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Immediate Breast Reconstruction with a Latissimus Dorsi Flap Has No Detrimental Effects on Shoulder Motion or Postsurgical Complications up to 1 Year after Surgery

de Oliveira, Riza Rute Ph.D.; do Nascimento, Simony Lira Ph.D.; Derchain, Sophie F. M. M.D., Ph.D.; Sarian, Luís Otávio M.D., Ph.D.

Plastic and Reconstructive Surgery: May 2013 - Volume 131 - Issue 5 - p 673e–680e
doi: 10.1097/PRS.0b013e31828659de
Breast: Original Articles

Background: Mastectomy negatively affects scapulothoracic and glenohumeral kinematics. Breast reconstructive methods such as the latissimus dorsi flap can result in anatomical modifications that may in theory further affect the shoulder apparatus. The purpose of this study was to examine the effects of latissimus dorsi flap reconstruction on the recovery of shoulder motion and other postsurgical problems during the first year after mastectomy.

Methods: This was a prospective cohort study of 104 consecutive mastectomies (47 with immediate latissimus dorsi flaps). Shoulder range of motion was assessed before and at 1, 3, 6, and 12 months after surgery. Pain, tissue adhesion, scar enlargement, and web syndrome were assessed during follow-up.

Results: There was a 30 percent decrease of shoulder range of motion 1 month after surgery, with gradual recovery over time. However, mean abduction and flexion capacities did not reach baseline levels and were on average 5 to 10 percent lower than baseline, even after 1 year. Over time, the latissimus dorsi flap was not associated with restriction of flexion or abduction. Scar enlargement (at the first month, p = 0.009) and tissue adhesion (at month 12, p = 0.032) were significantly less common in the latissimus dorsi flap group.

Conclusions: The authors’ study clearly suggests that the additional anatomical manipulation required for the latissimus dorsi flap procedure does not further affect shoulder kinematics and is associated with a lower incidence of tissue adhesion.


Campinas, São Paulo, Brazil

From the Department of Obstetrics and Gynecology, State University of Campinas, Faculty of Medical Sciences.

Received for publication July 16, 2012; accepted November 2, 2012.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Department of Obstetrics and Gynecology, State University of Campinas, Faculty of Medical Sciences, R. Alexander Flemming, 101, CEP 13083–881, Campinas, São Paulo, Brazil,

©2013American Society of Plastic Surgeons