Grants We Funded

Abstract
There are over 250,000 new cases of breast cancer diagnosed in the United States each year. In women pursuing post-mastectomy breast reconstruction, an implant-based technique is commonly used requirnig disinsertion of either the pectoralis major muscle or latissimus dorsi muscle to provide soft tissue coverage of the breast prosthesis. These muscles are principal stabilizers of the shoulder girdle and their disinsertion has been shown to increase shoulder instability with short- and long-term functional deficits. Despite the growing evidence that post-mastectomy breast reconstruction produces shoulder morbidity, clinicians have a poor understanding of the pathophysiological mechanisms leading to shoulder impairment, or what might be done to prevent or improve these issues. The overall objective of this proposal is to identify the mechanism responsible for shoulder morbidity after implant-based breast reconstruction by investigating changes to the mechanical properties of the shoulder joint and its underlying musculature. We hypothesize that alterations in muscle length following disinsertion of either the pectoralis major muscle or latissimus dorsi muscle at the time of implant-based breast reconstruction will result in a reduction in the stiffness capacity and force generation of the donor muscle leading to increased shoulder instability. The proposed work is the first attempt to characterize physiological changes within both the donor muscle and the shoulder following implant-based breast reconstruction. Our study will utilize a cross-sectional design to identify the effects of two different implant-based breast reconstruction techniques on upper extremity biomechanics using objective functional measures. Additionally, patient reported outcomes measures utilizing validated questionnaires will characterize the reliability of the biomechanical assessments in predicting a patient's upper extremity dysfunction post-operatively. By understanding the mechanisms of why certain patients develop post-reconstruction shoulder disability, we hope to develop prospective strategies to identify and rehabilitate at-risk patients to improve the quality of life in cancer survivors.

Biography
I am a fourth-year plastic surgery resident with an interest in breast reconstruction and clinical outcomes research. The goal of this proposal is to identify the mechanisms responsible for shoulder morbidity after implant-based breast reconstruction by investigating changes to the mechanical properties of the shoulder joint and its underlying musculature. My previous work in breast reconstruction outcomes related to acellular dermal matrix use in implant-based breast reconstruction provided me with experience in scientific presentations and manuscript preparation, and the mentors chosen for guidance and leadership with the current proposed biomechanical study are experts in clinical outcomes research. The combination of a focused research plan and mentors with expertise in breast reconstruction and musculoskeletal biomechanics will ensure successful completion of the proposed project.