Abstract 75: Advantages Of The Delayed-Immediate Microsurgical Breast Reconstruction: Extending The Choice

DeBrock, Will; Pittelkow, Eric; Christopher, Laura; Mercho, Raphael; Hartman, Brett; Lester, Mary; Hassanein, Aladdin H.

doi:10.1097/01.gox.0000667360.62541.39

Cited by 3 publications

(1 citation statement)

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“…10 In addition to the above findings, there have also been reported benefits of delayed and delayed-immediate reconstruction such as high patient-reported outcomes and satisfaction with their breasts, 23 shorter operative times than immediate flap reconstruction, and the opportunity to give patients more time to decide their final reconstructive plan, thereby strengthening the patient-centered decision-making process. 24 As such, in patients who will require PMRT, delayedimmediate reconstruction is often recommended to optimize outcomes. While delayed autologous breast reconstruction is widely accepted, the optimal duration of delay between PMRT completion and reconstruction remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Optimal Timing of Delayed Microvascular Breast Reconstruction after Radiation Therapy

Arnautovic

Karinja

Olafsson

et al. 2022

J Reconstr Microsurg

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Background The purpose of this study was to determine the optimal timing of delayed microvascular breast reconstruction after completion of postmastectomy radiation therapy (PMRT). The authors evaluated whether the timing of reconstruction after PMRT completion affects the development of major postoperative complications. We hypothesize that delayed microvascular breast reconstruction can be safely performed within 12 months of PMRT completion. Methods A retrospective chart review of microvascular, autologous breast reconstructions at Brigham and Women's Hospital from 2007 to 2019 was performed. Logistic regression analysis and marginal estimation methods were used to estimate the probability of any major complication (flap compromise requiring operative intervention, hematoma formation requiring evacuation, infection requiring readmission, and flap necrosis requiring operative debridement) occurring in 2-month intervals after PMRT. Patients were classified as having undergone reconstruction 0 to 12 months after PMRT (group 1), 12 to 18 months after PMRT (group 2), or 18 to 50 months after PMRT (group 3). Results A total of 303 patients were identified. All patients received postmastectomy radiation (n = 143 group 1, n = 57 group 2, n = 103 group 3). Mean follow-up time was 71.4 ± 38 months. Patients in group 1 were significantly younger and more likely to have undergone neoadjuvant chemotherapy (p < 0.05). Major complications occurred in 10% of patients. There was no significant difference in the development of major complications between the three groups (p = 0.57). Although not statistically significant, the probability of any major complication peaked 2 to 6 months after PMRT completion. Conclusion There was no significant difference in major complications among patients who underwent delayed, microvascular breast reconstruction within versus beyond 1 year of PMRT completion. These findings suggest that delayed microvascular breast reconstruction can be safely performed beginning 6 months after PMRT completion.

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Section: Discussionmentioning

confidence: 99%

Optimal Timing of Delayed Microvascular Breast Reconstruction after Radiation Therapy

Arnautovic

Karinja

Olafsson

et al. 2022

J Reconstr Microsurg

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Delayed-immediate breast reconstruction: An assessment of complications and outcomes in the context of anticipated post-mastectomy radiotherapy

Cuffolo

Pandey²,

Windle³

et al. 2023

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Evaluation of Prepectoral Breast Tissue Expander Reconstruction Intraoperative Fill: Air or Saline

Bamba

Christopher

Mailey

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Summary: Staged implant-based breast reconstruction with immediate tissue expanders (TEs) is the most common method of breast reconstruction after mastectomy. TEs traditionally are filled with saline for expansion. Some surgeons have advocated initial intraoperative fill of the TE with air to avoid excess pressure on ischemic mastectomy skin flaps. The purpose of the study was to compare intraoperative air versus saline tissue fills. All patients who underwent prepectoral TE reconstruction after mastectomy from 2017 to 2019 were reviewed. The primary predictive variable was whether saline or air was used for initial tissue expansion. Outcome variables included mastectomy skin necrosis, nipple necrosis, infection, number of expansions, hematoma, and explantation. A total of 53 patients (88 TEs) were included in the study: 28 patients (44 TEs) who underwent initial intraoperative fill with air and 25 patients (44 TEs) who underwent an initial saline fill were assessed. There were no significant differences in complication rates between initial TE fill with saline versus air, including nipple necrosis, wound dehiscence, cellulitis, abscess, or TE removal (P = 1.0). The number of postoperative TE fills in the initial air fill group was 3.2 compared to 2.7 in the initial saline fill group (P = 0.27). Prepectoral TE initial fill with air has similar postoperative outcomes compared to initial saline fill. The authors found no benefit to initially filling prepectoral TEs with air intraoperatively. Given the additional effort of exchanging air for saline during the first postoperative fill, there was no clinical advantage of filling prepectoral TEs with air. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Abstract 75: Advantages Of The Delayed-Immediate Microsurgical Breast Reconstruction: Extending The Choice

Cited by 3 publications

References 0 publications

Optimal Timing of Delayed Microvascular Breast Reconstruction after Radiation Therapy

Optimal Timing of Delayed Microvascular Breast Reconstruction after Radiation Therapy

Delayed-immediate breast reconstruction: An assessment of complications and outcomes in the context of anticipated post-mastectomy radiotherapy

Evaluation of Prepectoral Breast Tissue Expander Reconstruction Intraoperative Fill: Air or Saline

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