A retrospective review of the incidence of various complications in different delayed breast reconstruction methods

Thórarinsson, Andri; Fröjd, Victoria; Kölby, Lars; Lewin, Richard; Molinder, Niclas; Lundberg, Jonas; Elander, Anna; Mark, Hans

doi:10.3109/2000656x.2015.1066683

Cited by 39 publications

(46 citation statements)

References 66 publications

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“…The domain satisfaction with outcome measures the overall sense of satisfaction with the outcome after undergoing breast reconstruction. 32 The patients who underwent DIEP were more satisfied with their reconstruction; this is especially interesting, given that the patients in this group had a higher frequency of complications than the patients in the other groups (previously published data), 33 and it is known that postoperative complications tend to decrease satisfaction with the outcome of breast reconstruction. The results of the present study therefore do not agree with those of previous studies.…”

Section: Discussionmentioning

confidence: 77%

Long-Term Health-Related Quality of Life after Breast Reconstruction: Comparing 4 Different Methods of Reconstruction

Thórarinsson

Fröjd

Kölby

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Studies have confirmed that breast reconstruction is beneficial to improve health-related quality of life (HR-QoL) in breast cancer patients. Our aim was to compare 4 different methods of breast reconstruction on patient satisfaction and HR-QoL using both general and specific patient-reported outcome instruments.Methods:Retrospectively, 459 patients who underwent breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap, latissimus dorsi flap, lateral thoracodorsal flap, or expander with secondary implant and who had responded to the questionnaires were enrolled. Questionnaire answers, together with demographic and follow-up data, were statistically analyzed and compared between groups. Short-Form 36 Health Survey (SF-36) results were also compared with those from a sample of 930 age-matched women from the Swedish population.Results:There were slight differences in the SF-36 results but no significant differences in Psychological General Well-Being Index and EuroQoL-5 Dimension Questionnaire results between groups. Analysis of Breast-Q showed that the DIEP group had significantly higher score on the scale satisfaction with breast, significantly higher score in satisfaction with outcome than the lateral thoracodorsal flap (P = 0.014) and EXP groups (P = 0.024). There were no significant differences in most of the domains of the HR-QoL instruments. The higher satisfaction with breasts and outcome in the DIEP group is interesting, considering the higher complication rates associated with this reconstruction method.Conclusions:Patients who underwent breast reconstruction with a DIEP flap were more satisfied with their reconstructed breast and outcome than the other 3 groups. Breast reconstruction centers should make DIEP reconstruction widely available to patients after mastectomy.

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Section: Discussionmentioning

confidence: 77%

Long-Term Health-Related Quality of Life after Breast Reconstruction: Comparing 4 Different Methods of Reconstruction

Thórarinsson

Fröjd

Kölby

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…Patient demography, perioperative parameters, and frequency of postoperative complications with respect to the different reconstructive methods for this group has previously been published (82).…”

Section: Demographic Datamentioning

confidence: 99%

“…The registered complications can be seen in Table 1. Detailed definitions of the registered complications have been previously published (82). The data was processed in a secure FileMaker database (Filemaker Inc., Santa Clara, CA, USA).…”

Section: Registered Postoperative Complicationsmentioning

confidence: 99%

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

et al. 2017

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being, health-related quality of life and satisfaction (5,7-10).Patients' satisfaction and health-related quality of life are frequently used as parameters for outcome measurement in plastic surgery. Postoperative complications after breast reconstruction are common and affect patient satisfaction.Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially.Conclusions: Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.

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“…These findings are in agreement with other studies reporting on breast reconstruction complications, with the DIEP flap to be associated with higher early flap-related complication rates, compared with other autologous or implant-based reconstructive methods. 30,31 Use of new modalities, such as preoperative infrared thermography 32 or intraoperative fluorescent angiography with indocyanine green 33,34 has recently been suggested as a useful tool for reducing perfusion-related problems, that is, flap ischemia and fat necrosis.…”

Section: Discussionmentioning

confidence: 99%

Fat-Augmented Latissimus Dorsi versus Deep Inferior Epigastric Perforator Flap: Comparative Study in Delayed Autologous Breast Reconstruction

Demiri

Tsimponis

Pagkalos

et al. 2020

J Reconstr Microsurg

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Background The use of autologous tissues is considered the mainstay for delayed breast reconstruction. Aside the free abdominal flaps, which are most commonly used, the fat-augmented latissimus-dorsi (FALD) flap has been recently shown a reliable alternative option for pure autologous breast reconstruction. In this retrospective study, we aim to compare outcomes of autologous breast reconstructions using the extended FALD and deep inferior epigastric perforator flap (DIEP) flap, with an emphasis on patients' characteristics, demographic data, complications, and patients' satisfaction after a minimum 12-month follow-up. Methods Our series consists of 135 women who underwent a delayed postmastectomy unilateral autologous breast reconstruction from 2011 to 2017: 36 patients (Group A) had an extended FALD flap and 99 (Group B) a free DIEP flap performed by the same surgeons. Demographic data, breast volume, medical history, smoking, complications, and patients' satisfaction were recorded and analyzed. Student's t-test for independent variables, Mann–Whitney U-test, and Chi-squared test were used to compare the reported variables. Results Patients' age, body mass index (BMI), and pregnancy history were statistically different between groups (p < 0.001, p = 0.004, p < 0.001, respectively); younger age (35.1 vs. 41.2 years), lower BMI (25.6 vs. 28.4), and fewer pregnancies were recorded in Group A. Breast volume was also found significantly smaller in Group A patients (p = 0.009). Past medical history using the ASA physical status classification score, previous radiation therapy, history of smoking, and incidence of overall complications were similar in both groups. Overall satisfaction scores were found slightly higher, but not statistically significant, in the free-flap group (p = 0.442). Conclusion The use of the FALD flap may provide comparable outcome to the DIEP flap in delayed breast reconstruction in terms of complications and patients' satisfaction; it should be considered a good reconstructive option for young and thin nulliparous patients, with small to medium size opposite breast.

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A retrospective review of the incidence of various complications in different delayed breast reconstruction methods

Cited by 39 publications

References 66 publications

Long-Term Health-Related Quality of Life after Breast Reconstruction: Comparing 4 Different Methods of Reconstruction

Long-Term Health-Related Quality of Life after Breast Reconstruction: Comparing 4 Different Methods of Reconstruction

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

Fat-Augmented Latissimus Dorsi versus Deep Inferior Epigastric Perforator Flap: Comparative Study in Delayed Autologous Breast Reconstruction

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