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Impact of Combined Skin Sparing Mastectomy and Immediate Subpectoral Prosthetic Reconstruction on the Pectoralis Major Muscle Function: A Preoperative and Postoperative Comparative Study

Hage, J. Joris MD, PhD*; van der Heeden, Jorine F. MSc; Lankhorst, Kristel M. MSc; Romviel, Suzanne M.G. MSc; Vluttters, Maaike E. MSc; Woerdeman, Leonie A.E. MD, PhD*; Visser, Bart PhD; Veeger, H.E.J. PhD

doi: 10.1097/SAP.0b013e318269e4ee
Breast Surgery

Background: We assessed the subjective and objective functional loss induced by detachment of the pectoralis major muscle and whether synergistic function of adjacent muscles compensates for such loss.

Methods: A preoperative to postoperative comparison of the Disability of the Arm, Shoulder and Hand score, 3-dimensional video-analysis of the range of motion, and dynamometric force assessment with electromyography registration were prospectively conducted in 22 women who underwent bilateral preventive breast surgery.

Results: Although the statistically significant postoperative increase of the Disability of the Arm, Shoulder and Hand score (P = < 0.01) was indicative of more subjective disability, this difference is irrelevant for activities of daily life. This is in line with the observed postoperative lack of restrictions of range of motion of the shoulder. The mean postoperative maximum force measured in 4 directions reflective of the pectoralis major muscle function was 7.13 N, or 3.8%, lower than the preoperative force (P = 0.079). The mean postoperative maximum force in the 2 contramovement directions was 15.5 N, or 14%, higher than the preoperative force (P = 0.04). Electromyographically, both parts of the deltoid muscle preoperatively and postoperatively showed the same peaks in the 6 directions. Contrastingly, the clavicular part of the pectoralis major muscle postoperatively showed a statistically significant increase of peak of muscle activity in 3 of 4 directions reflective of pectoralis major function and in both contramovement directions, indicating compensatory activity.

Conclusions: Daily life consequences of partial detachment of the pectoralis major muscle were acceptable in our patients.

From the *Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital; and †Research Institute Move, Faculty of Human Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands.

Received April 11, 2012, and accepted for publication, after revision, July 15, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: J. Joris Hage, MD, PhD, Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, the Netherlands. E-mail: j.hage@nki.nl.

© 2014 by Lippincott Williams & Wilkins