Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, New York.
Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
J Reconstr Microsurg. 2020 Feb;36(2):151-156. doi: 10.1055/s-0039-1698439. Epub 2019 Oct 23.
After mastectomy and breast reconstruction, many patients experience upper extremity complications, such as pain, restriction in motion, and lymphedema. Despite an aesthetically satisfactory outcome, these occurrences can diminish a patient's postoperative quality of life. Several studies have investigated the causes and incidence of these complications. However, there is currently a paucity of data comparing postoperative upper extremity function according to reconstruction technique.
A review was performed of patients enrolled in a physical therapy (PT) program after mastectomy and immediate breast reconstruction. PT initial encounter evaluations were used to gather data on patients' postoperative upper extremity function. Hospital records were used to gather surgical and demographic data. For each patient, data were collected for each upper extremity that was ipsilateral to a reconstructed breast. Data were then compared between patients who underwent implant-based versus autologous deep inferior epigastric perforator flap reconstruction.
A total of 72 patients were identified, including 39 autologous and 33 implant-based reconstruction cases. Proportions of patients who underwent sentinel lymph node biopsies and axillary lymph node dissections were similar between the two groups. The autologous-based reconstruction patients had significantly higher arm pain at rest ( = 0.004) and with activity ( = 0.031) compared with implant patients. Shoulder range of motion and manual muscle test results were similar between groups, with the exception of elbow flexion, which was weaker in implant patients ( = 0.030). Implant patients were also more likely to report "severe difficulty" or "inability" to perform activities of daily living ( = 0.022). Edema/swelling, axillary cording, and lymphedema girth measurements were similar between the two groups.
Different techniques of breast reconstruction can result in different postoperative upper extremity complications. These data show specific areas where postoperative care and PT can be customized according to reconstruction type. Investigation is currently underway to determine the effect of PT on upper extremity function in these patients.
乳房切除和乳房重建后，许多患者会出现上肢并发症，如疼痛、运动受限和淋巴水肿。尽管外观令人满意，但这些情况会降低患者术后的生活质量。已有多项研究探讨了这些并发症的原因和发生率。然而，目前尚无数据比较根据重建技术的术后上肢功能。
对参加乳房切除和即刻乳房重建物理治疗（PT）项目的患者进行了回顾性研究。PT 初始评估用于收集患者术后上肢功能的数据。医院记录用于收集手术和人口统计学数据。对于每一位患者，同侧重建乳房的每只上肢都收集了数据。然后比较了接受植入物为基础与自体深下腹部穿支皮瓣重建的患者之间的数据。
共确定了 72 例患者，包括 39 例自体和 33 例植入物为基础的重建病例。接受前哨淋巴结活检和腋窝淋巴结清扫术的患者在两组之间的比例相似。与植入物患者相比，自体重建患者的静息时（ = 0.004）和活动时（ = 0.031）手臂疼痛比例更高。肩运动范围和手动肌肉测试结果在两组之间相似，但植入物患者的肘部弯曲较弱（ = 0.030）除外。植入物患者也更有可能报告“严重困难”或“无法”进行日常生活活动（ = 0.022）。两组之间的水肿/肿胀、腋窝条索和淋巴水肿周长测量值相似。
不同的乳房重建技术会导致不同的术后上肢并发症。这些数据显示了根据重建类型定制术后护理和 PT 的具体领域。目前正在调查 PT 对这些患者上肢功能的影响。
