Survey assessment of physical function following postmastectomy breast reconstruction

Although isokinetic testing has demonstrated postoperative declines in trunk function following transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction, there is little research assessing effects of these procedures on patient-reported measures of physical functioning. The authors used patient surveys to assess the affect of breast reconstruction on postoperative physical functioning.

Patients were recruited from 12 institutions and underwent expander/implant, pedicle TRAM flap, or free TRAM flap reconstruction. Preoperatively and 2 years postoperatively participants completed self-administered surveys, including the Medical Outcome Study Short Form-36 physical and role functioning subscales; the Functional Assessment of Cancer Therapy-Breast physical and functional well-being subscales; and new, condition-specific items. Multiple regressions evaluated the effects of procedure type on postoperative subscale scores.

Of 295 patients recruited, 207 completed surveys at year 2, including 167 unilateral and 40 bilateral reconstructions. TRAM flaps were performed in 159 of 207 patients. There were 133 immediate and 74 delayed procedures. For unilateral reconstructions, no statistically significant procedure type differences were noted in the postoperative subscale scores. Reconstruction timing had a significant effect on function for only one of the subscales, with delayed reconstruction patients reporting significantly lower postoperative scores for Functional Assessment of Cancer Therapy-Breast functional well-being compared with women receiving immediate procedures. On most of the measures, high levels of preoperative functioning were significantly associated with better postoperative scores.

Although deficits in trunk function have been demonstrated objectively following TRAM flap reconstruction, these changes have minimal impact on patients' daily physical functioning.