Evidence map›Paper›PMID 33009332›Full record

ArticlePlastic and reconstructive surgery2021

The Influence of Functional Shoulder Biomechanics as a Mediator of Patient-Reported Outcomes following Mastectomy and Breast Reconstruction.

Joshua M Leonardis, Daniel A Lyons, Kelley M Kidwell, Aviram M Giladi, David B Lipps, Adeyiza O Momoh

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Plastic and reconstructive surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Development of a breast reconstruction-specific computational model to predict shoulder function in breast cancer survivors.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Joshua M LeonardisFrom the School of Kinesiology, the Department of Biostatistics, School of Public Health, and the Department of Biomedical Engineering, University of Michigan; the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System; and The Curtis National Hand Center, MedStar Union Memorial Hospital.
Daniel A LyonsFrom the School of Kinesiology, the Department of Biostatistics, School of Public Health, and the Department of Biomedical Engineering, University of Michigan; the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System; and The Curtis National Hand Center, MedStar Union Memorial Hospital.
Kelley M KidwellFrom the School of Kinesiology, the Department of Biostatistics, School of Public Health, and the Department of Biomedical Engineering, University of Michigan; the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System; and The Curtis National Hand Center, MedStar Union Memorial Hospital.
Aviram M GiladiFrom the School of Kinesiology, the Department of Biostatistics, School of Public Health, and the Department of Biomedical Engineering, University of Michigan; the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System; and The Curtis National Hand Center, MedStar Union Memorial Hospital.
David B LippsFrom the School of Kinesiology, the Department of Biostatistics, School of Public Health, and the Department of Biomedical Engineering, University of Michigan; the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System; and The Curtis National Hand Center, MedStar Union Memorial Hospital.
Adeyiza O MomohFrom the School of Kinesiology, the Department of Biostatistics, School of Public Health, and the Department of Biomedical Engineering, University of Michigan; the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System; and The Curtis National Hand Center, MedStar Union Memorial Hospital.

Funding

Improving the assessment and diagnosis of shoulder morbidity following mastectomy with breast reconstructionR03HD097704 · NICHD · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI LIPPS, DAVID B · 2019 to 2020
$298k
NICHD NIH HHS R03 HD097704
6 · The paper itself

Abstract

backgroundPostmastectomy breast reconstruction techniques differentially influence patient-reported physical and psychosocial well-being. Objective measures of shoulder biomechanics, which are uniquely influenced by reconstruction technique, may provide insight into the influence of reconstruction technique on patient-reported outcomes.

methodsRobot-assisted measures of shoulder strength and stiffness, and five validated patient-reported outcomes surveys were obtained from 46 women who had undergone mastectomy and a combined latissimus dorsi flap plus subpectoral implant, subpectoral implant, or DIEP flap breast reconstruction. Mediation analyses examined the role of functional shoulder biomechanics as a mediator between reconstruction technique and patient-reported outcomes.

resultsReconstruction technique affected shoulder biomechanics, with latissimus dorsi flap plus subpectoral implant patients exhibiting reduced shoulder strength and stiffness compared with subpectoral implant and DIEP flap patients. Increasing external rotation strength was predictive of improved upper extremity function (p = 0.04). Increasing shoulder stiffness while at rest was predictive of worsened upper extremity function (p = 0.03). Increasing shoulder stiffness at rest and during contraction was indicative of worsened psychosocial well-being (all p ≤ 0.02). Reconstruction technique did not predict survey scores of function directly, or when mediated by functional shoulder biomechanics.

conclusionsIn the current cohort, latissimus dorsi plus subpectoral implant breast reconstructions significantly reduced shoulder strength and stiffness when compared with the other techniques. In addition, objective measures of shoulder biomechanics were predictive of patient-reported physical and psychosocial well-being. The results emphasize the need for improved perioperative screening for shoulder functional deficits in patients undergoing breast reconstruction. CLINICAL QUESITON/LEVEL OF EVIDENCE: Therapeutic, II.

Indexed as

Patient Reported Outcome MeasuresQuality of LifeAdultBiomechanical PhenomenaBreastBreast ImplantsBreast NeoplasmsFemaleHumansMammaplastyMastectomyMiddle AgedPectoralis MusclesRetrospective StudiesShoulder JointSuperficial Back Muscles

Identifiers

PMID33009332
PMCPMC7770065

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.