’Implant-based and DIEP flap breast reconstruction: a comparison of breast sensation and quality of life within a singular patient sample’’

Abstract

Background: In this cohort study, the authors compared breast sensation and quality of life (QoL) after replacement of an implant-based breast reconstruction with a deep inferior epigastric perforator (DIEP) flap reconstruction in a singular sample of women. Methods: Women with implant-based breast reconstruction before their DIEP flap were included. Women formed their own control. Breast sensation was measured using Semmes-Weinstein monofilaments. QoL was evaluated using BREAST-Q questionnaires. Preoperative (T0) sensation and QoL were compared with postoperative values at 6 months (T1), at 12 months (T2), and at maximum follow-up (Tmax, sensation only). A linear mixed effects regression was used for Semmes-Weinstein monofilaments measurements; a paired samples t test was used for BREAST-Q scores. Most women chose replacement of their implant by a DIEP flap because of implant-related complaints. Results: Postoperative sensation decreased significantly compared with preoperative sensation after T1 (mean, 5.1 months), T2 (mean, 14.6 months), and Tmax (mean, 17.6 months) for the total breast but recovers to preoperative levels for the native skin after an average of 1.5 years. Nerve coaptation positively influenced recovery of sensation. BREAST-Q scores increased significantly after 6 and 12 months over the domains Satisfaction with Breasts, Psychosocial Well-Being, Physical Well-Being of the Chest, and Sexual Well-Being. Scores decreased significantly in Physical Well-Being of the Abdomen after 6 months. Conclusion: Replacing an implant with a DIEP flap initially causes a decrease in overall breast sensation, gradually recovering to preoperative levels for native skin, and can significantly increase QoL with the right indication. Superior recovery of sensation and QoL may be obtained by accompanying the DIEP flap with nerve coaptation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The Influence of a Previous Implant-Based Breast Reconstruction on Postoperative Sensation of the Deep Inferior Epigastric Artery Perforator Flap

“…[14,16] Van Rooij et al recently showed that swapping an implant reconstruction for a DIEP ap initially decreases postoperative sensation, but that sensation levels return to their preoperative value after approximately 1.5 years. [17] However, whether an implant does or does not in uence postoperative sensation of the DIEP ap had not been studied before.…”

“…have found no correlation between implant volume and breast sensation when the implant is in place. [17] Second, the data used in our study has been collected prospectively for another study but has been retrospectively analyzed for the current study. Hence, we have included as much patients as possible but have not performed a power analysis speci cally for this study.…”

“…[13][14][15][16] Van Rooij et al recently showed that it takes approximately 1.5 years after switching an IBBR for a DIEP ap reconstruction for sensation to recover back to the levels of IBBR. [17] In spite of this, the in uence of a previous breast implant on the sensation of the replacing DIEP ap remains unknown.…”

Letter to the Editor per Lu Wang et al.

“…Theoretically, the TE may have served as a barrier, partially preventing nerve growth toward the skin coming from underneath the pectoralis major muscle 8 . Also, the replacement of the TE with the DIEP flap causes renewed damage to the growing nerve sprouts and significantly influences postoperative breast sensation, since it is an additional surgery 4 …”

Discussion: Replacing an Implant-Based with a DIEP Flap Breast Reconstruction: Breast Sensation and Quality of Life

“…In this issue of Plastic and Reconstructive Surgery , van Rooij et al present a cohort study comparing breast sensation and quality-of-life measurements in patients undergoing replacement of implant-based breast reconstruction with deep inferior epigastric perforator (DIEP) flaps with and without neurotization. 1 The authors’ stated aim was to be able to better inform women about what to expect should they decide to undergo implant removal and breast reconstruction with a DIEP flap.…”