In this procedure, called latissimus dorsi flap reconstruction, the surgeon cuts the muscle from the back and pulls it into the chest to restore the breast mound and create a flap for the implant. Women undergoing radiation therapy often need this type of reconstruction because radiation therapy causes scar tissue to form in the skin and pectoral muscles. It is therefore necessary to integrate the muscle of the back in the surgery.
The study followed 24 patients who underwent breast reconstruction with one of the 3 procedures studied, latissimus dorsi flap reconstruction, placement of an implant under the pectoralis major muscle and DIEP flap reconstruction.
- Latissimus dorsi flap reconstruction objectively significantly reduces shoulder strength. This severe side effect, the authors point out, should be communicated to patients in advance because it is likely to modify the decision of the procedure. The idea supported by these doctors would be, in the long term, to try to reduce the number of breast reconstructions using the dorsal and pectoral muscles. In addition, research should be conducted to better identify the factors of biomechanical changes in the shoulder depending on the lifestyle and activities of the patient as well as her own perception of shoulder function.
- Using the pectoral muscles to reconstruct the breast by inserting tissue expanders under the muscle to make room for a future implant, a procedure that accounts for more than 60% of all reconstructions results in good results for future breast function. the shoulder.
- Breast reconstruction without an implant by transfer of abdominal tissue to the thorax (or DIEP flap for perforator flap of the deep inferior epigastric artery), also makes it possible to preserve the function and stability of the shoulder.
The team's goal is not only to optimize post-breast reconstruction rehabilitation but also to develop new screening tools for loss of shoulder function to improve these rehabilitation programs.