Visual Perception of Breast Free Flap Size Is Influenced by Radiation Changes of Surrounding Tissue

Abstract

Introduction: Microsurgical reconstruction for bilateral mastectomy defects after unilateral radiation often results in asymmetry, despite both flap tissues never being radiated. Methods: Photos of 16 patients who received prior radiation to one breast and underwent bilateral abdominal free flap reconstruction were taken postoperatively. Layperson and expert assessment of were attained via online crowdsourcing and a panel of attending surgeons and senior residents. Stratified by inter-flap weight differences was done for sub-analysis. Results: A totally of 399 laypersons responded with the majority (57.3%) reporting that the radiated breast appeared smaller than the non-radiated breast. When the photos were stratified by inter-flap weight differences, the photos with the radiated side flap weight over 3% more than nonradiated side were significantly more likely to be perceived by laypersons as the same size (OR=2.7, p < 0.001) and of similar aesthetic (OR = 1.9, p < 0.001) when compared with photos with same-sized flaps. Of the expert responses (n=16), the radiated side was perceived as smaller 72.3% of the time and the nonradiated side appeared more aesthetic 52.7% of the time. Contrary to layperson responses, the experts tend to report the radiated side as smaller despite varying flap weight. Interestingly, expert raters were significantly more likely to rate the flaps of equal aesthetics when the radiated side has a flap larger by 3% or more (OR=3.6, p<0.001). Conclusion: Higher aesthetic scores were noted when larger flaps were inset to the radiated envelope by both laypersons and experts, suggesting potential technical refinement in reconstructive outcomes.

Outpatient Prescription Opioid Use following Discharge after Deep Inferior Epigastric Perforator Breast Reconstruction with and without an Educational Intervention

“…15 16 17 18 19 Additionally, a recent study suggests that postoperative magnesium repletion in abdominal based free-flap reconstruction led to a significant decrease in postoperative narcotic consumption, suggesting a multimodal approach in addition to patient education may help reduce opioid consumption. 20…”