Functional morbidity following latissimus dorsi flap breast reconstruction

According to the National Institutes of Health, more than 230,000 new cases of breast cancer will be diagnosed in 2014 alone. Following mastectomy, several reconstructive options exist for women with breast cancer. The timing and approach for reconstruction must be addressed rapidly. Although abdominal tissue transfer is described as the preferred method, it may not be best suited to all patients. The latissimus dorsi (LD) muscle flap is a widely available, proven, and reliable modality. The majority of studies support that shoulder functional morbidity is minimal, but this should be more accurately quantified to allow patients to assess the possible impact on their daily lives. A critical appraisal of the available evidence was undertaken to determine the incidence of new functional morbidity involving the ipsilateral arm following LD pedicled flap breast reconstruction. The process for identifying articles included preappraised and secondary literature sources published between 2005 and 2013. Randomized controlled trials, evidence-based practice, clinical guidelines, and systematic reviews were the quality filters applied. This literature review confirmed that LD muscle transfer does lead to measurable reductions in shoulder joint stability, strength, range of motion, and general functionality. However, these deficiencies resolve in the vast majority of women within 6 to 12 months. Ultimately, the consequences of shoulder function morbidity must be considered and discussed with patients prior to making a final decision.