A client of mine has been diagnosed with breast cancer. Her doctors have suggested a back flap (where they bring the latissimus dorsi around to the chest). The research I’ve done explains briefly that it can impair muscle power for some sports such as tennis or swimming. My client is a keen golfer and tennis player. Would the back flap impair power? Does the whole latissimus come around? Would it affect her golf swing, and will she have full range of movement after rehabilitating?
This response is not intended to substitute for medical advice.
The questions you raise are thought provoking and relevant. A mastectomy involves removal of breast tissue possibly accompanied by an axillary dissection, which is lymph node removal. As a result, there can be scar tissue in the breast area as well as in the axillary region (armpit). This scar tissue in the pectoralis area especially can limit mobility for shoulder external rotation and abduction. In addition, the axillary lymph node dissection can be a factor in the development of lymphedema. This can complicate one’s ability to exercise in the usual manner.
Breast reconstruction is the surgical procedure to build the breast after a mastectomy (simple or modified radical). It can be performed immediately after a mastectomy or even years later. There are several options including a breast implant, taking muscle, skin and fat from the stomach (TRAM flap) or from the back (lat flap). For the lat flap, the latissimus dorsi (on the affected side only) is slid under the skin to the breast area. It is then shaped and sewn into place. Blood vessels that were cut during surgery are reattached. There may not be enough tissue, so an implant may be necessary. The implant is placed behind the new tissue. Complications can include a build up of scar tissue or rupture. The lat flap is considered an excellent method of breast reconstruction and is useful for women who are not good candidates for abdominally based flaps. However, the back may appear uneven after the procedure. Function and strength are not usually affected, but this can vary from woman to woman and will depend on activity level and type.
Let’s look at the function of the latissimus dorsi. It is a powerful shoulder extensor, shoulder adductor and internal rotator along with pectoralis major. Normally the internal rotators are stronger than the external rotators. We have a loss of power and flexibility, which could theoretically affect your client’s mobility and strength for activities such as golf and tennis. Your client must undergo rehabilitation after surgery for at least six weeks with an occupational or physical therapist to maximize function. The return of your client to her beloved activities should be done in a gradual manner secondary to risk of lymphedema. Range of motion is the priority, then strengthening. In addition, you should network with the rehabilitation provider to ensure your client’s safety during training. He or she will be able to recommend appropriate exercises. Following these recommendations will optimize your client’s recovery.