Differential effect of anthracycline and trastuzumab cancer therapeutic related vascular toxicity in patients with breast cancer

Abstract Introduction Both anthracyclines and trastuzumab are key regiments for the treatment of breast cancer, but their concurrent use is contraindicated because of their cardiotoxicity. Their effects on vascular function have been less well studied. Purpose We explored the effects of the anthracycline-based chemotherapy followed by trastuzumab-based treatment on endothelial function and arterial stiffness in patients with breast cancer. Methods 46 female patients (54.56±11.5 years old) with breast cancer scheduled for anthracycline-based chemotherapy followed by the combination of trastuzumab and taxane were enrolled. Trastuzumab was continued until the completion of one-year treatment. All participants underwent assessment of the brachial flow mediated dilatation (FMD), endothelial independent dilatation (EID), carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx) at baseline (BL), at the end of anthracycline treatment (FU1), 3 months following initiation of trastuzumab with taxane (FU2) and at the completion of treatment with trastuzumab (FU3). Results Over the follow-up period (15 months) there was significant deterioration in FMD (p=0.04) (Table 1, Figure 1). Importantly, while there was no significant difference in FMD between BL vs FU1 (p=0.6), FMD has been significantly deteriorated over the treatment with trastuzumab with taxane FU1 vs FU2 (p=0.01) and FU2 vs FU3 (p=0.01) (Table 1, Figure 1). EID did not change over the follow-up period (Figure 1). Similarly, PWV has been significantly increased over the follow up period (p=0.03). There was no significant difference in PWV BL vs FU1 (p=0.1), however PWV has been significantly increased over the treatment with trastuzumab with taxane FU1 vs FU 2 (p=0.02) and FU2 vs FU3 (p=0.01) (Table 1, Figure 1). A similar pattern of impairment was observed with AIx (Table 1, Figure 1). Conclusion We report a significant adverse effect of the anthracycline- and trastuzumab-based therapy on the arterial stiffness and endothelial function. This effect is more considerable after the exposure to trastuzumab. Figure 1. Changes of FMD, PWV, Alx, EID during FU Funding Acknowledgement Type of funding source: None

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Abstract 380: Favorable Effects of Flavonoids on Endothelial Function and Arterial Stiffness in Healthy Smokers

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.32.suppl_1.a380 ◽

2012 ◽

Vol 32 (suppl_1) ◽

Author(s):

Eleni Kokkou ◽

Gerasimos Siasos ◽

Dimitrios Tousoulis ◽

Evangelos Oikonomou ◽

Marilena Kollia ◽

...

Keyword(s):

Arterial Stiffness ◽

Cigarette Smoking ◽

Endothelial Function ◽

Vascular Function ◽

Augmentation Index ◽

Oral Treatment ◽

Grape Juice ◽

Arterial Tree ◽

Significant Difference ◽

Concord Grape

Background: Smoking is associated with impaired vascular function. Consumption of concord grape juice (CGJ), a rich source of flavonoids, has previously been shown to have antithrombotic and antioxidant effects and moreover can modify cardiovascular risk factors. In the present study we assessed the hypothesis that CGJ can improve endothelial function and arterial stiffness in healthy smokers. Methods: We studied the effect of a 2 weeks oral treatment with 7cc/Kg/day of CGJ (Welch’s 100% Concord Grape) in 20 healthy smokers (aged 26±5y) on two occasions (day 0: baseline and day 14). The study was carried out on two separate arms, one with CGJ and one with placebo, according to a randomized, placebo-controlled, double-blind, cross-over design. Measurements were carried out before (pSm) and immediately after (Sm0) cigarette smoking. Endothelial function was evaluated by flow-mediated dilation (FMD) of the brachial artery. Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of arterial wave reflections. Results: At baseline measurements, compared to pSm, cigarette smoking decreased FMD values (8.58±3.17% vs.5.65±1.98%, p<0.001) and moreover caused an increase in AIx (4.19±9.13% vs. 6.26±9.81%, p=0.013) and PWV (6.02±0.67m/sec vs. 6.21±0.68m/sec, p<0.046). Treatment with CGJ, improved pSm values of: FMD (7.87±2.79% vs. 9.43±2.62%, p=0.024), PWV (6.11±0.58m/sec vs. 5.70±0.6m/sec, p=0.013) and AIx (3.03±7.70% vs. -0.59±8.56%, p=0.016), while there was no statistically significant difference with placebo administration. Finally, compared with placebo, at day 14, treatment with CGJ, blunted the acute smoking-induced increase in PWV (placebo: from 5.67±0.64m/sec Psm to 6.00±0.78m/sec Sm0), (CGJ: from 6.00±0.73m/sec Psm to 6.23±0.66m/sec Sm0) (p=0.012). Conclusion: Concord grape juice contains specific flavonoids that may improve endothelium-dependent vasodilation and vascular elastic properties of the arterial tree in healthy smokers. Improved endothelial function and decreased arterial stiffness is a potential mechanism by which flavonoids may prevent cardiovascular events.

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Abstract 12770: The Significant Role of Endothelium and Arterial Wall Properties in Patients With Pseudoexfoliative Glaucoma

Circulation ◽

10.1161/circ.132.suppl_3.12770 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Georgia Siasou ◽

Gerasimos Siasos ◽

Marilita M Moschos ◽

Nikolaos Gouliopoulos ◽

Evangelos Oikonomou ◽

...

Keyword(s):

Arterial Stiffness ◽

Endothelial Function ◽

Significant Role ◽

Vascular Function ◽

Arterial Wall ◽

Augmentation Index ◽

Open Angle Glaucoma ◽

Anterior Segment ◽

Pseudoexfoliative Glaucoma

Introduction: Primary open-angle glaucoma (POAG) is one of the most prevalent causes of irreversible blindness and is associated with endothelial dysfunction and arterial stiffness. Pseudoexfoliative glaucoma (PEG) is another type of glaucoma observed in pseudoexfoliation syndrome. It is characterized by the deposition of pseudoexfoliative material not only to the anterior segment of the eye, but also to the vessels, heart and other organs. Hypothesis: Endothelial function and arterial stiffness are impaired in patients with POAG and PEG supporting the significant role of vascular function impairment in the progression of the disease. Methods: Forty four POAG patients, 22 PEG and 38 healthy subjects (Cl) were included in this study. All subjects were free of cardiovascular or inflammatory diseases. Endothelial function was evaluated by flow-mediated dilatation (FMD). Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of arterial wave reflections Results: Between the three study groups CL, POAG, PEG there was no difference in age (67±10years vs. 70±9years vs. 66±12yeras, p=0.12) or prevalence of male sex (70% vs. 57% vs. 50%, p=0.21). Importantly, there was a linear impairment of FMD (7.35±2.77% vs. 6.58±3.18% vs. 4.88±3.29%, p=0.006), PWV (7.98±1.56m/sec vs. 9.20±1.84m/sec vs. 9.22±2.16m/sec, p=0.004) and AIx (21.29±8.77% vs. 25.14±5.71% vs. 28.20±8.75%, p=0.002) from CL to POAG and PEG. Interestingly post hoc test after Scheffe correction revealed also that PEG subjects had not only significantly impaired FMD, compared to control subjects, but also compared to POAG subjects (4.88±3.29% vs. 6.58±3.18%, p=0.02). Conclusions: Endothelial function and arterial stiffness are significantly impaired in patients with pseudoexfoliative glaucoma. These findings shed some light in the pathophysiology of pseudoexfoliative glaucoma and support the theory that pseudoexfoliative fibrils may also accumulate and damage the arterial wall.

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Repeatability of Peripheral Artery Tonometry in Female Subjects

ISRN Vascular Medicine ◽

10.1155/2013/383624 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

Andrew J. Degnan ◽

Nandini Shah ◽

David M. Carty ◽

John R. Petrie ◽

Christian Delles ◽

...

Keyword(s):

Arterial Stiffness ◽

Endothelial Function ◽

Estrous Cycle ◽

Vascular Function ◽

Augmentation Index ◽

Reactive Hyperemia ◽

Intraclass Correlation ◽

Peripheral Arterial Tonometry ◽

Peripheral Arterial ◽

Female Subjects

Background. Peripheral arterial tonometry (PAT) is a novel, non-invasive and operator-independent method for simultaneous assessment of endothelial function and arterial stiffness. We examined the repeatability of PAT in females and the influence of the estrous cycle. Methods. In 14 healthy female and five healthy male control subjects, PAT was performed on three separate occasions with 10 days between visits. Reactive hyperemia index (RHI), a measure of endothelial function, and peripheral augmentation index (AIx), a measure of arterial stiffness, were determined with the EndoPAT-2000 system. Intraclass correlation coefficient (ICC) was calculated as a measure of repeatability. Results. In both female and male groups, RHI and AIx did not differ between the three measurements (all n.s. by 1-way ANOVA). In females, reanalyzing the data after taking phase of estrous cycle into account had no effect on the results. Repeatability for RHI and AIx in females (ICC for RHI = 0.43, ICC for AIx = 0.78) was similar to that in male subjects (ICC for RHI = 0.42, ICC for AIx = 0.63). Conclusions. PAT measurements were not affected by the estrous cycle in females, and repeatability was comparable to that in males. This should facilitate inclusion of female subjects into vascular function studies using PAT.

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Effects of Smoking Cessation with Nicotine Replacement Therapy on Vascular Endothelial Function, Arterial Stiffness, and Inflammation Response in Healthy Smokers

Angiology ◽

10.1177/0003319719853458 ◽

2019 ◽

Vol 70 (8) ◽

pp. 719-725 ◽

Cited By ~ 4

Author(s):

Chao Xue ◽

Qi Zhi Chen ◽

Ling Bian ◽

Zhao Fang Yin ◽

Zuo Jun Xu ◽

...

Keyword(s):

Smoking Cessation ◽

Arterial Stiffness ◽

Endothelial Function ◽

Replacement Therapy ◽

Nicotine Replacement Therapy ◽

Vascular Function ◽

Inflammatory Markers ◽

Vascular Endothelial ◽

Vascular Endothelial Function

The effects of nicotine replacement therapy (NRT)-aided smoking cessation on vascular function are not fully clarified. We investigated 100 healthy smokers who were motivated to quit and received NRT for a 3-month period. Vascular endothelial function (measured by reactive hyperemia-peripheral arterial tonometry [RH-PAT]), arterial stiffness (measured by augmentation index [AI] and brachial-ankle pulse wave velocity [baPWV]), and systemic inflammation markers (including serum soluble intercellular adhesion molecule-1 [sICAM-1] and interleukin-1β [IL-1β]) were assessed at baseline and 3 and 12 months of follow-up. After 3 months of intervention, endothelial function, arterial stiffness, and inflammatory markers significantly improved (RH-PAT increased, AI and baPWV decreased, sICAM-1 and IL-1β decreased, all P < .05) for the participants who abstained from smoking completely, but for those who did not abstained completely, RH-PAT, AI, baPWV, and IL-1β remained unchanged. At 12 months follow-up, endothelial function (RH-PAT), arterial stiffness (AI and baPWV), and inflammatory markers (sICAM-1 and IL-1β) were further improved in participants who abstained from smoking ( P < .001), while the above parameters deteriorated in continued smokers ( P < .05). In conclusion, vascular dysfunction can be reversible after NRT-aided smoking cessation in healthy smokers and vascular function could be further damaged if they continue smoking.

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P1573Chemotherapy-induced vasotoxicity in patients undergoing therapy for breast cancer

European Heart Journal ◽

10.1093/eurheartj/ehz748.0333 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Anastasiou ◽

A S Antonopoulos ◽

E Oikonomou ◽

F Zagouri ◽

G Siasos ◽

...

Keyword(s):

Breast Cancer ◽

Arterial Stiffness ◽

Vascular Function ◽

Augmentation Index ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Flow Mediated Dilation ◽

Vascular Effects ◽

Ventricular Ejection Fraction ◽

Her 2

Abstract Background Cardiotoxicity is a well-known adverse effect of anthracycline and HER-2 monoclonal antibodies, however the vascular effects of these agents remain less-well studied. Purpose To explore the effects of breast chemotherapy on vascular function. Methods A total of 57 female patients undergoing breast diagnosed with breast cancer and scheduled for anthracycline-based and HER-2 chemotherapy were included in this study. At baseline, at 3, 6 and 12 months, patients underwent assessment of cardiac function by transthoracic echocardiography, endothelial function assessment by brachial flow mediated dilation (FMD) and assessment of arterial stiffness by carotid-radial pulse wave velocity (PWV) and augmentation index (Aix). Results There was a significant decrease in left ventricular ejection fraction (LVEF) overtime compared to baseline (A). This was paralleled by a significant decrease in brachial FMD at 6 months (B) and a significant increase in PWV compared to baseline (C). There was no significant change in Aix compared to baseline levels (D). Chemotherapy-induced cardiotoxicity (expressed by the change in LVEF) was not associated with either the change in FMD or PWV at 6 months. Conclusions Breast chemotherapy-induced cardiotoxicity is paralleled by vasotoxicity, which is manifested as endothelial dysfunction and increased arterial stiffness. Systemic vasotoxicity is not directly related to cardiotoxicity, suggesting that monitoring of both cardiac and vascular function could be useful in identifying early signs of cardiovascular toxicity.

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Arterial Stiffness: Effects of Anticancer Drugs Used for Breast Cancer Women

Frontiers in Physiology ◽

10.3389/fphys.2021.661464 ◽

2021 ◽

Vol 12 ◽

Author(s):

Giuseppina Novo ◽

Daniela Di Lisi ◽

Roberta Manganaro ◽

Girolamo Manno ◽

Simone Lazzara ◽

...

Keyword(s):

Breast Cancer ◽

Blood Pressure ◽

Arterial Stiffness ◽

Anticancer Drugs ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Vascular Toxicity

Purpose: It is well known that anticancer drugs used for treating breast cancer can cause cardiac toxicity, and less is known about vascular toxicity. The aim of this study was to assess subclinical vascular effects of anthracyclines and trastuzumab (TRZ) in women treated for breast cancer.Methods: We enrolled 133 female patients with breast cancer undergoing adjuvant treatment with anthracycline-containing chemotherapy (CT) followed by taxane (paclitaxel/docetaxel) + TRZ. Patients underwent a standard echocardiography including measurement of left ventricular ejection fraction and global longitudinal strain at baseline and at follow-up. Vascular toxicity was evaluated by measuring brachial blood pressure (BP) and arterial stiffness indices (pulse wave velocity and Beta stiffness index) at T0 (baseline), T1 (3 months), T2 (6 months), and T3 (12 months).Results: Arterial stiffness indices were significantly increased at T1 in patients treated with anthracycline-containing CT (PWV 5.5 m/s IQR 5.15–6.4 at T0 vs. PWV 6.7 m/s IQR 5.6–7.2 at T1, p < 0.05; Beta index PWV 6.7 IQR 5.25–6.65 at T0, PWV 8.35 IQR 6.5–10.15 at T1, p < 0.05) but not at T2 and T3, when treatment with anthracyclines was stopped and patients were under treatment with taxane and TRZ. Blood pressure values did not significantly change during follow-up.Conclusion: Changes in arterial stiffness parameters occur early after starting treatment with anthracyclines, and they seem to be reversible if anthracycline treatment is stopped. These changes are not influenced by blood pressure values modifications. Therefore, in breast cancer women, anthracyclines seem to cause early reversible subclinical vascular injury.

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Η επίδραση της θεραπείας με LHRH ανάλογο στην ελαστικότητα των αγγείων και στην λειτουργικότητα του ενδοθηλίου σε ασθενείς με καρκίνο του προστάτη

10.12681/eadd/42147 ◽

2014 ◽

Author(s):

Παναγιώτης Μουρμούρης

Keyword(s):

Arterial Stiffness ◽

Endothelial Function ◽

Metastatic Prostate Cancer ◽

Pulse Wave ◽

Augmentation Index ◽

Prospective Analysis ◽

Peripheral Arteries ◽

Flow Mediated Dilatation ◽

Maximal Androgen Blockade

Objective To study the effect of androgen deprivation therapy with an LHRH analogue in arterial stiffness and endothelial function of peripheral arteries as a possible mechanism increasing their cardiovascular riskMaterial- Methods This pilot study is a prospective analysis of 32 patients with metastatic prostate cancer who received Maximal Androgen Blockade. We evaluated the endothelial function of brachial artery through ultrasound and measurement of Flow Mediated Dilatation (FMD) and we assessed the central arterial stiffness of the aorta by measuring Augmentation index (AIX) and velocity of the aortic pulse wave (PWV). The measurements were performed one day before starting treatment and then three months and six months after the initiation of treatment.Results PWV increased significantly by 8, 26% from three to six months of follow up (p=0,037). FMD was found slightly elevated from baseline to 6 months of follow up by 7, 18% (p>0, 99), but AI was increased significantly (15, 53%, p=0,007) at six months as compared with baseline measures. Glucose, LDL, Triglycerides were increased by 15, 23% (p=0,002) 14, 34% (p<0,001), and 13, 46 %( p<0,001) respectively at 6 months follow up and these values increased significantly between all other time points. HDL was decreased statistically significantly by 14, 56 %( p<0,001) during the follow up of 6 months.Conclusions We found that these agents cause changes in arterial stiffness of the aorta and the endothelial function of peripheral arteries and we proposed them as a possible mechanism of increasing their cardiovascular risk

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Osteoprotegerin and Osteopontin Serum Levels are Associated with Vascular Function and Inflammation in Coronary Artery Disease Patients

Current Vascular Pharmacology ◽

10.2174/1570161117666191022095246 ◽

2020 ◽

Vol 18 (5) ◽

pp. 523-530 ◽

Cited By ~ 2

Author(s):

Konstantinos Maniatis ◽

Gerasimos Siasos ◽

Evangelos Oikonomou ◽

Manolis Vavuranakis ◽

Marina Zaromytidou ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Endothelial Function ◽

Vascular Function ◽

Serum Levels ◽

Atherosclerosis Progression ◽

Control Subjects ◽

Significant Difference ◽

Artery Disease ◽

Stable Cad

Background: Osteoprotegerin and osteopontin have recently emerged as key factors in both vascular remodelling and atherosclerosis progression. Interleukin-6 (IL-6) is an inflammatory cytokine with a key role in atherosclerosis. The relationship of osteoprotegerin, osteopontin, and IL-6 serum levels with endothelial function and arterial stiffness was evaluated in patients with coronary artery disease (CAD). Methods: We enrolled 219 patients with stable CAD and 112 control subjects. Osteoprotegerin, osteopontin and IL-6 serum levels were measured using an ELISA assay. Endothelial function was evaluated by flow-mediated dilation (FMD) in the brachial artery and carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness. Results: There was no significant difference between control subjects and CAD patients according to age and sex. Compared with control subjects, CAD patients had significantly impaired FMD (p<0.001) and increased PWV (p=0.009). CAD patients also had significantly higher levels of osteoprotegerin (p<0.001), osteopontin (p<0.001) and IL-6 (p=0.03), compared with control subjects. Moreover, IL-6 levels were correlated with osteoprotegerin (r=0.17, p=0.01) and osteopontin (r=0.30, p<0.001) levels. FMD was correlated with osteoprotegerin levels independent of possible confounders [b coefficient= - 0.79, 95% CI (-1.54, -0.05), p=0.04]. Conclusion: CAD patients have increased osteoprotegerin, osteopontin and IL-6 levels. Moreover, there is a consistent association between osteoprotegerin and osteopontin serum levels, vascular function and inflammation in CAD patients. These findings suggest another possible mechanism linking osteoprotegerin and osteopontin serum levels with CAD progression through arterial wall stiffening and inflammation.

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Sex modulates the association of radial artery augmentation index with renal function decline in individuals without chronic kidney disease

International Urology and Nephrology ◽

10.1007/s11255-020-02776-5 ◽

2021 ◽

Author(s):

Qiao Qin ◽

Fangfang Fan ◽

Jia Jia ◽

Yan Zhang ◽

Bo Zheng

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Arterial Stiffness ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Augmentation Index ◽

Renal Function Decline

Abstract Purpose An increase in arterial stiffness is associated with rapid renal function decline (RFD) in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether the radial augmentation index (rAI), a surrogate marker of arterial stiffness, affects RFD in individuals without CKD. Methods A total of 3165 Chinese participants from an atherosclerosis cohort with estimated glomerular filtration rates (eGFR) of ≥ 60 mL/min/1.73 m2 were included in this study. The baseline rAI normalized to a heart rate of 75 beats/min (rAIp75) was obtained using an arterial applanation tonometry probe. The eGFRs at both baseline and follow-up were calculated using the equation derived from the Chronic Kidney Disease Epidemiology Collaboration. The association of the rAIp75 with RFD (defined as a drop in the eGFR category accompanied by a ≥ 25% drop in eGFR from baseline or a sustained decline in eGFR of > 5 mL/min/1.73 m2/year) was evaluated using the multivariate regression model. Results During the 2.35-year follow-up, the incidence of RFD was 7.30%. The rAIp75 had no statistically independent association with RFD after adjustment for possible confounders (adjusted odds ratio = 1.12, 95% confidence interval: 0.99–1.27, p = 0.074). When stratified according to sex, the rAIp75 was significantly associated with RFD in women, but not in men (adjusted odds ratio and 95% confidence interval: 1.23[1.06–1.43], p = 0.007 for women, 0.94[0.76–1.16], p = 0.542 for men; p for interaction = 0.038). Conclusion The rAI might help screen for those at high risk of early rapid RFD in women without CKD.

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Breast reconstruction after breast cancer surgery – persistent pain and quality of life 1–8 years after breast reconstruction

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0026 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Nina Honkanen ◽

Laura Mustonen ◽

Eija Kalso ◽

Tuomo Meretoja ◽

Hanna Harno

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Breast Reconstruction ◽

Perforator Flap ◽

Persistent Pain ◽

Rectus Abdominis ◽

Preoperative Pain ◽

Significant Difference

Abstract Objectives To assess the long-term outcome of breast reconstructions with special focus on chronic postsurgical pain (CPSP) in a larger cohort of breast cancer survivors. Methods A cross-sectional study on 121 women with mastectomy and breast reconstruction after mean 2 years 4 months follow up. The mean time from breast reconstruction to the follow-up visit was 4 years 2 months. We studied surveys on pain (Brief Pain Inventory, BPI and Douleur Neuropathique 4, DN4), quality of life (RAND-36 health survey), sleep (insomnia severity questionnaire, ISI), mood (Beck’s Depression Index, BDI; Hospital Anxiety and Depression Scale, HADS), and a detailed clinical sensory status. Patients were divided into three groups: abdominal flap (Deep inferior epigastric perforator flap, DIEP; Free transverse rectus abdominis flap, fTRAM, and Pedicled transverse rectus abdominis flap, pTRAM), dorsal flap (Latissimus dorsi flap, LD and Thoracodorsal artery perforator flap, TDAP), and other (Transverse myocutaneous gracilis flap, TMG; implant). Clinically meaningful pain was defined ≥ 4/10 on a numeric rating scale (NRS). We used patients’ pain drawings to localize the pain. We assessed preoperative pain NRS from previous data. Results 106 (87.6%) of the patients did not have clinically meaningful persistent pain. We found no statistically significant difference between different reconstruction types with regards to persistent pain (p=0.40), mood (BDI-II, p=0.41 and HADS A, p=0.54) or sleep (p=0.14), respectively. Preoperative pain prior to breast reconstruction surgery correlated strongly with moderate or severe CPSP. Conclusions Moderate to severe CPSP intensity was present in 14% of patients. We found no significant difference in the prevalence of pain across different reconstruction types. Preoperative pain associated significantly with postoperative persistent pain.

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