odds ratio 3,61 95% IC 1,36-9,41). Concluiu-se que IMC ≥25kg/m2 anterior ao tratamento para câncer de mama pode ser considerado fator de risco para desenvolvimento do linfedema dois anos apos a cirurgia. Nao houve associacao entre IMC e outras complicacoes.