Myung Yujin, Choi Bomi, Kwon Heeyeon, Heo Chan Yeong, Kim Eun-Kyu, Kang Eunyoung, Jeong Jae Hoon, Yang Eun Joo
Department of Plastic and Reconstructive Surgery Department of Surgery Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Medicine (Baltimore). 2018 Jun;97(24):e10979. doi: 10.1097/MD.0000000000010979.
Immediate breast reconstruction (IBR) after mastectomy has been proven to affect patient quality of life, psychological well-being, and functional capacities. In the present study, we aimed to investigate the effect of breast reconstruction on postoperative shoulder function and muscle performance by evaluating isokinetic muscle performance tests.A retrospective chart review to collect data on shoulder function analysis with isokinetic muscle performance testing was performed among patients who received mastectomy with IBR from July 2013 to March 2015. Patients were categorized into 4 groups: a control group that underwent mastectomy without reconstruction, a tissue expander/implant insertion group, a pedicled latissimus dorsi (LD) flap group, and a free transverse rectus abdominis muscle (TRAM) flap group.Analysis of the groups at 1 to 3, 4 to 6, 7 to 9, 10 to 12, and 13 to 15 months postoperatively showed significant shoulder function improvement in the tissue expander/implant and TRAM groups as measured by linear regression analysis. Compared with the control group, patients who received immediate reconstruction with tissue expander/implant insertion or a TRAM flap showed statistically significant improvement in shoulder function after mastectomy.IBR with a TRAM flap or tissue expander/implant insertion were more beneficial for shoulder rehabilitation and for regaining function compared to mastectomy alone and breast reconstruction with a LD flap.
乳房切除术后即刻乳房重建（IBR）已被证明会影响患者的生活质量、心理健康和功能能力。在本研究中，我们旨在通过评估等速肌肉性能测试来研究乳房重建对术后肩部功能和肌肉性能的影响。
对2013年7月至2015年3月接受IBR乳房切除术的患者进行回顾性图表审查，以收集等速肌肉性能测试的肩部功能分析数据。患者分为4组：未进行重建的乳房切除对照组、组织扩张器/植入物植入组、带蒂背阔肌（LD）皮瓣组和游离腹直肌（TRAM）皮瓣组。
术后1至3个月、4至6个月、7至9个月、10至12个月和13至15个月对各组进行分析，通过线性回归分析显示，组织扩张器/植入物组和TRAM组的肩部功能有显著改善。与对照组相比，接受组织扩张器/植入物植入或TRAM皮瓣即刻重建的患者在乳房切除术后肩部功能有统计学意义的改善。
与单纯乳房切除术和LD皮瓣乳房重建相比，TRAM皮瓣或组织扩张器/植入物植入的IBR对肩部康复和功能恢复更有益。
