ORIGINAL ARTICLE Luiz Felipe Nevola Teixeira & Visnu Lohsiriwat & Mario Casales Schorr & Alberto Luini & Viviana Galimberti & Mario Rietjens & Cristina Garusi & Sara Gandini & Luis Otavio Zanatta Sarian & Fabio Sandrin & Maria Claudia Simoncini & Paolo Veronesi Received: 31 July 2013 /Accepted: 8 January 2014 /Published online: 4 February 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract Purpose Axillary lymph node dissection is part of breast cancer surgery, and winged scapula is a possible sequela. Data regarding its incidence, predictive factors, and patient prog- nosis remains inconsistent. Ignorance of its diagnosis may lead to undertreatment with physical morbidity. Methods Breast cancer patients with axillary lymph node dissection were prospectively recruited. Postoperative exami- nations by the physiotherapy staff were performed. Results One hundred eighty-seven patients were recruited during July-October 2012; 51 patients had a positive diagnosis (27.2 %), with 38 patients (86 %) who recovered completely from the winged scapula, while 6 patients (13 %) still had winged scapula at 6 months after surgery. One hundred thirty patients underwent mastectomy and 100 cases had immediate reconstruction. Age, BMI, previous shoulder joint morbidity, and breast surgery were not associated with winged scapula. Neoadjuvant treatment, mastectomy or conservative surgery, immediate reconstruction, tumor size, and nodal involvement also did not show any correlation. Breast reconstruction with prosthesis, even with serratus muscle dissection, does not increase the incidence of winged scapula. Conclusion Winged scapula is not an uncommon incidence after breast cancer surgery. Physiotherapy is related to the complete recovery. The severity or grading of the winged scapula and the recovery time after physiotherapy should be investigated in the future studies. Keywords Breast neoplasms . Breast reconstruction . Lymph node dissection, physiotherapy, rehabilitation Introduction Even though breast cancer is considered a systemic disease, the significance of local disease control cannot be overlooked [1, 2]. The surgical procedure tends toward less radical sur- gery for both breast and axillary regions without compromis- ing oncologic control, overall survival, and disease-free sur- vival [3–7]. However a certain number of patients who have undergone axillary surgery are still associated with postsurgi- cal treatment sequelae such as arm pain, numbness, weakness, stiffness, and swelling [8]. One of these complications is long thoracic nerve injury, which leads to functional deficit of the serratus anterior muscle. This muscle is responsible for stabi- lizing the medial and lower borders of the scapula to the chest wall. Injury to the long thoracic nerve and consequent dys- function of the serratus anterior muscle cause the posterior L. F. Nevola Teixeira (*) : F. Sandrin : M. C. Simoncini Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy e-mail: LuizFelipe.NevolaTeixeira@ieo.it V. Lohsiriwat : M. C. Schorr : M. Rietjens : C. Garusi Division of Plastic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy V. Lohsiriwat Department of Surgery, Mahidol University School of Medicine, 2 Prannok Rd, Bangkoknoi, Bangkok 10700, Thailand M. C. Schorr Universidade Federal de Ciencias da Saude de Porto Alegre, Rua Sarmento Leite, 245, 90050-170 Porto Alegre, Brazil A. Luini : V. Galimberti : P. Veronesi Division of Senology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy S. Gandini Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy L. O. Z. Sarian Medical Sciences Department, University of Campinas, Zeferino Vaz SN—Cidade Universitaria, Campinas 13083-970, Brazil Support Care Cancer (2014) 22:1611–1617 DOI 10.1007/s00520-014-2125-3 Incidence, predictive factors, and prognosis for winged scapula in breast cancer patients after axillary dissection