Clinical trial NCT02491762: The Effect of Breast Reconstruction Surgery Using Tissue Expanders on Respiratory Functions
Official title: The Effect of Breast Reconstruction Surgery Using Tissue Expanders on Respiratory Functions
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Respiratory Function
Breast Reconstruction
Keywords: Serratus Anterior
Accessory Respiratory
Tissue Expander
Respiratory Function Tests
Lead sponsor: Carmel Medical Center
Sponsor class: OTHER
First posted: 2015-07-08
Enrollment: 45
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 90
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: patients elected for breast reconstruction surgery using tissue expander-implant technique

Brief summary: This study evaluates the effect of breast reconstruction surgery on respiratory functions. 45 patients elected for unilateral or bilateral breast reconstruction surgery will go through respiratory function examinations a month prior to the surgery, one month after surgery and three months after surgery.

Detailed description: Breast reconstruction surgery using tissue expander and implant technique is the most common breast reconstruction surgery. During this procedure, the surgeon will insert a silicone expander under the Pectoralis Major muscle. In order to fully cover the expander, the surgeon will detach the Serratus Anterior \[SA\] muscle from its natural attachments in the rib cage and will attach the free edges to the lateral edge of the Pectoralis Major muscle. After the wound is healed, a gradual inflation of the expander with a physiological fluid will be done by injecting the fluid into a subcutaneous filling port connected to the expander by silicone tubing. When the tissues around the expander will reach the required size, the tissue expander can be replaced by a permanent silicone implant.

The SA attachments are to the superior angle, medial border and inferior angle of the scapula and to the first to eighth ribs. Its main functions are stabilization and protraction of the scapula and turning the glenoid cavity superiorly in abduction of arms. In addition, the SA is an accessory respiratory muscle: when the scapula is stabilized, its contraction will lift the rib cage in order to help breathing. The importance of the SA in breathing has been examined since the late 19th century and until this day it is not fully agreed upon. Most studies agree that the SA major role in breathing is in deep breaths and is that the muscle is most effective for this purpose when arms are lifted.

Since breast reconstruction procedure includes detachment of the SA from the rib cage and there by canceling its respiratory function, an examination of the respiratory functions before and after the procedure is in order to determine whether or not the overall respiratory functions had been effected.

45 patients elected for unilateral or bilateral breast reconstruction surgery will go through respiratory function examinations a month prior to the surgery, one month after surgery and three months after surgery. The examinations will include the following tests: Spirometry: FVC, FEV1, MVV. Lung capacities: FRC, RV, TLC. Breathing muscle strength: MIP, MEP.

Eligibility criteria: Inclusion Criteria:

* all subjects were elected for a unilateral or bilateral breast reconstruction using tissue expander by the Oncoplastic Committee of the plastic surgery unit in Carmel Medical Center.
* all subjects agrees to enroll in research

Exclusion Criteria:

* subject is in a mental or physical condition that does not allow her to go through respiratory function tests.
* subject was found with a respiratory disfunction or disease in the first respiratory function tests.

Primary outcomes:
measure: Forced vital capacity -FVC
timeFrame: a month prior to surgery
measure: Forced expiratory volume at one second -FEV1
timeFrame: a month prior to surgery
measure: Maximum voluntary ventilation-MVV
timeFrame: a month prior to surgery
measure: Functional residual capacity-FRC
timeFrame: a month prior to surgery
measure: Residual volume -RV
timeFrame: a month prior to surgery.
measure: Total lung capacity-TLC
timeFrame: a month prior to surgery.
measure: Maximal inspiratory pressure-MIP
timeFrame: a month prior to surgery.
measure: Maximal expiratory pressure-MEP
timeFrame: a month prior to surgery.
measure: Forced vital capacity -FVC
timeFrame: a month after surgery
measure: Forced vital capacity -FVC
timeFrame: three months after surgery
measure: Forced expiratory volume at one second -FEV1
timeFrame: a month after surgery
measure: Forced expiratory volume at one second -FEV1
timeFrame: three months after surgery
measure: Maximum voluntary ventilation-MVV
timeFrame: a month after surgery
measure: Maximum voluntary ventilation-MVV
timeFrame: three months after surgery
measure: Functional residual capacity-FRC
timeFrame: a month after surgery
measure: Functional residual capacity-FRC
timeFrame: three months after surgery
measure: Residual volume -RV
timeFrame: a month after surgery
measure: Residual volume -RV
timeFrame: three months after surgery
measure: Total lung capacity-TLC
timeFrame: a month after surgery.
measure: Total lung capacity-TLC
timeFrame: three months after surgery.
measure: Maximal inspiratory pressure-MIP
timeFrame: a month after surgery
measure: Maximal inspiratory pressure-MIP
timeFrame: three months after surgery.
measure: Maximal expiratory pressure-MEP
timeFrame: a month after surgery.
measure: Maximal expiratory pressure-MEP
timeFrame: three months after surgery.
Secondary outcomes:
Other outcomes:
Locations:
city: Haifa
country: Israel
facility: Carmel Medical Center
Study officials:
affiliation: Carmel Medical Center-Israel
name: Yaron Har-Shai, Proffesor
role: PRINCIPAL_INVESTIGATOR
References:
citation: Terakado S, Takeuchi T, Miura T, Sato H, Nishioka N, Fujieda Y, Kobayashi R, Ibukiyama C. Early occurrence of respiratory muscle deoxygenation assessed by near-infrared spectroscopy during leg exercise in patients with chronic heart failure. Jpn Circ J. 1999 Feb;63(2):97-103. doi: 10.1253/jcj.63.97.
citation: Legrand R, Marles A, Prieur F, Lazzari S, Blondel N, Mucci P. Related trends in locomotor and respiratory muscle oxygenation during exercise. Med Sci Sports Exerc. 2007 Jan;39(1):91-100. doi: 10.1249/01.mss.0000241638.90348.67.
citation: Legrand R, Prieur F, Marles A, Nourry C, Lazzari S, Blondel N, Mucci P. Respiratory muscle oxygenation kinetics: relationships with breathing pattern during exercise. Int J Sports Med. 2007 Feb;28(2):91-9. doi: 10.1055/s-2006-924056. Epub 2006 Jul 12.
citation: Lomax M, Tasker L, Bostanci O. An electromyographic evaluation of dual role breathing and upper body muscles in response to front crawl swimming. Scand J Med Sci Sports. 2015 Oct;25(5):e472-8. doi: 10.1111/sms.12354. Epub 2014 Dec 30.
citation: Machado de Sousa O, Costacurta L. Electromyographic study of the M. serratus anterior during respiration. Electromyogr Clin Neurophysiol. 1984 Nov-Dec;24(7):547-59. No abstract available.
citation: Mancini DM, Ferraro N, Nazzaro D, Chance B, Wilson JR. Respiratory muscle deoxygenation during exercise in patients with heart failure demonstrated with near-infrared spectroscopy. J Am Coll Cardiol. 1991 Aug;18(2):492-8. doi: 10.1016/0735-1097(91)90605-9.
citation: Matusiewicz AK, Carter AE, Landes RD, Yi R. Statistical equivalence and test-retest reliability of delay and probability discounting using real and hypothetical rewards. Behav Processes. 2013 Nov;100:116-22. doi: 10.1016/j.beproc.2013.07.019. Epub 2013 Aug 14.
citation: Moalla W, Dupont G, Berthoin S, Ahmaidi S. Respiratory muscle deoxygenation and ventilatory threshold assessments using near infrared spectroscopy in children. Int J Sports Med. 2005 Sep;26(7):576-82. doi: 10.1055/s-2004-830332.
citation: Ogata H, Arimitsu T, Matsuura R, Yunoki T, Horiuchi M, Yano T. Relationship between oxygenation in inactive biceps brachii muscle and hyperventilation during leg cycling. Physiol Res. 2007;56(1):57-65. doi: 10.33549/physiolres.930888. Epub 2006 Feb 23.
citation: Ogata H, Reyihan A, Yano T. Kinetics of oxygenation in inactive forearm muscle during ramp leg cycling. J Physiol Anthropol Appl Human Sci. 2004 Jan;23(1):7-17. doi: 10.2114/jpa.23.7.
citation: Reid DC, Bowden J, Lynne-Davies P. Role of selected muscles of respiration as influenced by posture and tidal volume. Chest. 1976 Nov;70(5):636-40. doi: 10.1378/chest.70.5.636.
citation: TOKIZANE T, KAWAMATA K, TOKIZANE H. Electromyographic studies on the human respiratory muscles; studies on the activity pattern of neuromuscular units. Jpn J Physiol. 1952 Feb;2(3):232-47. doi: 10.2170/jjphysiol.2.232. No abstract available.
citation: Tsoi B, Ziolkowski NI, Thoma A, Campbell K, O'Reilly D, Goeree R. Systematic review on the patient-reported outcomes of tissue-expander/implant vs autologous abdominal tissue breast reconstruction in postmastectomy breast cancer patients. J Am Coll Surg. 2014 May;218(5):1038-48. doi: 10.1016/j.jamcollsurg.2014.02.011. Epub 2014 Feb 19. No abstract available.
citation: Wang L, Yoshikawa T, Hara T, Nakao H, Suzuki T, Fujimoto S. Which common NIRS variable reflects muscle estimated lactate threshold most closely? Appl Physiol Nutr Metab. 2006 Oct;31(5):612-20. doi: 10.1139/h06-069.
citation: Cannon DT, Grout SL, May CA, Strom SD, Wyckoff KG, Cipriani DJ, Buono MJ. Recruitment of the serratus anterior as an accessory muscle of ventilation during graded exercise. J Physiol Sci. 2007 Apr;57(2):127-31. doi: 10.2170/physiolsci.RP001807. Epub 2007 Apr 6.
citation: Cerqueira EP, Garbellini D. Electromyographic study of the pectoralis major, serratus anterior and external oblique muscles during respiratory activity in humans. Electromyogr Clin Neurophysiol. 1999 Apr-May;39(3):131-7.
citation: Chawla AK, Kachnic LA, Taghian AG, Niemierko A, Zapton DT, Powell SN. Radiotherapy and breast reconstruction: complications and cosmesis with TRAM versus tissue expander/implant. Int J Radiat Oncol Biol Phys. 2002 Oct 1;54(2):520-6. doi: 10.1016/s0360-3016(02)02951-6.
citation: Fischer JP, Wes AM, Nelson JA, Basta M, Rohrbach JI, Wu LC, Serletti JM, Kovach SJ. Propensity-matched, longitudinal outcomes analysis of complications and cost: comparing abdominal free flaps and implant-based breast reconstruction. J Am Coll Surg. 2014 Aug;219(2):303-12. doi: 10.1016/j.jamcollsurg.2014.02.028. Epub 2014 Apr 8.
citation: Gallistel CR. The importance of proving the null. Psychol Rev. 2009 Apr;116(2):439-53. doi: 10.1037/a0015251.
citation: GRONBAEK P, SKOUBY AP. The activity pattern of the diaphragm and some muscles of the neck and trunk in chronic asthmatics and normal controls. A comparative electromyographic study. Acta Med Scand. 1960 Dec 20;168:413-25. doi: 10.1111/j.0954-6820.1960.tb06672.x. No abstract available.
citation: JEFFERSON NC, OGAWA T, SYLEOS C, ZAMBETOGLOU A, NECHELES H. Restoration of respiration by nerve anastomosis. Am J Physiol. 1960 May;198:931-3. doi: 10.1152/ajplegacy.1960.198.5.931. No abstract available.
citation: Johnson BD, Babcock MA, Suman OE, Dempsey JA. Exercise-induced diaphragmatic fatigue in healthy humans. J Physiol. 1993 Jan;460:385-405. doi: 10.1113/jphysiol.1993.sp019477.