Analysis of Breast Aesthetic Revision Procedures after Unilateral Abdominal-based Free-flap Breast Reconstruction: A Single-center Experience with 1251 Patients

Abstract

Breast INTRODUCTIONAlthough patient satisfaction can be achieved in breast reconstruction using either a device-based approach or the patient's own tissue, studies have demonstrated that using autologous techniques results in superior long-term outcomes, particularly in the setting of radiation therapy. [1][2][3] Unilateral autologous free-flap breast reconstruction aims to create a durable, aesthetic breast mound that mirrors the size, shape, and contour of the contralateral native breast. However, symmetry can be difficult to achieve, and breast asymmetry has been shown to have a significant negative impact on patient body image and patient satisfaction. 4,5 As such, additional surgical procedures on the reconstructed breast, the contralateral breast, or both may be necessary to restore maximum balance and symmetry. [6][7][8][9][10] Data are lacking on the variables that influence the number, type, and timing of enhancement procedures Original articleBackground: Although autologous free-flap breast reconstruction is the most durable means of reconstruction, it is unclear how many additional operations are needed to optimize the aesthetic outcome of the reconstructed breast. The present study aimed to determine the average number of elective breast revision procedures performed for aesthetic reasons in patients undergoing unilateral autologous breast reconstruction and to analyze variables associated with undergoing additional procedures. Methods: A retrospective review of all unilateral abdominal-based free-flap breast reconstructions performed from 2000 to 2014 was undertaken at a tertiary academic center. Results: Overall, 1251 patients were included in the analysis. The average number of breast revision procedures was 1.1 ± 0.9, and 903 patients (72.2%) underwent at least one revision procedure. Multiple logistic regression analysis demonstrated that younger age, higher body mass index, and prior oncologic surgery on the reconstructed breast were factors associated with increased likelihood of undergoing a revision procedure. The probability of undergoing at least one revision increased by 4% with every 1-unit (kg/m 2 ) increase in a patient's body mass index. Multiple Poisson regression modeling demonstrated that younger age, prior oncologic surgery on the reconstructed breast, and bipedicle flap reconstruction were significant factors associated with undergoing a greater number of revision procedures. Conclusions: Most patients who undergo unilateral autologous breast reconstruction require at least one additional operation to optimize their breast aesthetic results. Young age and obesity increase the likelihood of undergoing additional operations. These findings can aid reconstructive microsurgeons in counseling patients and establishing patient expectations prior to their undergoing microvascular breast reconstruction.

No Skin Paddle, No Problem: Burying Deep Inferior Epigastric Artery Flaps in the Immediate Setting is Safe in Select Patient Populations

“…The aesthetic subunit concept is particularly important for the reconstructed breast. In conventional autologous breast reconstruction, a skin paddle is incorporated into the flap design and can serve as a useful monitoring tool as well as providing soft tissue to resurface and contour the breast 4 .…”

“…In conventional autologous breast reconstruction, a skin paddle is incorporated into the flap design and can serve as a useful monitoring tool as well as providing soft tissue to resurface and contour the breast. 4 Unfortunately, the location of the monitoring paddle may violate the breast's aesthetic subunits, creating an inharmonious proportion and drawing the observer's eye to a patch-like area of scarring and discordant pigmentation.…”

How to Start a Microsurgery Practice: Success and Sustainability in Academic Practice

“…A single breast cancer referral, if the patient selects delayed-immediate autologous reconstruction, commits the patient to at least three operations on average. 4 , 5 …”