Abdominal Flap-based Breast Reconstruction versus Abdominoplasty: The Impact of Surgical Procedure on Scar Location

Abstract

Background: Autologous breast reconstruction has been demonstrated to be associated with superior patient-reported outcomes, and hence is regarded as the gold standard reconstructive modality. A common drawback of this procedure, however, is related to a high abdominal scar. Recently, hybrid breast reconstruction (ie, the combination of autologous and implant-based reconstruction) was presented as an approach that would combine the benefits of both reconstructive modalities. In this study, we sought to assess abdominal aesthetic outcomes associated with this approach. Methods: Thirty-two blinded reviewers evaluated standardized pre- and postoperative abdominal images of patients following autologous reconstruction with free abdominal flap (Group 1; N = 10), hybrid reconstruction (Group 2; N = 5), and abdominoplasty (Group 3; N = 10). Aesthetic abdominal appearance, including overall result, scar position, skin redundancy, and lateral abdominal contour, was rated on a 5-point Likert scale and a comparative analysis was performed. Results: Hybrid reconstruction was associated with significantly lower abdominal scars compared with Group 1 (P = 0.01), nearing results of patients in Group 3 (P = 0.39). Significantly higher aesthetic ratings were ascribed to Groups 2 and 3 when compared with Group 1 (P < 0.001) with regard to scar positioning (P < 0.001), skin redundancy (P < 0.001), and lateral abdominal contour (P < 0.001). No significant difference in aesthetic ratings was noted between Groups 2 and 3. Conclusions: When applied to the appropriate patient population, hybrid breast reconstruction is a powerful method to achieve reconstructive goals while optimizing abdominal aesthetics. A significantly lower scar position was noted and higher abdominal aesthetic ratings were given following abdominoplasty and hybrid reconstruction compared with conventional abdominal flap-based reconstruction.

Breast and abdominal scarring after DIEP flap breast reconstruction: An exploration of patient-reported scar quality

“…This difference could be explained by the challenge of the DIEP flap procedure, where sufficient abdominal soft tissue is needed to create the volume for the reconstructed breast(s) while respecting underlying perforator anatomy. DIEP flap donor site closure can result in a more tighter and higher scar location than an abdominoplasty [24]. In the absence of data into scarring after BR, we found that women in our study population appraised their breast scars similar to women who had undergone a breast augmentation [25] and better than women after a reduction mammoplasty [26].…”

“…However, in these studies, women after DIEP flap reconstruction were not included. Although one of the main appeals for women opting for a DIEP flap BR is the possibility of an 'abdominoplasty' like improvement of their abdomen [4,24], it is plausible that women who wish to have BR are primarily focused on restoring the breast, instead of a additional consequence such as the large abdominal scar. The worse scar appraisal of the abdomen could be explained by the dissatisfaction with the size and noticeability of this scar, which women in our study rated significantly worse than the breast scar.…”

Hybridrekonstruktion der Brust nach Mastektomie

“…Auch wird durch die Hebung der Lappenplastik nicht nur der infraumbilikale Haut-/Weichteilüberschuss korrigiert, sondern es resultiert auch die Möglichkeit einer, im Vergleich zur konventionellen autologen Brustrekonstruktion, tieferen Narbenplatzierung. Es ist erwähnenswert, dass diese tiefere Narbenlokalisation mit einer besseren ästhetischen Beurteilung einhergeht 14…”

“…Das rekonstruktive Ziel nach Mastektomie ist eine Brust von adäquater Größe und Form, welche symmetrisch, weich und sensibel ist ("5 S": size, shape, symmetry, softness, sensation) [14]. Selbstverständlich sollte das gewählte Verfahren sicher ("safe") sein, so dass auch von den "6 S" gesprochen werden könnte.…”

“…Das rekonstruktive Ziel nach Mastektomie ist eine Brust von adäquater Größe und Form, welche symmetrisch, weich und sensibel ist („5 S“: size, shape, symmetry, softness, sensation) 14 Selbstverständlich sollte das gewählte Verfahren sicher („safe“) sein, so dass auch von den „6 S“ gesprochen werden könnte. Um dieses Ziel zu erreichen, werden Patientinnen in der Regel zwei rekonstruktive Verfahren vorgestellt, nämlich die Implantat-basierte vs. autologe Brustrekonstruktion.…”