American Association of Plastic Surgeons

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Postoperative Upper Extremity Function in Implant and Autologous Breast Reconstruction
Brandon Alba, BA, Benjamin Schultz, MD, Lei Alexander Qin, BA, Danielle Cohen, BA, Matthew DelMauro, MD, Soyouen Ahn, DPT, Adam Perry, MD, Armen Kasabian, MD, Neil Tanna, MD.
Division of Plastic & Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA.

PURPOSE:
After mastectomy and breast reconstruction, patients can experience a variety of upper extremity (UE) complications. Several studies have investigated the causes and incidence of these complications. However, there is currently a paucity of data comparing postoperative UE function according to reconstruction technique.
METHODS:
We reviewed patients enrolled in a physical therapy (PT) program after mastectomy and immediate breast reconstruction. Hospital records provided surgical data. PT initial evaluations provided data on postoperative UE function prior to PT. For analysis, we included data for each UE that was ipsilateral to a reconstructed breast. Patients who underwent implant-based versus autologous abdominal flap reconstruction were compared.
RESULTS:
A total of 72 patients were identified, including 39 autologous and 33 implant-based reconstructions. Frequencies of sentinel lymph node biopsies and axillary lymph node dissections were similar between groups. Autologous reconstruction patients had significantly higher arm pain at rest (p=0.0040) and with activity (p=0.0309) compared to implant patients. UE range of motion and manual muscle test results were similar between groups, with the exception of shoulder internal rotation being more restricted among implant patients (p=0.0146). Implant patients were also more likely to report "severe difficulty" or "inability" to perform activities of daily living (p=0.0224). Axillary cording and lymphedema girth measurements were similar between groups.
CONCLUSIONS:
Different techniques of breast reconstruction can result in different postoperative UE complications. This data shows how postoperative care and PT can be customized according to reconstruction type. Investigation is currently underway to determine the effect of PT on UE function.


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