Shoulder-related donor site morbidity and patient-reported satisfaction after delayed breast reconstruction with pedicled flaps from the back: A comparative analysis

Publication date: Available online 13 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mikkel Børsen Rindom, Gudjon L. Gunnarsson, Marianne D. Lautrup, René D. Christensen, Professor Jens A. Sørensen, Jørn B. Thomsen
BackgroundWe report a study evaluating and comparing shoulder-related morbidity associated with delayed breast reconstruction using either the conventional latissimus dorsi (LD) flap or the thoracodorsal artery perforator (TAP) flap.Material & MethodsWe conducted a retrospective cohort study of women over 18 years who had a unilateral, delayed breast reconstruction by either a LD or TAP flap at one centre over a 56 months period. Shoulder function was assessed using the Constant Shoulder Score (CSS), evaluating pain, activity in daily life (ADL), range of motion (ROM) and strength. A number of secondary outcomes were also examined.Results49 women were included. Demographics and breast treatment data were comparable between the groups. For the TAP flap there was a statistically significant better score for the reconstructed side of 10.9 points, 95%CI(2.6-19.2), p-value 0.01. The CSS-score did not differ statistically significant between groups for the non-reconstructed side with a difference of 0.1, 95%CI (-6.1-6.2), p-value 0.98. The sub score-analysis revealed an advantage to the TAP flap of 3.2 points for pain (p-value 0.003) and 5.5 points for ROM (p-value 0.011). The factors ADL and strength were of equal magnitude in both groups.ConclusionsPatients who undergo delayed breast reconstruction by the TAP flap seem less prone to suffer from postoperative pain and restricted ROM, why this flap should be considered an advantageous alternative to the conventional LD flap. A randomized clinical trial is warranted to lend sufficient evidence to this statement.