Long-term prospective assessment of shoulder function after breast reconstruction involving a latissimus dorsi muscle flap transfer and postoperative radiotherapy.

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Several investigators have evaluated the impaired function of the shoulder after removal of the latissimus dorsi muscle for breast reconstruction. However, a few investigators have studied whether including radiotherapy has a negative effect on functional recovery of the shoulder by a long-term follow-up after surgery. In this study, we compared objective measurements of shoulder function preoperatively and postoperatively for 3years after latissimus dorsi muscle (LDM) flap transfer and postoperative radiotherapy (PRT). Eighteen patients who underwent unilateral transfer of a pedicled LDM flap and PRT within 2months of breast-conserving surgery were enrolled in this study. Range of motion (ROM) and muscle strength in exhaustive shoulder movements were measured before surgery, and at 3 and 6months, and 1 and 3years. The results of ROM measurements at 3months postsurgery showed significant decreases in both flexion and abduction by 7.1 and 9.2% and at 3years postsurgery by 4.7 and 5.7%. The muscle strength measurements at 3months postsurgery showed statistically significant decreases both in adduction and in the 2nd medial rotation by 30.7 and 25.9% and at 3years postsurgery by 36.4 and 20.4%. A significant improvement in these impairments was not observed for 3years after surgery compared with that at 3months after surgery. A combination of the LDM flap procedure and PRT could be associated with a higher incidence of tissue adhesions in both flexion and abduction and muscle deficit both in adduction and in the 2nd medial rotation.