A comparison of long-term cost and clinical outcomes between the two-stage sequence expander/prosthesis and autologous deep inferior epigastric flap methods for breast reconstruction in a public hospital

Lagares-Borrego, Araceli; Gacto-Sánchez, Purificación; Infante-Cossio, Pedro; Barrera-Pulido, Fernando; Sicilia-Castro, Domingo; Gómez-Cía, Tomás

doi:10.1016/j.bjps.2015.11.027

Cited by 48 publications

(66 citation statements)

References 39 publications

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“…To date, published analyses of breast reconstruction complications have been limited by a range of methodological flaws, including single surgeon/single center designs, small patient populations, and lack of control for treatment selection bias and/or confounding variables. 4–7 For mastectomy patients and their providers to make truly informed reconstructive decisions, high-quality research is needed to assess the risks of these procedures.…”

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confidence: 99%

Complications in Postmastectomy Breast Reconstruction

et al. 2018

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Objective In postmastectomy reconstruction, procedure choice is heavily influenced by the relative risks of the various options. This study sought to evaluate complications in a large, multicenter patient population. Summary of Background Data Previous studies have reported widely varying complication rates, but have been limited by their single center designs and inadequate controlling for confounders in their analyses. Methods Eleven sites enrolled women undergoing first time, immediate, or delayed reconstruction following mastectomy for cancer treatment or prophylaxis. Procedures included expander/implant, latissimus dorsi (LD), pedicle transverse rectus abdominis musculocutaneous (PTRAM), free TRAM (FTRAM), and deep inferior epigastric perforator (DIEP) techniques. Data were gathered pre- and postoperatively from medical records. Separate logistic regressions were conducted for all complications and major complications (those requiring rehospitalization and/or reoperation) within 1 year. Odds ratios (ORs) were calculated for procedure type, controlling for site, demographic, and clinical variables. Results Complication rates for 2234 patients were analyzed. Compared with expander/implant reconstructions, LD (OR) 1.95, P = 0.026), PTRAM (OR 1.89, P = 0.025), FTRAM (OR 1.94, P = 0.011), and DIEP (OR 2.22, P < 0.001) procedures were associated with higher risks of complications. Significantly higher risks were also associated with older age, higher body mass index (BMI), immediate reconstruction, bilateral procedures, and radiation. For major complications, regression showed significantly greater risks for PTRAM (OR 1.86, P = 0.044) and DIEP (OR 1.75, P = 0.004), than expander/implant reconstructions. Failure rates were relatively low, ranging from 0% for PTRAM to 5.9% for expander/implant reconstructions. Conclusion In this multicenter analysis, procedure choice and other patient variables were significant predictors of 1-year complications in breast reconstruction. These findings should be considered in counseling patients on reconstructive options.

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confidence: 99%

Complications in Postmastectomy Breast Reconstruction

et al. 2018

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“…Free tissue transfer has been demonstrated to provide better patient satisfaction compared to implant-based reconstructions [1]. Moreover, microsurgical reconstruction offers an alternative that allows patients being discharged sooner [2], with less need of revision surgery, resulting in an overall financial benefit for health systems [3].…”

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confidence: 99%

Simultaneous bi-pedicled DIEP and TUG flaps to enhance cosmetic outcome in unilateral delayed breast reconstruction: two flaps with three pedicles for one breast

2020

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Autologous breast reconstruction using free tissue transfer allows 'like-for-like' restoration of skin and volume following a mastectomy. Even though the majority of patients will require only one flap to restore their anatomy, occasionally, more than one flap is needed to get the best possible cosmetic outcome. For reconstructing the breast of a slim 49-year-old female patient, a bi-pedicled deep inferior epigastric perforator flap was used to replace the missing skin envelope, in combination with a buried transverse upper gracilis flap for volume restoration. The internal mammary vessels between the second and fourth costal cartilages were used as sole vessel recipient site, by preserving their intercostal perforators. Postoperative recovery was uneventful, and the patient was discharged 2 days after her operation. This case shows how a bi-pedicled DIEP with a TUG flap can be used for the challenging scenario in which reconstructive and cosmetic goals are equally important. Level of evidence: Level V, therapeutic study.

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“…A number of reconstructive techniques exist for breast reconstruction. The two most frequently employed techniques include the autologous deep inferior epigastric perforator (DIEP) flap and implant-based reconstruction [ 11 ]. The choice of treatment is determined by combination of patient factors (individual preference, age, body image) and surgeon factors (team experience, availability of resources) [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite this, many plastic surgery units worldwide regard autologous flap reconstruction as the superior technique as it follows the paradigm of replacing ‘like with like’ [ 10 ]. Indeed, there is growing evidence to support increased aesthetic patient satisfaction with autologous flap reconstruction compared to implants, as well as increased suppleness and resiliency, especially in irradiated recipient beds [ 11 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…This is because it results in less abdominal donor site morbidity compared to the traditional transverse rectus abdominus myocutaneous (TRAM) flap, by preserving the continuity of the rectum abdominis muscles [ 23 ]. Compared to implant-based reconstruction, some authors have argued that DIEP flap reconstruction is more cost-effective and results in fewer complications [ 11 , 24 ]. Modern healthcare aims to provide cost-effective treatment, and thus, discussion on reconstructive modalities warrants scrutiny on cost associated with autologous and implant-based reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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Protocol for a systematic review and meta-analysis on the clinical outcomes and cost of deep inferior epigastric perforator (DIEP) flap versus implants for breast reconstruction

et al. 2017

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BackgroundMastectomy in the context of breast malignancy can have a profoundly negative impact on a woman’s self-image, impairing personal, sexual and social relationships. The deep inferior epigastric perforator (DIEP) flap and implants are the two commonest reconstructive modalities that can potentially overcome this psychological trauma. The comparative data on clinical outcomes and costs of the two modalities is limited. We aim to synthesise the current evidence on DIEP versus implants to establish which is the superior technique for breast reconstruction, in terms of clinical outcomes and cost-effectiveness.MethodsA comprehensive search will be undertaken of EMBASE, MEDLINE, Google Scholar, CENTRAL and Science citation index databases (1994 up to August 2017) to identify studies relevant for the review. Primary human studies evaluating clinical outcomes and cost of DIEP and implant-based reconstruction in context of breast malignancy will be included. Primary outcomes will be patient satisfaction and cosmetic outcome from patient-reported outcome measures (scores from validated tools, e.g. BREAST-Q tool), complications and cost-analysis. The secondary outcomes will be duration of surgery, number of surgical revisions, length of stay, availability of procedures and total number of clinic visits.DiscussionThis will be the first systematic review and meta-analysis in available literature comparing the clinical outcomes and cost-effectiveness of DIEP and implants for breast reconstruction. This review is expected to guide worldwide clinical practice for breast reconstruction.Systematic review registrationPROSPERO CRD42017072557.Electronic supplementary materialThe online version of this article (10.1186/s13643-017-0628-y) contains supplementary material, which is available to authorized users.

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A comparison of long-term cost and clinical outcomes between the two-stage sequence expander/prosthesis and autologous deep inferior epigastric flap methods for breast reconstruction in a public hospital

Cited by 48 publications

References 39 publications

Complications in Postmastectomy Breast Reconstruction

Complications in Postmastectomy Breast Reconstruction

Simultaneous bi-pedicled DIEP and TUG flaps to enhance cosmetic outcome in unilateral delayed breast reconstruction: two flaps with three pedicles for one breast

Protocol for a systematic review and meta-analysis on the clinical outcomes and cost of deep inferior epigastric perforator (DIEP) flap versus implants for breast reconstruction

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