Long-term follow-up of changing practice patterns in breast reconstruction due to increased use of tissue expanders and perforator flaps

Abstract

Background: As the science of breast reconstruction evolves, significant changes in reconstruction strategies and outcomes are expected. The purpose of this study is to determine the changes in breast reconstruction trends and outcomes that occurred at a multidisciplinary academic institution during the last decade. Methods: We compared 265 patients over two distinct 6-month intervals separated by 5 years (2002 vs. 2007) and performed long-term follow-up (4.75 6 3.38 years 2002, 2.99 6 2.25 years 2007). We studied patients seeking prophylactic mastectomy, patients with early breast cancer, and patients with locally advanced disease. We analyzed demographic data, breast cancer history and treatment, type and timing of reconstruction, and complications. Results: Implant to flap reconstruction ratio was 48:49 in 2002 and 76:102 in 2007. Use of transverse rectus abdominis myocutaneous flap declined from 57 to 4%; conversely, deep inferior epigastric perforator flap increased from 27 to 91% (P < 0.001). Correspondingly, donor site chronic pain (4 vs. 0, P 5 0.012) and postoperative abdominal wall bulge (9 vs. 3, P 5 0.004) rates decreased. Timing of reconstruction showed increased staged cases in 2007 compared to 2002 (P 5 0.045). Post-final reconstruction radiation therapy was reduced in 2007 (P 5 0.016), with subsequent lower rates of implant rupture (P < 0.001). Conclusions: At our institution and over the last decade, increasing staged reconstructions have successfully reduced the rates of post-final reconstruction radiotherapy with optimized outcomes. Contrary to national trends, the rates of autologous flap reconstructions have increased with reduced donor site morbidity. This suggests that academic breast reconstruction trends are independent from national trends. V C 2014 Wiley Periodicals, Inc. Microsurgery 34:595-601, 2014.

Optimizing Efficiency in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

“…This is almost half of the time reported in the literature. 1,8 Therefore, we studied each group individually to determine which variables contributed to a reduction in operative time.…”

Spontaneous Reinnervation of Deep Inferior Epigastric Perforator Flaps after Delayed Breast Reconstruction

“…The examined breasts were divided into different zones and segments that were similar to the model described by Blondeel et al 8 The first segment represented the mediocranial zone and the fifth segment the reconstructed areola ( [1] mediocranial, [2] laterocranial, [3] mediocaudal, [4] laterocaudal, and [5] reconstructed areola, if present).…”

Breast Reconstruction Using the Geometrically Modified Profunda Artery Perforator Flap From the Posteromedial Thigh Region

“…To maximize flap volume and to minimize scar visibility, the following modified flap geometry was chosen (Figs. [1][2][3][4]. Horizontal crescentic flaps were drawn on the posteromedial thigh, anterior and posterior endpoints being the anterior border of the gracilis muscle, and the end point of the gluteal crease, respectively.…”

“…[1][2][3][4] This flap, however, is occasionally unavailable due to insufficient abdominal tissue, previous operations, or patient's preference. Advantages and disadvantages of alternative options, such as the superior gluteal artery perforator (SGAP) flap, the inferior gluteal artery perforator (IGAP) flap, and the transverse upper gracilis (TUG) flap have been extensively reported.…”