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Shiraishi M, Sowa Y, Tsuge I, Kodama T, Inafuku N, Morimoto N. Long-Term Patient Satisfaction and Quality of Life Following Breast Reconstruction Using the BREAST-Q: A Prospective Cohort Study. Front Oncol 2022; 12:815498. [PMID: 35692774 PMCID: PMC9178786 DOI: 10.3389/fonc.2022.815498] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBreast reconstruction is a promising surgical technique to improve health-related quality of life (HRQoL) in patients with breast cancer. However, the long-term risk factors associated with HRQoL after breast surgery are still unclear. Our aim was to evaluate breast satisfaction and HRQoL following breast reconstruction to identify clinical factors associated with each domain of BREAST-Q in the long-term.MethodsPatient-reported BREAST-Q outcomes were analyzed 1 and 5 years after breast reconstruction in a single-blinded, prospective study. Multiple regression analysis was performed to identify the risk and protective factors associated with BREAST-Q scores. These scores at 1 and 5 years were also compared across three types of operation: mastectomy only, tissue expander/implant (TE/Imp), and a deep inferior epigastric perforator (DIEP) flap.ResultsSurveys were completed by 141 subjects after 1 year and 131 subjects after 5 years. Compared to mastectomy only, breast reconstruction was significantly associated with greater “Satisfaction with breasts” (TE/Imp, p < 0.001; DIEP, p < 0.001) and “Psychosocial well-being” (TE/Imp, p < 0.001; DIEP, p < 0.001), higher body mass index (BMI) resulted in lower “Satisfaction with breasts” (p = 0.004), and a history of psychiatric or neurological medication was significantly associated with “Physical well-being” at 1-year postoperatively (p = 0.02). At 5 years, reconstructive procedures were significantly positively associated with greater “Satisfaction with breasts” (TE/Imp, p < 0.001; DIEP, p < 0.001) and “Psychosocial well-being” (TE/Imp, p = 0.03; DIEP, p < 0.001), and a bilateral procedure was a significant risk factor for lower “Psychosocial well-being” (p = 0.02).ConclusionsThe results of this study show that breast reconstruction improves “Satisfaction with Breasts” and “Psychosocial well-being” compared to mastectomy. Among all three types of operation, DIEP gave the best scores at 5 years postoperatively. Thus, autologous reconstruction is recommended for promotion of long-term HRQoL after breast surgery.
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Affiliation(s)
- Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- *Correspondence: Yoshihiro Sowa,
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuya Kodama
- Department of Plastic and Reconstructive Surgery, Fukuchiyama City Hospital, Fukuchiyama, Japan
| | - Naoki Inafuku
- Department of Plastic and Reconstructive Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Mullen LA, Harvey SC. Review of axillary web syndrome: What the radiologist should know. Eur J Radiol 2019; 113:66-73. [PMID: 30927961 DOI: 10.1016/j.ejrad.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/19/2022]
Abstract
Axillary web syndrome is common after axillary surgery, frequently affecting breast cancer patients. In this condition, patients develop one or more linear bands of firm tissue, also known as "cords", in the axilla and arm, associated with pain and limited range of motion of the shoulder and arm. Radiologists may encounter this syndrome in patients referred for axillary or upper extremity ultrasound, and should be aware of the physical examination and ultrasound findings for accurate diagnosis. However, there are currently limited articles about this syndrome published in radiology journals, suggesting that radiologists may be unaware of this entity. In this work, axillary web syndrome will be discussed, including background knowledge, incidence, clinical presentation, possible etiology, and ultrasound appearance.
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Affiliation(s)
- Lisa A Mullen
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, 601 N. Caroline St., Suite 4120, Baltimore, MD, 21287, USA.
| | - Susan C Harvey
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, 601 N. Caroline St., Suite 4120, Baltimore, MD, 21287, USA.
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Harris SR. Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication. Breast Care (Basel) 2018; 13:132-135. [PMID: 29887791 PMCID: PMC5981636 DOI: 10.1159/000485023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The purpose of this review is to define axillary web syndrome (AWS) and describe its diagnosis and management. The following databases were searched through July 2017: PubMed, EMBASE (OvidSP), Cumulative Index for Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Cochrane Database of Systematic Reviews. Search terms included 'axillary web syndrome', 'axillary cording', and 'lymphatic cording'. 49 articles were identified; 8 did not relate to breast cancer, and 3 were not in English. Of the remaining articles, the majority were case reports, case series, or descriptive reviews. 2 systematic reviews were located as well as 1 randomized trial, 6 prospective cohort studies, and 2 retrospective cohort studies. Although a common sequela after axillary surgery for breast cancer staging, AWS has been poorly described in the medical literature as to the underlying pathophysiology, diagnosis, and management. Interventions range from patient education and simple reassurance that the syndrome will resolve spontaneously to active physical or manual therapies to maintain upper extremity range-of-motion, especially adequate motion for undergoing radiation therapy. Oncologists, breast surgeons, family physicians, and oncology nurse practitioners that work with patients with breast cancer should educate them about this prevalent complication and inform them preoperatively about what to anticipate.
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Affiliation(s)
- Susan R. Harris
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Baggi F, Nevola Teixeira LF, Gandini S, Simoncini MC, Bonacossa E, Sandrin F, Sciotto Marotta M, Lanni G, Dadda P, Colpani D, Luini A. Axillary web syndrome assessment using a self-assessment questionnaire: a prospective cohort study. Support Care Cancer 2018; 26:2801-2807. [PMID: 29508139 DOI: 10.1007/s00520-018-4123-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/20/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Surgical procedure for breast cancer is not without its side effects and one such side effect is axillary web syndrome (AWS), characterized by palpable fibrotic-like cords in the operated arm. As physical evaluation is the only gold standard method used, our study aims to assess the incidence and early detection of AWS with a self-assessment questionnaire. METHODS From July 2013 to July 2014, 370 breast cancer patients were enrolled. AWS incidence was 51.1%, with 94.1% onset in the first 4 weeks after surgery; 43.5% of the patients did not recover in the first 8 weeks. Univariate analysis showed that BMI (P < 0.001), age (P < 0.001), educational level (P = 0.01), and exercise frequency in the eighth week of follow-up (P < 0.001) were significantly associated with the AWS detection, and multivariate analyses confirmed that younger patients (age < 50) have significantly higher AWS detection (OR = 2.38 (95%CI 1.53, 3.71) and that BMI is associated with AWS, with normal weight patients (BMI ≤ 25) having a significantly greater AWS detection with an odds ratio of 2.11 (95%CI 1.33, 3.36). CONCLUSION Our findings indicated that the incidence of AWS is high in breast cancer patients, particularly in the first month after surgery. Not all patients achieved recovery during our 8 week follow-up, suggesting that evaluation and treatment should be longer. Double AWS detection was found for patients who were younger (age < 50) and with normal weight.
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Affiliation(s)
- F Baggi
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | | | - S Gandini
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - M C Simoncini
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - E Bonacossa
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - F Sandrin
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - M Sciotto Marotta
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - G Lanni
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - P Dadda
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - D Colpani
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - A Luini
- Breast Surgery Unit, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
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Furlan C, Matheus CN, Jales RM, Derchain S, Sarian LO. Vascular Alterations in Axillary and Brachial Vessels in Patients with Axillary Web Syndrome After Breast Cancer Surgery. Lymphat Res Biol 2017; 16:287-293. [PMID: 28961070 DOI: 10.1089/lrb.2017.0037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgical manipulations of the axilla may cause a condition known as Axillary Web Syndrome (AWS). The systems compromised and the sequence of events leading to this syndrome remains unknown. This study evaluated clinical, surgical, and vascular factors associated with onset and duration of AWS after breast cancer surgery. METHODS AND RESULTS In this prospective study, 155 women were included. They were submitted to a physical examination that consisted of ultrasound Doppler of axillary and brachial vessels and the evaluation of AWS in 1, 3, and 6 months after breast cancer surgery. Women with advanced disease had a significantly higher incidence of AWS than those with early stage breast cancer (p = 0.02). In addition, women who underwent mastectomy or axillary lymph node dissection (ALND) had a significantly higher incidence of AWS in the 1-month (p < 0.01; p < 0.01) and 3-months (p < 0.01; p = 0.02) assessment rounds, respectively. The cross-sectional area of brachial artery was significantly smaller (p = 0.04) in women with AWS at the 3-months postoperative visit. The peak systolic velocity and the blood flow of the axillary artery was significantly higher in women with AWS 6 months after surgery (p < 0.03 and p = 0.02 respectively). CONCLUSION Our study confirm the combined changes of lymphatic and vascular systems in woman with AWS, since AWS was associated with more extensive dissection of axillary lymph nodes, compromised lymph nodes, and with abnormalities of the vascular parameters.
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Affiliation(s)
- Cintia Furlan
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Carolina Nascimben Matheus
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Rodrigo Menezes Jales
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,3 Radiology Sector, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Sophie Derchain
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Luís Otávio Sarian
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
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Huang HC, Liu HH, Yin LY, Yeh CH, Tu CW, Yang CS. The upper-limb volumetric changes in breast cancer survivors with axillary web syndrome. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28181311 DOI: 10.1111/ecc.12637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/28/2022]
Abstract
Whether upper-limb swelling is associated with axillary web syndrome (AWS) is unknown. We recruited unilateral breast cancer (BC) patients who were scheduled for surgical intervention and lymph node dissection. The pre-operative assessment and post-operative assessment 3-4 weeks after surgery evaluated the upper-limb circumferential measurements, segmental limb volume, pain scores, grasp, shoulder range of motion (ROM), shoulder muscle power and quality-of-life scores. In the control group, the peri-elbow volume and upper-arm volume were significantly higher post-operatively than pre-operatively. In the AWS group, no significant difference was found. In comparison with the control group, the AWS group had significantly more pain, less active ROM in shoulder abduction and a lower upper-limb volume at 0-10 cm proximal to the lateral epicondyle. The incidence of lymphedema was 9.9% and was not associated with AWS. AWS is a common morbidity of lymph node dissection and causes significant pain and restricted shoulder abduction in the affected limb in BC survivors. This study is the first to investigate post-operative upper-limb volumetric changes in BC survivors with and without AWS. Our findings are of great value for the clinical effect of AWS in BC survivors, for patient education, and for developing diagnostic tools for detecting AWS.
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Affiliation(s)
- H-C Huang
- Department of Physical Medicine and Rehabilitation, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - H-H Liu
- Department of Physical Medicine and Rehabilitation, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - L-Y Yin
- Department of Physical Medicine and Rehabilitation, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - C-H Yeh
- Department of Physical Medicine and Rehabilitation, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - C-W Tu
- Department of General Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - C-S Yang
- Department of Sports, Health, and Leisure, Tatung Institute of Technology, Chiayi City, Taiwan.,Department of Plastic Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
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Nieves Maldonado S, Pubul Núñez V, Argibay Vázquez S, Macías Cortiñas M, Ruibal Morell Á. Axillary web syndrome following sentinel node biopsy for breast cancer. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nieves Maldonado SM, Pubul Núñez V, Argibay Vázquez S, Macías Cortiñas M, Ruibal Morell Á. Axillary web syndrome following sentinel node biopsy for breast cancer. Rev Esp Med Nucl Imagen Mol 2016; 35:325-8. [PMID: 27246290 DOI: 10.1016/j.remn.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 04/08/2016] [Accepted: 04/18/2016] [Indexed: 11/16/2022]
Abstract
A 49 year-old woman diagnosed with infiltrating lobular breast carcinoma, underwent a right mastectomy and sentinel node biopsy (SLNB). The resected sentinel lymph nodes were negative for malignancy, with an axillary lymphadenectomy not being performed. In the early post-operative period, the patient reported an axillary skin tension sensation, associated with a painful palpable cord. These are typical manifestations of axillary web syndrome (AWS), a poorly known axillary surgery complication, from both invasive and conservative interventions. By presenting this case we want to focus the attention on a pathological condition, for which its incidence may be underestimated by not including it in SLNB studies. It is important for nuclear medicine physicians to be aware of AWS as a more common complication than infection, seroma, or lymphoedema, and to discuss this possible event with the patient who is consenting to the procedure.
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Affiliation(s)
- S M Nieves Maldonado
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España.
| | - V Pubul Núñez
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - S Argibay Vázquez
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - M Macías Cortiñas
- Servicio de Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Á Ruibal Morell
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
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A systematic review of axillary web syndrome (AWS). J Cancer Surviv 2015; 9:576-98. [PMID: 25682072 DOI: 10.1007/s11764-015-0435-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/27/2015] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Axillary web syndrome (AWS) can result in early post-operative and long-term difficulties following lymphadenectomy for cancer and should be recognised by clinicians. This systematic review was conducted to synthesise information on AWS clinical presentation and diagnosis, frequency, natural progression, grading, pathoaetiology, risk factors, symptoms, interventions and outcomes. METHODS Electronic searches were conducted using Cochrane, Pubmed, MEDLINE, CINAHL, EMBASE, AMED, PEDro and Google Scholar until June 2013. The methodological quality of included studies was determined using the Downs and Black checklist. Narrative synthesis of results was undertaken. RESULTS Thirty-seven studies with methodological quality scores ranging from 11 to 26 on a 28-point scale were included. AWS diagnosis relies on inspection and palpation; grading has not been validated. AWS frequency was reported in up to 85.4 % of patients. Biopsies identified venous and lymphatic pathoaetiology with five studies suggesting lymphatic involvement. Twenty-one studies reported AWS occurrence within eight post-operative weeks, but late occurrence of greater than 3 months is possible. Pain was commonly reported with shoulder abduction more restricted than flexion. AWS symptoms usually resolve within 3 months but may persist. Risk factors may include extensiveness of surgery, younger age, lower body mass index, ethnicity and healing complications. Low-quality studies suggest that conservative approaches including analgesics, non-steroidal anti-inflammatory drugs and/or physiotherapy may be safe and effective for early symptom reduction. CONCLUSIONS AWS appears common. Current evidence for the treatment of AWS is insufficient to provide clear guidance for clinical practice. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors should be informed about AWS. Further investigation is needed into pathoaetiology, long-term outcomes and to determine effective treatment using standardised outcomes.
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