Visual assessment of scapular position following delayed breast reconstruction with the latissimus dorsi flap or the thoracodorsal artery perforator flap

Abstract

Background: The latissimus dorsi (LD) flap and the thoracodorsal artery perforator (TAP) flap can both be used for delayed breast reconstruction. There is an ongoing debate, whether the LD flap causes shoulder and arm morbidity in the short as well as the long term. The TAP flap technique has been developed to avoid the possible morbidity caused by the harvest of the LD flap. The aim of this study was to develop a method for photographic assessment of the back and position of the scapula following delayed breast reconstruction using the LD flap or the TAP flap Methods: We examined 33 women aged 38 to 71 years, who had a delayed breast reconstruction with the LD flap in 16 cases and a TAP flap in 17 cases. We recorded standardized photos of all participants, which were marked by Styrofoam balls at four anatomical landmarks in the back. The position of the corners of the scapula was marked relative to the columna. These positions were used to calculate the position of the scapula relative to the columna and then divided into a score for the operated side (Sop) and a score for the non-operated side (Snop) as well as the difference between the two (Sdiff). The Sdiff was used as a measure of scapula asymmetry. We used a Student’s t-tests to compare the Sdiff between the LD group and the TAP group to examine if there was a significant difference between groups. Results: There was a significant difference between scapular position in the LD and the TAP group, Sdiff (LD: 57.2 Â ±11.6, TAP: 18.6 Â ±8.3, P=0.01) and for Sop (LD: 322.6 Â ±9.8, TAP: 287.4 Â ±7.4, P=0.007). The was no significant difference between the Snop. Conclusions: We developed a method for assessment of the scapula position in patients who had a delayed breast reconstruction with a skin flap from the back. There was a significant difference between the position of the scapula operated by the LD flap and the TAP flap in the Sop but not in the Snop.