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Improving the assessment and diagnosis of shoulder morbidity following mastectomy with breast reconstruction

改善乳房切除术后肩部发病率的评估和诊断

基本信息

批准号：
9912793
负责人：
David B Lipps
金额：
$ 14.89万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-10 至 2022-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9912793
关键词：
Abdomen Address Adjuvant Radiotherapy Adoption Anatomy Assessment tool Autologous Breast Breast Cancer Patient Breast Cancer survivor Chest Chest wall structure Chronic Cosmetics Development Diagnosis Early Diagnosis Epigastric Evaluation Functional disorder Future Goals Image Implant Implantation procedure Inferior Intervention Investigation Joint structure of shoulder region Knowledge Late Effects Malignant Neoplasms Mammaplasty Mastectomy Measures Mechanics Medical center Methods Mission Morbidity - disease rate Muscle Musculoskeletal System Operative Surgical Procedures Outcome Outcome Measure Patient Outcomes Assessments Patients Perioperative Physiological Postoperative Care Postoperative Period Prevention Preventive Procedures Prognostic Marker Public Health Quality of life Radiation Radiation therapy Reconstructive Surgical Procedures Reporting Research Shoulder Shoulder Pain Sternum Surgical Flaps Surveys Technology Testing Therapeutic Therapeutic Intervention Tissue Expanders Tissues Ultrasonography Upper Extremity Variant Vertebral column Woman Work arm base cancer recurrence clinical practice cohort cost elastography follow-up functional outcomes functional status impaired driving performance improved innovation novel diagnostics operation pectoralis major muscle performance based measurement prospective psychosocial radiation effect reconstruction rehabilitation research rib bone structure standard of care

项目摘要

Mastectomy rates in the U.S. are increasing, driven by more breast cancer patients opting for a mastectomy with breast reconstruction. The cosmetic and psychosocial benefits to post-mastectomy breast reconstruction may come at a significant functional cost given the invasiveness of these procedures to the musculoskeletal system. It is critical that we understand the functional impact of different breast reconstruction approaches to help us enhance the availability of reconstruction surgeries within minimal functional impact and to better identify patients who will need therapeutic interventions as no standard of post-operative care currently exists. Our long term goal is to alleviate functional deficits following breast reconstruction by improving existing surgical approaches to lessen functional morbidity and enhancing the early detection of patients predisposed to shoulder morbidity. The overall objectives of this proposal is to begin addressing our goal by using ultrasound shear wave elastography (SWE) to identify reconstruction surgeries that significantly impact the pectoralis major, and by determining if these SWE measures can predict post-operative functional deficits. Our central hypothesis is that reconstructive procedures that require muscle disinsertion produce greater mechanical deficits of the pectoralis major and poorer upper extremity functional outcomes. The rationale for our proposed study is that it will allow us to identify the precursors of functional deficits in breast reconstruction patients. We will test our hypothesis by pursing two specific aims: 1) Determine how variations in surgical approaches to immediate or delayed breast reconstruction impact the mechanical integrity of the pectoralis major; and 2) Identify how post-operative mechanical changes to the pectoralis major relate to upper extremity functional status and quality of life. Under the first aim, breast cancer patients undergoing four different approaches to breast reconstruction will have the stiffness of the pectoralis major muscle prospectively evaluated with SWE. Under the second aim, these prospective evaluations of the pectoralis major will be associated with performance-based measures of upper extremity functional status and validated patient reported outcomes. The approach is innovative, in the applicant's opinion, because it presents a new and substantive method for evaluating post-operative function in patients following breast reconstruction, and is an important first step in validating this technology as a prognostic biomarker for future shoulder morbidity. The proposed research is significant, because it is expected to have broad translational importance for the prevention and treatment of shoulder morbidity in breast reconstruction patients. We expect these findings will immediately impacting clinical practice, including the adoption of surgical approaches with significantly reduced functional morbidity and bringing new focus to the for active surveillance in reconstruction patients whose procedures predispose them to functional morbidity. Ultimately, such knowledge has the potential to inform the development of a new standard of care for breast cancer patients in the U.S.

项目成果

期刊论文数量（6）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Neuromuscular compensation strategies adopted at the shoulder following bilateral subpectoral implant breast reconstruction.

DOI：
10.1016/j.jbiomech.2021.110348
发表时间：
2021-05-07
期刊：
JOURNAL OF BIOMECHANICS
影响因子：
2.4
作者：
Leonardis, Joshua M.;Wolff, Whitney L.;Momoh, Adeyiza O.;Lipps, David B.
通讯作者：
Lipps, David B.

Age and sex influence the activation-dependent stiffness of the pectoralis major.

年龄和性别影响胸大肌的激活依赖性僵硬度。

DOI：
10.1111/joa.13455
发表时间：
2021
期刊：
Journal of anatomy
影响因子：
2.4
作者：
Setlock,CherylA;Lulic-Kuryllo,Tea;Leonardis,JoshuaM;Kulik,Madison;Lipps,DavidB
通讯作者：
Lipps,DavidB

Assessing shoulder muscle stretch reflexes following breast cancer treatment and postmastectomy breast reconstruction.

评估乳腺癌治疗和乳房切除术后乳房重建后的肩部肌肉牵张反射。