Shoulder Function Assessment After Fald Flap Breast Reconstruction: Comparing Ultrasound Results and Patients’ Self Perception

Background. The Fat-Augmented LD (FALD) flap is a workhorse flap for autologous breast reconstruction (BR). Latissimus Dorsi muscle is responsible for upper limb medial rotation, adduction and extension and contributes to the glenohumeral joint stabilization. To date, controversial conclusions have been reached about shoulder impairment following BR with FALD flap. Methods. The study prospectively enrolled 36 patients (46 flaps) who underwent BR with FALD flap. Participants underwent a shoulder ultrasound imaging, analysing the acromio-humeral interval (AHI) measurement pre-operatively (t0), at 6 (t1) and 12 (t2) months after surgery and completed the DASH questionnaire. Teres major thickness was determined with dorsal ultrasound, preoperatively and at least 12 months after surgery. Statistical analysis using linear mixed effects model was performed with significant values < 0.05.Results. Comparing the mean AHI value of each follow-up time (t1 and t2) to the mean AHI value at the baseline (t0) the pattern remained quite the same, with a non-significant reduction between t0-t1 (p = 0.873) and a little increase between t0-t2 (p = 0.468). Self-reported outcomes showed a similar trend with a reduction in upper limb function initially compared to pre-operative status (t0), followed by an improvement at the subsequent intervals (all p < 0.05). Dorsal US showed an increase in TM thickness postoperatively compared to preoperative values (11.4 vs 12.4 mm; p = 0.01984). Conclusions. BR with FALD flap is a safe procedure since no long-term shoulder disability was found according to AHI, dorsal US, and DASH questionnaire assessments.