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The Functional Impact of Breast Reconstruction: An Overview and Update

As rates of bilateral mastectomy and immediate reconstruction rise, the aesthetic and psychosocial benefits of breast reconstruction are increasingly well understood. However, an understanding of functional outcome and its optimization is still lacking. This endpoint is critical to maximizing postop...

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Detalles Bibliográficos
Autores principales: Nelson, Jonas A., Lee, Iris T., Disa, Joseph J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5908499/
https://www.ncbi.nlm.nih.gov/pubmed/29707442
http://dx.doi.org/10.1097/GOX.0000000000001640
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author Nelson, Jonas A.
Lee, Iris T.
Disa, Joseph J.
author_facet Nelson, Jonas A.
Lee, Iris T.
Disa, Joseph J.
author_sort Nelson, Jonas A.
collection PubMed
description As rates of bilateral mastectomy and immediate reconstruction rise, the aesthetic and psychosocial benefits of breast reconstruction are increasingly well understood. However, an understanding of functional outcome and its optimization is still lacking. This endpoint is critical to maximizing postoperative quality of life. All reconstructive modalities have possible functional consequences. Studies demonstrate that implant-based reconstruction impacts subjective movement, but patients’ day-to-day function may not be objectively hindered despite self-reported disability. For latissimus dorsi flap reconstruction, patients also report some dysfunction at the donor site, but this does not seem to result in significant, long-lasting limitation of daily activity. Athletic and other vigorous activities are most affected. For abdominal free flaps, patient perception of postoperative disability is generally not significant, despite the varying degrees of objective disadvantage that have been identified depending on the extent of rectus muscle sacrifice. With these functional repercussions in mind, a broader perspective on the attempt to ensure minimal functional decline after breast surgery should focus not only on surgical technique but also on postoperative rehabilitation. Early directed physical therapy may be an instrumental element in facilitating return to baseline function. With the patient’s optimal quality of life as an overarching objective, a multifaceted approach to functional preservation may be the answer to this continued challenge. This review will examine these issues in depth in an effort to better understand postoperative functional outcomes with a focus on the younger, active breast reconstruction patient.
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spelling pubmed-59084992018-04-27 The Functional Impact of Breast Reconstruction: An Overview and Update Nelson, Jonas A. Lee, Iris T. Disa, Joseph J. Plast Reconstr Surg Glob Open Special Topic As rates of bilateral mastectomy and immediate reconstruction rise, the aesthetic and psychosocial benefits of breast reconstruction are increasingly well understood. However, an understanding of functional outcome and its optimization is still lacking. This endpoint is critical to maximizing postoperative quality of life. All reconstructive modalities have possible functional consequences. Studies demonstrate that implant-based reconstruction impacts subjective movement, but patients’ day-to-day function may not be objectively hindered despite self-reported disability. For latissimus dorsi flap reconstruction, patients also report some dysfunction at the donor site, but this does not seem to result in significant, long-lasting limitation of daily activity. Athletic and other vigorous activities are most affected. For abdominal free flaps, patient perception of postoperative disability is generally not significant, despite the varying degrees of objective disadvantage that have been identified depending on the extent of rectus muscle sacrifice. With these functional repercussions in mind, a broader perspective on the attempt to ensure minimal functional decline after breast surgery should focus not only on surgical technique but also on postoperative rehabilitation. Early directed physical therapy may be an instrumental element in facilitating return to baseline function. With the patient’s optimal quality of life as an overarching objective, a multifaceted approach to functional preservation may be the answer to this continued challenge. This review will examine these issues in depth in an effort to better understand postoperative functional outcomes with a focus on the younger, active breast reconstruction patient. Wolters Kluwer Health 2018-03-06 /pmc/articles/PMC5908499/ /pubmed/29707442 http://dx.doi.org/10.1097/GOX.0000000000001640 Text en Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Special Topic
Nelson, Jonas A.
Lee, Iris T.
Disa, Joseph J.
The Functional Impact of Breast Reconstruction: An Overview and Update
title The Functional Impact of Breast Reconstruction: An Overview and Update
title_full The Functional Impact of Breast Reconstruction: An Overview and Update
title_fullStr The Functional Impact of Breast Reconstruction: An Overview and Update
title_full_unstemmed The Functional Impact of Breast Reconstruction: An Overview and Update
title_short The Functional Impact of Breast Reconstruction: An Overview and Update
title_sort functional impact of breast reconstruction: an overview and update
topic Special Topic
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5908499/
https://www.ncbi.nlm.nih.gov/pubmed/29707442
http://dx.doi.org/10.1097/GOX.0000000000001640
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