Objective assessment of flap volume changes and aesthetic results after adjuvant radiation therapy in patients undergoing immediate autologous breast reconstruction

Myung, Yujin; Son, Yousung; Nam, Tae Hyun; Kang, Eunyoung; Kim, Eun Kyu; Kim, In Ah; Eom, Keun Yong; Heo, Chan Yeong; Jeong, Jae Hoon

doi:10.1371/journal.pone.0197615

Cited by 18 publications

(29 citation statements)

References 21 publications

(21 reference statements)

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“…In this study, among capsular contracture grades II and III patients, the proportion of patients receiving RT was 14 out of 22 (63.6%) and the positive correlation between RT and capsular contracture was also statistically significant (P<0.05, chi-squared test). However, in the case of patients undergoing RT, there may be a bias in evaluating low-grade capsular contracture due to changes in soft tissue, such as volume reduction and contracture following postoperative RT ( 19 ). The Baker grading system is a subjective classification based on clinical findings consisting of hardness and shape ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for chest wall depression after implant insertion for breast reconstruction: a retrospective quantitative study

Kim¹,

Lee²,

Najmiddinov³

et al. 2022

Gland Surg

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Background: Implant-based reconstruction represents the most common form of breast reconstruction after mastectomy. Although the complication rate has lowered owing to the current advances, various implant-related complications are still a problem. There have been few reports discussing chest wall deformation following implant insertion. The aim of this study was to quantify chest wall depression (CWD) after breast implant insertion and identify possible risk factors.Methods: Patients who underwent unilateral direct-to-implant reconstruction were included in the study.We measured the pre-and postoperative antero-posterior length of the chest wall and used a CWD ratio to measure the change in length. Multivariate analysis was performed with factors with P values of <0.2 in univariate analyses to identify factors associated with CWD.Results: A total of 57 patients were included in this study. The pre-and postoperative difference of anteroposterior length was statistically significant using a paired t-test. Average depth of CWD was 4.16 mm (range, −2.16 to 13.82 mm). In multivariate analysis, capsular contracture and age were the independent prognostic factors correlated with CWD.Conclusions: This study showed the possibility of CWD following implant insertion. Surgeons and specialists should be aware of the possibility and risk factors of CWD following implant insertion to better inform patients.

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Section: Discussionmentioning

confidence: 99%

Risk factors for chest wall depression after implant insertion for breast reconstruction: a retrospective quantitative study

Kim¹,

Lee²,

Najmiddinov³

et al. 2022

Gland Surg

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“…They did not report on the relationship between these complications and flap volume differences, and it remains unknown whether radiation affects flap volume without such complications. 1 In fact, Halyard et al reviewed data from patients who received radiation after TRAM flap reconstruction and found that there were 8 fat necrosis cases of the total 15 cases, 6 of which occurred before radiation. 31 It is necessary to confirm the relationship between PMRT and fat necrosis and the volume change of the fat tissue in the flap without fat necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…6 In the area of breast cancer, studies have investigated the effect of postmastectomy radiation therapy (PMRT) on flap volume. Some authors have claimed that PMRT affects flap volume, 1,[20][21][22] whereas others claim the opposite. [23][24][25][26][27][28][29][30][31][32][33] Myung et al investigated the effect of radiotherapy on flap volume by comparing the flap volume with and without radiation therapy after breast reconstruction using free TRAM flap.…”

Section: Table 3 Comparison Of the Volume Decrease Rate Of The Muscle...mentioning

confidence: 99%

“…These myocutaneous flaps are composed of muscle and fat portions, and exhibit volume changes with time, which has a significant effect on the long-term results after breast reconstruction is performed using pLDMCFs. 1 , 2 Although breast reconstruction is successful with the pLDMCF, the flap could shrink, and the reconstructed breast can undergo changes over time from the immediate postoperative state. Therefore, it is important to determine the volume of the flap that could decrease over time.…”

Section: Introductionmentioning

confidence: 99%

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Volume Change of Muscle and Fat Portions of Latissimus Dorsi Myocutaneous Flap after Breast Reconstruction

Kang

Shim

Park

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Myocutaneous flaps are composed of muscle and fat portions, and exhibit volume changes with time. However, no consideration is generally given to volume changes of muscle and fat portions occurring in the flap. Therefore, we conducted this study to analyze the volume changes of muscle and fat portions of pedicled latissimus dorsi myocutaneous flaps over time. Methods: Sixteen patients who underwent breast reconstruction using a latissimus dorsi myocutaneous flap between 2009 and 2017 were enrolled in this study. Using their postoperative computed tomography scan data, we measured the volume of muscle and fat portions of the flap, and performed a statistical analysis of volume changes over time. We also measured the volume of latissimus dorsi muscle on the opposite side and compared the difference in muscle volume. Results: The volume of the muscle portion of latissimus dorsi myocutaneous flap decreased by approximately 24%, from 6 months to postoperative year 2; from the third year, it shrank with a decrease rate similar to that of normal muscle. The fat portion of the flap showed no regular volume changes. Conclusions: Atrophy of the muscle portion is the primary cause of volume change of latissimus dorsi myocutaneous flaps over time. it is necessary to understand the difference in the volume change patterns of the muscle and fat. To maintain a long-term satisfactory result, it is better to make the maximum possible use of the relatively stable fat portion rather than the muscle portion.

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“…Out of the 23 studies, 12 focused on immediate reconstruction (before PMRT), 6,[10][11][12][13][14][15][16][17][18][19][20] seven focused on delayed reconstruction (after PMRT), [21][22][23][24][25][26][27] and four studies included both groups. 8,28-30 There were 729 patients who underwent immediate reconstruction, summarized in ►Table 1.…”

Section: Data Extraction and Analysismentioning

confidence: 99%

A Meta-Analysis of Autologous Microsurgical Breast Reconstruction and Timing of Adjuvant Radiation Therapy

Heiman

Gabbireddy

Kotamarti

et al. 2020

J Reconstr Microsurg

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Background Postmastectomy radiation therapy (PMRT) decreases loco-regional recurrence and improves survival in patients with locally advanced breast cancer. Autologous free flap reconstruction, while more durable in the setting of radiation than alloplastic reconstruction, is still susceptible to radiation-induced fibrosis, contracture, fat necrosis, volume loss, and distortion of breast shape. Options for reconstruction timing (immediate vs. delayed) have been discussed to mitigate these effects, but a clear optimum is not known. Methods A systematic review of the literature was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using search terms “breast reconstruction AND (radiation OR irradiation OR radiotherapy)” were used. Inclusion criteria consisted of studies reporting complications for free flap breast reconstruction in the setting of PMRT. Patients who underwent PMRT were pooled into two groups: those who underwent immediate free flap reconstruction prior to PMRT and those who underwent delayed reconstruction after PMRT. Results Out of the 23 studies, 12 focused on immediate reconstruction, seven focused on delayed reconstruction, and four studies included both groups. Overall, 729 patients underwent immediate reconstruction, while 868 underwent delayed reconstruction. Complete and partial flap loss rates were significantly higher in patients undergoing delayed reconstruction, while infection and wound-healing complication rates were higher in those undergoing immediate reconstructions. Rates of unplanned reoperations, vascular complications, hematoma/seroma, and fat necrosis did not differ significantly between the two groups. However, rates of planned revision surgeries were higher in the delayed reconstruction group. Conclusion Immediate free flap breast reconstruction is associated with superior flap survival compared with delayed reconstruction. Rates of complications are largely comparable, and rates of revision surgeries are equivalent. The differences in long-term aesthetic outcomes are not, however, clearly assessed by the available literature. Even in the face of PMRT, immediate free flap breast reconstruction is an effective approach.

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Objective assessment of flap volume changes and aesthetic results after adjuvant radiation therapy in patients undergoing immediate autologous breast reconstruction

Cited by 18 publications

References 21 publications

Risk factors for chest wall depression after implant insertion for breast reconstruction: a retrospective quantitative study

Risk factors for chest wall depression after implant insertion for breast reconstruction: a retrospective quantitative study

Volume Change of Muscle and Fat Portions of Latissimus Dorsi Myocutaneous Flap after Breast Reconstruction

A Meta-Analysis of Autologous Microsurgical Breast Reconstruction and Timing of Adjuvant Radiation Therapy

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