Avaliação do equilíbrio postural estático e força muscular dos membros superiores em mulheres submetidas à reconstrução imediata da mama após mastectomia por câncer

Abstract

Introduction: Surgical treatment of breast cancer may involve partial or total removal of the affected breast, which can lead to neurobiomechanical changes related to posture, balance, and upper limb motor performance. Therefore, studying these repercussions is important. Objective: The aim of this research is to evaluate motor performance in the upper limbs and postural balance in women who underwent mastectomy for breast cancer followed by immediate breast reconstruction. Material and Methods: We initiated with a scoping review of the subject. Subsequently, a prospective, observational, longitudinal study was conducted with 10 women undergoing mastectomy for breast cancer and immediate reconstruction with latissimus dorsi or pectoralis major muscle flap. The measurements were performed in a private clinic, with pre- and 30-day postoperative assessments. Anthropometric assessments, physical activity level, and lateral preference were performed using an interviewer-administered questionnaire. Upper limb motor assessments were performed using handheld isometric dynamometry and shoulder isometric dynamometry to evaluate extension, flexion, abduction, adduction, horizontal flexion-adduction, and horizontal extension-abduction. Postural balance was assessed with a baropodometer by measuring center of pressure oscillation during the following tasks: eyes open and feet apart, eyes open and feet together, eyes closed and feet apart, and eyes closed and feet together. Results: The scoping review confirmed the scarcity of published studies on this topic. The women had a mean age of 54.1 years, and mostly presented right side limb preference. Seven out of 10 participants were sedentary, 4 underwent surgery on the right breast, while 6 on the left breast. Nine participants underwent reconstruction using the pectoralis major muscle flap, whereas one used latissimus dorsi muscle flap. Participant evaluations showed no significant differences in balance assessment or manual dynamometry. In the shoulder motor assessment, we found significant differences between pre- and postoperative periods in exercises that used the pectoralis major and latissimus dorsi muscles: flexion, horizontal flexionadduction, and horizontal extension-abduction. Conclusion: We concluded that immediate breast reconstruction surgery with latissimus dorsi or pectoralis major flap caused a decrease in motor performance in flexion, horizontal flexion-adduction and horizontal extension-abduction activities of the upper limb in compared measurements between pre- and 30-day postoperative. As of the postural balance, no statisticaly significant difference was observed comparing pre and postoperation. However, there was a tendency toward adecrease, of the center of presure. The results highlight the needs of postoperation muscle strengthening.