To investigate the incidence and severity of physical side-effects experienced by women following breast reconstructive surgery and the effect of these side-effects on physical activity and function.
Two hundred and thirty-one Australian women (55 years SD 6.5) who had previously had breast reconstruction surgery retrospectively self-reported the incidence and severity of eight physical side-effects and the perceived effect of these side effects on six physical functions, at three time points after their surgery. The frequency of the combined incidence/severity scores and their impact at the three time points were tabulated and compared using Chi-squared tests. A general linear regression was used to identify characteristics associated with moderate–very high (≥ 5/10) combined incidence/severity scores.
At 6 months following surgery, approximately 50% of respondents reported moderate to very high incidence/severity scores for physical side-effects across multiple body regions, which were perceived to limit their physical function and activity levels. The highest incidence/severity scores were associated with the following: (i) pre-existing physical problems before surgery, (ii) post-operative complications (seroma, infection, necrosis), and (iii) autologous rather than implant-based reconstructions.
A large percentage of women reported moderate to severe physical side-effects across multiple body regions following breast reconstructive surgery. These side-effects were perceived to negatively impact both physical function and activity. Early intervention, education and treatment are recommended to alleviate these issues and minimise their negative impact.
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Zhong T, McCarthy C, Min S, Zhang J, Beber B, Pusic AL, Hofer SOP (2012) Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction: a prospective analysis of early postoperative outcomes. Cancer. 118:1701–1709. https://doi.org/10.1002/cncr.26417
Blackburn N, Wilson I, McVeigh J, McCaughan E (2016) The extent and impact of musculoskeletal dysfunction on women following breast reconstruction using the latissimus dorsi muscle: a questionnaire survey. Eur J Surg Oncol 42:S235. https://doi.org/10.1016/j.ejso.2016.07.077
Lindenblatt N, Gruenherz L, Farhadi J (2019) A systematic review of donor site aesthetic and complications after deep inferior epigastric perforator flap breast reconstruction. Gland Surg 8:389–398. https://doi.org/10.21037/gs.2019.06.05
Adkinson JM, Miller NF, Murphy JRX (2014) Neurectomy for breast reconstruction-related spasms of the pectoralis major muscle. J Plast Reconstr Aesthet Surg 67:257–259. https://doi.org/10.1016/j.bjps.2013.06.025
Browne JP, Jeevan R, Pusic AL, Klassen AF, Gulliver-Clarke C, Pereira J, Caddy CM, Cano SJ (2018) Measuring the patient perspective on latissimus dorsi donor site outcomes following breast reconstruction. J Plast Reconstr Aesthet Surg 71:336–343. https://doi.org/10.1016/j.bjps.2017.08.028
Atisha D, Alderman AK (2009) A systematic review of abdominal wall function following abdominal flaps for postmastectomy breast reconstruction. Ann Plast Surg 63:222–230. https://doi.org/10.1097/SAP.0b013e31818c4a9e
Nelson JA, Fischer JP, Pasick C, Nelson P, Chen AJ, Fosnot J, Selber JC, Wu LC, Serletti JM (2013) Chronic pain following abdominal free flap breast reconstruction: a prospective pilot analysis. Ann Plast Surg 71:278–282. https://doi.org/10.1097/SAP.0b013e31828637ec
Blackburn NE, Mc Veigh JG, Mc Caughan E, Wilson IM (2018) The musculoskeletal consequences of breast reconstruction using the latissimus dorsi muscle for women following mastectomy for breast cancer: a critical review. Eur J Cancer Care 27:e12664. https://doi.org/10.1111/ecc.12664
Lee KT, Mun GH (2014) A systematic review of functional donor-site morbidity after latissimus dorsi muscle transfer. Plast Reconstr Surg 134:303–314. https://doi.org/10.1097/PRS.0000000000000365
Woo KJ, Lee KT, Mun GH, Pyon JK, Bang SI (2018) Effect of breast reconstruction modality on the development of postmastectomy shoulder morbidity. J Plast Reconstr Aesthet Surg 71:1761–1767. https://doi.org/10.1016/j.bjps.2018.07.033
Yang JD, Huh JS, Min YS, Kim HJ, Park HY, Jung TD (2015) Physical and functional ability recovery patterns and quality of life after immediate autologous latissimus dorsi breast reconstruction: a 1-year prospective observational study. Plast Reconstr Surg 136:1146–1154. https://doi.org/10.1097/PRS.0000000000001769
van Huizum MA, Hoornweg MJ, de Ruiter N, Oudenhoven E, Hage JJ, Veeger DJ (2016) Effect of latissimus dorsi flap breast reconstruction on the strength profile of the upper extremity. J Plast Surg Hand Surg 50:202–207. https://doi.org/10.3109/2000656X.2016.1151436
McNeely ML, Binkley JM, Pusic AL, Campbell KL et al (2012) A prospective model of care for breast cancer rehabilitation: postoperative and postreconstructive issues. [review]. Cancer. 118:2226–2236. https://doi.org/10.1002/cncr.27468
Ozturk CN, Kundu N, Bernard S, Cooper K, Ozturk C, Djohan R (2014) Breast reconstruction with abdominal-based free flaps in high body mass index population: postoperative complications and impact of weight loss. Ann Plast Surg 72:13–22. https://doi.org/10.1097/SAP.0b013e31825c07f3
Roth RS, Qi J, Hamill JB, Kim HM, Ballard TNS, Pusic AL, Wilkins EG (2018) Is chronic postsurgical pain surgery-induced? A study of persistent postoperative pain following breast reconstruction. Breast. 37:119–125. https://doi.org/10.1016/j.breast.2017.11.001
Chun YS, Sinha I, Turko A, Yueh JH, Lipsitz S, Pribaz JJ, Lee BT (2010) Comparison of morbidity, functional outcome, and satisfaction following bilateral TRAM versus bilateral DIEP flap breast reconstruction. Plast Reconstr Surg 126:1133–1141. https://doi.org/10.1097/PRS.0b013e3181ea42d3
Hage JJ, van der Heeden JF, Lankhorst KM, Romviel SM et al (2014) Impact of combined skin sparing mastectomy and immediate subpectoral prosthetic reconstruction on the pectoralis major muscle function: a preoperative and postoperative comparative study. Ann Plast Surg 72:631–637. https://doi.org/10.1097/SAP.0b013e318269e4ee
Cattelani L, Polotto S, Arcuri MF, Pedrazzi G, Linguadoca C, Bonati E (2017) One-step prepectoral breast reconstruction with dermal matrix–covered implant compared to submuscular implantation: functional and cost evaluation. Clin Breast Cancer 18:e703–e711. https://doi.org/10.1016/j.clbc.2017.11.015
Gho SA, Steele JR, Munro BJ (2010) Is bra discomfort a barrier to exercise for breast cancer patients? J Support Care Cancer 18:735–741. https://doi.org/10.1007/s00520-009-0707-2
van Bemmel AJ, van de Velde CJ, Schmitz RF, Liefers GJ (2011) Prevention of seroma formation after axillary dissection in breast cancer: a systematic review. Eur J Surg Oncol 37:829–835. https://doi.org/10.1016/j.ejso.2011.04.012
Kulkarni AR, Pusic AL, Hamill JB, Kim HM, Qi J, Wilkins EG, Roth RS (2017) Factors associated with acute postoperative pain following breast reconstruction. J Plast Reconstr Aesthet Surg 11:1–13. https://doi.org/10.1016/j.jpra.2016.08.005
Herrera de la Muela M, Garcia Lopez E, Frias Aldeguer L, Gomez-Campelo P (2017) Protocol for the BRECAR study: a prospective cohort follow-up on the impact of breast reconstruction timing on health-related quality of life in women with breast cancer. BMJ Open 7:e018108. https://doi.org/10.1136/bmjopen-2017-018108
De Gournay E, Bonnetain F, Tixier H, Loustalot C et al (2010) Evaluation of quality of life after breast reconstruction using an autologous latissimus dorsi myocutaneous flap. Eur J Surg Oncol 36:520–527. https://doi.org/10.1016/j.ejso.2010.04.008
Zhong T, McCarthy C, Min S, Zhang J et al (2012) Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction: a prospective analysis of early postoperative outcomes. Cancer 118:1701–1709. https://doi.org/10.1002/cncr.26417
Kibar S, Dalyan Aras M, Unsal DS (2017) The risk factors and prevalence of upper extremity impairments and an analysis of effects of lymphoedema and other impairments on the quality of life of breast cancer patients. Eur J Cancer Care (Engl) 26: e12433. https://doi.org/10.1111/ecc.12433
Dylke ES, Kilbreath K (2015) Current rehabilitation processes do not prevent long-term impairments after treatment for breast cancer in Australia. Aust Fam Physician 44:405–409
Stubblefield MD, Keole N (2014) Upper body pain and functional disorders in patients with breast cancer. Phys Med Rehabil 6:170–183. https://doi.org/10.1016/j.pmrj.2013.08.605
Chaudhary A, Rai A, Gupta RS, Jain S et al (2015) Need for rehabilitation among the patients of breast cancer after mastectomy: a retrospective study. J Evi Based Med Healthcare 10:1494–1503. https://doi.org/10.18410/jebmh/2015/212
Hayes SC, Rye S, Battistutta D, DiSipio T, Newman B (2010) Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life. Health Qual Life Outcome 8:92. https://doi.org/10.1186/1477-7525-8-92
Nesvold IL, Reinertsen KV, Fossa SD, Dahl AA (2011) The relation between arm/shoulder problems and quality of life in breast cancer survivors: a cross-sectional and longitudinal study. J Cancer Surviv 5:62–72. https://doi.org/10.1007/s11764-010-0156-4
Harrington S, Michener LA, Kendig T, Miale S, George SZ (2014) Patient-reported upper extremity outcome measures used in breast cancer survivors: a systematic review. Arch Phys Med Rehabil 95:153–162. https://doi.org/10.1016/j.apmr.2013.07.022
Sagen A, Kaaresen R, Sandvik L, Thune I, Risberg MA (2014) Upper limb physical function and adverse effects after breast cancer surgery: a prospective 2.5-year follow-up study and preoperative measures. Arch Phys Med Rehabil 95:875–881. https://doi.org/10.1016/j.apmr.2013.12.015
Shamley D, Lascurain-Aguirrebena I, Oskrochi R, Srinaganathan R (2012) Shoulder morbidity after treatment for breast cancer is bilateral and greater after mastectomy. Acta Oncol 51:1045–1053. https://doi.org/10.3109/0284186X.2012.695087
Hidding JT, Beurskens CH, van der Wees PJ, van Laarhoven HW et al (2014) Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. PLoS One 9:e96748. https://doi.org/10.1371/journal.pone.0096748
American Cancer Society's SCS, II. Breast Cancer Facts and Figures 2017–2018. Breast Cancer Facts and Figures 2017–2018. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf. Accessed Dec 2019.
Blanchard CM, Courneya KS, Stein K, American Cancer Society's SCS, II (2008) Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol 26:2198–2204. https://doi.org/10.1200/JCO.2007.14.6217
Ilonzo N, Tsang A, Tsantes S, Estabrook A, Thu Ma AM (2017) Breast reconstruction after mastectomy: a ten-year analysis of trends and immediate postoperative outcomes. Breast. 32:7–12. https://doi.org/10.1016/j.breast.2016.11.023
Hong KY, Son Y, Chang H, Jin US (2018) Trends in breast reconstruction: implications for the National Health Insurance Service. Arch Plast Surg 45:239–245. https://doi.org/10.5999/aps.2017.01417
Hayes SC, Johansson K, Stout N, Prosnitz R et al (2012) Upper-body morbidity after breast cancer incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer. 118:2237–2249. https://doi.org/10.1002/cncr.27467
Tatham B, Smith J, Cheifetz O, Gillespie J, Snowden K, Temesy J, Vandenberk L (2013) The efficacy of exercise therapy in reducing shoulder pain related to breast cancer: a systematic review. Physiother Can 65:321–330. https://doi.org/10.3138/ptc.2012-06
McNeely ML, Campbell KL, Ospina M, Rowe BH et al (2010) Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev 16:CD005211. https://doi.org/10.1002/14651858.CD005211.pub2
Ribeiro IL, Moreira RF, Ferrari AV, Alburquerque-Sendín F, Camargo PR, Salvini TF (2019) Effectiveness of early rehabilitation on range of motion, muscle strength and arm function after breast cancer surgery: a systematic review of randomized controlled trials. Clin Rehabil 33:1876–1886. https://doi.org/10.1177/0269215519873026
Cheville AL, Tchou J (2007) Barriers to rehabilitation following surgery for primary breast cancer. J Surg Oncol 95:409–418. https://doi.org/10.1002/jso.20782
Craft PS, Buckingham JM, Dahlstrom JE, Beckmann KR, Zhang Y, Stuart-Harris R, Jacob G, Roder D, Tait N (2010) Variation in the management of early breast cancer in rural and metropolitan centres: implications for the organisation of rural cancer services. Breast. 19:396–401. https://doi.org/10.1016/j.breast.2010.03.032
Mehnert A, Koch U (2008) Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors. J Psychosom Res 64:383–391. https://doi.org/10.1016/j.jpsychores.2007.12.005
The authors would like to thank Breast Cancer Network Australia, Register4 and breast cancer support groups (including Reclaim Your Curves) for their support of this project.
The study was funded by the University of Wollongong, Faculty of Science, Medicine and Health.
Informed consent was assumed when the participants clicked “I agree” to progress with the online survey. The University Human Research Ethics Committee approved all data collection procedures (HE15/453).
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The authors declare that they have no conflicts of interest.
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McGhee, D.E., Steele, J.R. Physical side-effects following breast reconstructive surgery impact physical activity and function. Support Care Cancer 29, 787–794 (2021). https://doi.org/10.1007/s00520-020-05534-6