Comparison of immediate and delayed autologous breast reconstruction methods: A retrospective cohort study.

Abstract

e12739 Background: Breast reconstruction using autologous flaps is currently the gold standard in breast reconstructive plastic surgery. Anterior abdominal wall flaps yield the most natural aesthetic result due to the similar textures of the tissues of the anterior abdominal wall and breast. When choosing this type of breast reconstruction, one should take into account a number of factors, such as age, body mass index, comorbidities, the anatomical features of blood supply to the donor and recipient zones, a history of operations on the anterior abdominal wall and cicatricial deformity. The number of postoperative complications is larger in patients having risk factors. Studies aimed at reducing the incidence of complications from autologous breast reconstruction are now in progress. A retrospective study was conducted to assess the impact of complex treatment during autologous breast reconstruction using anterior abdominal wall flaps in patients with breast cancer. Methods: The study included 116 patients with stage 0-IIIC breast cancer with immediate or delayed autologous breast reconstruction (Group I [64 patients] underwent immediate and delayed breast reconstruction using a DIEP flap and Group II [52 patients] underwent immediate and delayed breast reconstruction using a TRAM flap. Results: The frequency of weakness of the anterior abdominal wall in the TRAM-flap group was significantly higher (p < 0.001). Partial flap necrosis occurred more frequently in the delayed TRAM flap group (p < 0.001), total flap necrosis occurred more frequently in the immediate DIEP flap group (p = 0.025). Complications in patients with obesity was significantly higher (p = 0.002). The duration of delayed autologous breast reconstruction does not correlate with the incidence of complications in patients who received radiation therapy and chemotherapy before surgery (p = 0.84, p = 0.131 respectively). During radiation therapy after autologous breast reconstruction, flap liponecrosis occurred significantly more often (p = 0.021), and the incidence of flap liponecrosis was significantly higher in the group of immediate operations than in delayed ones (p = 0.004). According to the results of the Breast-Q questionnaire, the indicators of psychosocial, sexual well-being, satisfaction with the reconstructed breast were significantly higher in the group of DIEP flaps (p = 0.002, p = 0.004, p = 0.046, respectively). Also, in the DIEP-flap group, physical well-being (p < 0.05) and postoperative satisfaction with the abdomen (p = 0.003) were rated higher. Conclusions: The results of the clinical study demonstrate that autologous reconstruction is promising method, but requires careful planning of the operation and selection of candidates. This operation is a necessary step for a full-fledged psycho-emotional, functional and aesthetic rehabilitation of the patient after mastectomy.