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

Demiri, Efterpi; Tsimponis, Antonios; Pagkalos, Anastasios; Georgiadou, Eleni; Goula, Olga-Christina; Spyropoulou, Georgia‐Alexandra; Dionyssiou, Dimitrios

doi:10.1055/s-0040-1716348

Cited by 18 publications

(12 citation statements)

References 44 publications

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“…Good results have been described in autologous reconstruction with fat augmented LD flap. 11 We have never performed a fat augmented TDAP flap, which could be an option to reach volume symmetry in the case of small breast reconstruction; anyhow we consider it a risky procedure on a perforator flap.…”

Section: Methodsmentioning

confidence: 99%

A Retrospective Comparative Analysis of Latissimus Dorsi (LD) Flap Versus Thoracodorsal Artery Perforator (TDAP) Flap in Total Breast Reconstruction with Implants: A Pilot Study

Brambilla

Parisi

Gatto

et al. 2021

J Reconstr Microsurg

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Introduction In breast surgery, an autologous flap combined with implant may reduce the risk or repair the soft-tissue defects in several cases. Traditionally, the preferred flap is the myocutaneous latissimus dorsi (LD) flap. In the perforator flap era, the evolution of LD flap is the thoracodorsal artery perforator (TDAP) flap. The aim of this study is the comparison between LD flap and TDAP flap with implants in terms of early complications and shoulder function. Methods We performed a retrospective cohort study in accordance with the STROBE guidelines. Between January 1 2015 and January 1 2020, 27 women underwent a unilateral total breast reconstruction with LD or TDAP flap combined with an implant at our institution. 15 women were operated with LD flap and 12 with TDAP flap. The most frequent indications for intervention were results of mastectomy and radiation-induced contracture. We evaluated several data in terms of clinical and demographical characteristics, operative and perioperative factors, and follow-up variables. We assessed shoulder function through the Disability of the Arm, Shoulder and Hand Questionnaire (DASH). Results The rate of complications was significantly lower in the TDAP group compared with the LD group (16.7% vs 60.0%, p = 0.047. Table 3). Although the small sample size limited further detailed statistical analyses, we particularly noticed no cases of donor site seroma in the TDAP group, as compared with four in the LD group. Patients in the TDAP group had an ∼11-point lower mean DASH score compared with the LD group (9.8 vs 20.5). This difference was statistically significant (p = 0.049). Conclusions TDAP flap seems to be a reliable technique for soft-tissue coverage in total breast reconstruction with implants. In comparison with the traditional LD flap, it could be a more favorable option in terms of less complications and better quality of life.

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Section: Methodsmentioning

confidence: 99%

A Retrospective Comparative Analysis of Latissimus Dorsi (LD) Flap Versus Thoracodorsal Artery Perforator (TDAP) Flap in Total Breast Reconstruction with Implants: A Pilot Study

Brambilla

Parisi

Gatto

et al. 2021

J Reconstr Microsurg

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“…1). 15–91 A list of all included studies is available in Supplemental Digital Content 3. ( See table, Supplementary Digital Content 3 , which displays characteristics and references of all included studies.…”

Section: Resultsmentioning

confidence: 99%

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Kim

Yuan

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Breast reconstruction after mastectomy in breast cancer patients is known to provide significant improvements in psychological well-being. 1 Among various techniques available, the deep inferior epigastric perforator (DIEP) flap is considered to be the gold standard for autologous breast reconstruction. 2 Despite the clinical importance and high regard of the DIEP flap technique, most research studies in leading plastic surgery journals are nonrandomized and observational in nature. 3 Nonrandomized observational studies on DIEP flap breast reconstruction have shown high risk of bias in their methodology. 2 Nonrandomized observational studies are generally considered to be of lesser quality evidence compared with randomized controlled trials (RCT) and systematic reviews/meta-analyses of RCTs. Nonetheless, observational studies are commonplace in plastic surgery. The prevalence of observational research, in part, is due to being less resource intensive and easier to conduct. 4 Other Breast Original articleBackground: The deep inferior epigastric artery perforator (DIEP) flap is widely used in autologous breast reconstruction. However, the technique relies heavily on nonrandomized observational research, which has been found to have high risk of bias. "Spin" can be used to inappropriately present study findings to exaggerate benefits or minimize harms. The primary objective was to assess the prevalence of spin in nonrandomized observational studies on DIEP reconstruction. The secondary objectives were to determine the prevalence of each spin category and strategy. Methods: MEDLINE and Embase databases were searched from January 1, 2015, to November 15, 2022. Spin was assessed in abstracts and full-texts of included studies according to criteria proposed by Lazarus et al. Results: There were 77 studies included for review. The overall prevalence of spin was 87.0%. Studies used a median of two spin strategies (interquartile range: 1-3). The most common strategies identified were causal language or claims (n = 41/77, 53.2%), inadequate extrapolation to larger population, intervention, or outcome (n = 27/77, 35.1%), inadequate implication for clinical practice (n = 25/77, 32.5%), use of linguistic spin (n = 22/77, 28.6%), and no consideration of the limitations (n = 21/77, 27.3%). There were no significant associations between selected study characteristics and the presence of spin. Conclusions:The prevalence of spin is high in nonrandomized observational studies on DIEP reconstruction. Causal language or claims are the most common strategy. Investigators, reviewers, and readers should familiarize themselves with spin strategies to avoid misinterpretation of research in DIEP reconstruction.

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“…26 With consistent advances in the field of breast reconstruction in the recent years, the types of reconstruction methods have also become more diverse. 27,28 While prosthetic reconstruction still accounts for a significant portion of all reconstructive surgeries, reconstructive methods using autologous tissues have become more and more popular, resulting in studies on various donor sites. Of these, the LP flap is one of the most commonly used flaps for Asians with small-to-moderate breast volume, which has its own advantages and disadvantages.…”

Section: Discussionmentioning

confidence: 99%

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

Lee

Cho

Kang

et al. 2023

J Reconstr Microsurg

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BACKGROUND The latissimus dorsi (LD) muscle has a dominant pedicle with one thoracodorsal artery and receives sufficient blood by segmental circulation through several perforators. Thus, it is widely used in various reconstructive surgeries. We are reporting on the patterns of the thoracodorsal artery analyzed by chest CT angiography. PATIENTS AND METHODS We analyzed the preoperative chest CT angiography results of 350 patients scheduled to undergo LD flap breast reconstruction following complete mastectomy for breast cancer between October 2011 and October 2020. RESULTS 700 blood vessels were classified according to the KNUPS TDA classification, 388 (185 Rt. and 203 Lt.), 126 (64 Rt. and 62 Lt.), 91 (49 Rt. and 42 Lt.), 57 (27 Rt. and 30 Lt.), and 38 (25 Rt. and 13 Lt.) vessels were classified as Type I, II, III, IV, and V, respectively. Among 350 patients, 205 patients showed matching types for Lt. and Rt. vessels, whereas 145 patients showed mismatching types. For 205 patients with matching types, the distribution by type was 134, 30, 30, 7, and 4 patients with Type I, II, III, IV, and V, respectively. For 145 patients with mismatching types, the distribution by different combinations was 48, 25, 28, 19, 2, 9, 7, 3, 1, and 3 patients with Types I+II, I+III, I+IV, I+V, II+III, II+IV, II+V, III+IV, III+V, and IV+V, respectively. CONCLUSIONS While there is some diversity in the vascular anatomical structures of the LD flap, the dominant vessel can be found in a similar location in almost all cases and no flap had absence of a dominant vessel. Therefore, in surgical procedures using the thoracodorsal artery as the pedicle, preoperative radiological confirmation is not absolutely necessary; however, due to variants, performing the surgery with an understanding of this aspect should lead to good outcomes.

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

Cited by 18 publications

References 44 publications

A Retrospective Comparative Analysis of Latissimus Dorsi (LD) Flap Versus Thoracodorsal Artery Perforator (TDAP) Flap in Total Breast Reconstruction with Implants: A Pilot Study

A Retrospective Comparative Analysis of Latissimus Dorsi (LD) Flap Versus Thoracodorsal Artery Perforator (TDAP) Flap in Total Breast Reconstruction with Implants: A Pilot Study

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

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