The Influence of Functional Shoulder Biomechanics as a Mediator of Patient Reported Outcomes Following Mastectomy and Breast Reconstruction.

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Citation: Plastic & Reconstructive Surgery. 2020 Oct 01PMID: 33009332Department: Curtis National Hand CenterForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020ISSN:
  • 0032-1052
Name of journal: Plastic and reconstructive surgeryAbstract: BACKGROUND: Post-mastectomy breast reconstruction techniques differentially influence patient-reported physical and psychosocial well-being. Objective measures of shoulder biomechanics, which are uniquely influenced by reconstruction technique, may provide insight into the influence of reconstruction technique on patient-reported outcomes.CONCLUSIONS: In the current cohort, LD+subpectoral implant breast reconstructions significantly reduced shoulder strength and stiffness when compared to the other techniques. Additionally, objective measures of shoulder biomechanics were predictive of patient-reported physical and psychosocial well-being. Our results emphasize the need for improved peri-operative screening for shoulder functional deficits in patients undergoing breast reconstruction.METHODS: Robot-assisted measures of shoulder strength and stiffness, and patient-reported outcomes surveys (PROMIS-UE, SPADI, QuickDASH, SF12-PCS, SF12-MCS) were obtained from 46 women who had previously undergone mastectomy and a combined latissimus dorsi flap + subpectoral implant (LD + subpectoral implant), subpectoral implant, or DIEP flap breast reconstruction. Mediation analyses examined the role of functional shoulder biomechanics as a mediator between reconstruction technique and patient-reported outcomes.RESULTS: Reconstruction technique uniquely affected shoulder biomechanics, with LD+subpectoral implant patients exhibiting reduced shoulder strength and stiffness compared to subpectoral implant and DIEP flap patients. Increasing external rotation strength was predictive of increasing PROMIS-UE score (p=0.04), indicating improved upper extremity function. Increasing shoulder stiffness while at rest was predictive of increasing QuickDASH score (p=0.03), indicating worsened upper extremity function, while increasing stiffness at rest and during contraction was indicative of decreasing SF12-MCS score (all p<=0.02), indicating worsened psychosocial well-being. Reconstruction technique did not predict survey scores of function directly, or when mediated by functional shoulder biomechanics.All authors: Giladi AM, Kidwell KM, Leonardis JM, Lipps DB, Lyons DA, Momoh AOFiscal year: FY2021Digital Object Identifier: Date added to catalog: 2020-12-29
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Journal Article MedStar Authors Catalog Article 33009332 Available 33009332

BACKGROUND: Post-mastectomy breast reconstruction techniques differentially influence patient-reported physical and psychosocial well-being. Objective measures of shoulder biomechanics, which are uniquely influenced by reconstruction technique, may provide insight into the influence of reconstruction technique on patient-reported outcomes.

CONCLUSIONS: In the current cohort, LD+subpectoral implant breast reconstructions significantly reduced shoulder strength and stiffness when compared to the other techniques. Additionally, objective measures of shoulder biomechanics were predictive of patient-reported physical and psychosocial well-being. Our results emphasize the need for improved peri-operative screening for shoulder functional deficits in patients undergoing breast reconstruction.

METHODS: Robot-assisted measures of shoulder strength and stiffness, and patient-reported outcomes surveys (PROMIS-UE, SPADI, QuickDASH, SF12-PCS, SF12-MCS) were obtained from 46 women who had previously undergone mastectomy and a combined latissimus dorsi flap + subpectoral implant (LD + subpectoral implant), subpectoral implant, or DIEP flap breast reconstruction. Mediation analyses examined the role of functional shoulder biomechanics as a mediator between reconstruction technique and patient-reported outcomes.

RESULTS: Reconstruction technique uniquely affected shoulder biomechanics, with LD+subpectoral implant patients exhibiting reduced shoulder strength and stiffness compared to subpectoral implant and DIEP flap patients. Increasing external rotation strength was predictive of increasing PROMIS-UE score (p=0.04), indicating improved upper extremity function. Increasing shoulder stiffness while at rest was predictive of increasing QuickDASH score (p=0.03), indicating worsened upper extremity function, while increasing stiffness at rest and during contraction was indicative of decreasing SF12-MCS score (all p<=0.02), indicating worsened psychosocial well-being. Reconstruction technique did not predict survey scores of function directly, or when mediated by functional shoulder biomechanics.

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