Incidence and risk factors for winged scapula after surgical treatment for breast cancer

Authors

  • Adriana de S Mastrella BSc, MsHSc,

    Physical Therapist
    1. Mastology Program, Hospital das Clinicas of the Federal University of Goiás, Goiânia, Brazil
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  • Ruffo Freitas-Junior MD, PhD,

    Professor, Corresponding author
    1. Mastology Program, Hospital das Clinicas of the Federal University of Goiás, Goiânia, Brazil
    • Correspondence: Ruffo Freitas-Junior, MD, PhD, Professor, Programa de Mastologia do Hospital das Clínicas da Universidade Federal de Goiás, 1ª Avenida, s/n, Setor Universitário, 74605-050 Goiânia, Goiás, Brasil. Telephone: +(5562) 39454769.

      E-mail: ruffojr@terra.com.br

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  • Régis R Paulinelli MD, PhD,

    Professor
    1. Mastology Program, Hospital das Clinicas of the Federal University of Goiás, Goiânia, Brazil
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  • Leonardo R Soares MD

    Post Graduate Student
    1. Mastology Program, Hospital das Clinicas of the Federal University of Goiás, Goiânia, Brazil
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  • This study was conducted in the Goiânia Network for Research on Mastology.

Abstract

Aims and objectives

To evaluate the incidence of winged scapula following surgical breast cancer treatment, determine its evolution over time and correlate factors that might influence this incidence.

Background

Winged scapula is a complication that may occur as a result of exposing the long thoracic nerve during axillary lymphadenectomy for the treatment for breast cancer. There is no consensus in the literature about the incidence of this complication after surgical treatment for breast cancer, and complication rates range from 1·5–74%.

Design

This is a prospective cohort study.

Methods

A prospective cohort study was conducted including 57 patients with breast cancer who underwent surgical treatment. Each patient was assessed before and after the surgery, by means of Hoppenfeld manoeuvre. The incidence rate of winged scapula was calculated at four different times.

Results

At the preoperative assessment, none of the patients presented with winged scapula, while 16 patients (28·1%) were shown to have this complication after the procedure. The incidence of winged scapula decreased over time. Factors associated with winged scapula were as follows: patients younger than 50 years, clinical stage I and II and no neoadjuvant chemotherapy. Other factors that were evaluated, such as type of surgery, number of lymph nodes compromised and removed, as well as body mass index, were not associated with the risk of winged scapula.

Conclusions

This study demonstrated that the incidence of winged scapula is low and decreased over time. Furthermore, a greater incidence of winged scapula was noted in young women at an initial stage of the disease who had not been treated with neoadjuvant chemotherapy.

Relevance to clinical practice

The result of this work may have great impact, for demonstrating what risk factors are significantly associated with winged scapula after surgical treatment for breast cancer.

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