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Komen for the Cure","doi-asserted-by":"publisher","award":["PDF15329262"],"award-info":[{"award-number":["PDF15329262"]}],"id":[{"id":"10.13039\/100000869","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002280","name":"Plastic Surgery Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002280","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal Orthopaedic Research"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Subpectoral implants for breast reconstruction after mastectomy requires the surgical disinsertion of the sternocostal fiber region of the pectoralis major. This technique is associated with significant shoulder strength and range of motion deficits, but it is unknown how it affects the underlying integrity of the shoulder joint or pectoralis major. The aim of this study was to characterize the long\u2010term effects of this reconstruction approach on shoulder joint stiffness and pectoralis major material properties. Robot\u2010assisted measures of shoulder strength and stiffness and ultrasound shear wave elastography images from the pectoralis major were acquired from 14 women an average of 549 days (range: 313\u2013795 days) post reconstruction and 14 healthy, age\u2010matched controls. Subpectoral implant patients were significantly weaker in shoulder adduction (<jats:italic>p\u2009&lt;\u2009<\/jats:italic>0.001) and exhibited lower shoulder stiffness when producing submaximal adduction torques (<jats:italic>p\u2009=\u2009<\/jats:italic>0.004). The underlying material properties of the clavicular fiber region of the pectoralis major were altered in subpectoral implant patients, with significantly reduced shear wave velocities in the clavicular fiber region of the pectoralis major when generating adduction torques (<jats:italic>p\u2009=\u2009<\/jats:italic>0.023). The clinical significance of these findings are that subpectoral implant patients do not fully recover shoulder strength or stability in the long\u2010term, despite significant recovery time, and substantial shoulder musculature left intact. The impact of these procedures extends to the remaining, intact volume of the pectoralis major. Optimization of shoulder function should be a key aspect of the post\u2010reconstruction standard of care. \u00a9 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. 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