Shoulder function and quality of life after latissimus dorsi breast reconstruction: impact of functional inactivation and hand dominance.

Abstract

The latissimus dorsi (LD) pedicled flap remains a widely used technique for breast reconstruction; however, the functional impact of thoracodorsal nerve division and/or tendon tenotomy on shoulder function has been insufficiently studied. This retrospective comparative study evaluated shoulder strength deficits and patient-reported outcomes in 46 patients who underwent unilateral LD flap breast reconstruction by comparing those with functional inactivation (n=16) and those without (n=30). Isometric shoulder strength was measured bilaterally using a handheld dynamometer (Tindeq Progressor 200) for adduction, extension, and internal rotation. The Oxford Shoulder Score and BREAST-Q Reconstruction module were administered. Significant strength deficits were observed on the operated side compared to the contralateral side for all three movements (p<0.001). No significant differences were found between the groups in strength deficits, OSS, or any BREAST-Q domain (all p>0.15). Multivariate analysis identified surgery on the dominant side as the only independent predictor of adduction deficit (B=+22.7, p=0.008), whereas fibromyalgia was a significant predictor of poorer BREAST-Q physical well-being of the back and shoulder (B=-38.7, p=0.001). Functional inactivation was not significantly associated with any outcome variable. Sensitivity analysis performed by excluding one outlier confirmed the robustness of the results. To our knowledge, this is the first study to identify hand dominance as a predictor of shoulder strength deficit following LD flap breast reconstruction. These findings suggest that functional inactivation was not associated with increased functional morbidity in this cohort and that patients undergoing surgery on their dominant side may benefit from targeted preoperative counselling and postoperative rehabilitation.