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Delayed versus Delayed-Immediate Autologous Breast Reconstruction: A Blinded Evaluation of Aesthetic Outcomes
Frank P. Albino, Medical Doctor, Ketan Patel, MD, Jesse Smith, MS, Maurice Nahabedian, MD.
Georgetown University Hospital, Washington, DC, USA.

Background:
The technique of delayed-immediate breast reconstruction includes immediate insertion of a tissue expander, post-mastectomy radiation, followed by reconstruction. The aesthetic benefits of delayed-immediate reconstruction compared to delayed reconstruction are postulated but remain unproven. The purpose of this study was to compare aesthetic outcomes in patients following delayed and delayed-immediate autologous breast reconstruction.
Methods:
A retrospective analysis was performed of all patients who underwent delayed or delayed-immediate autologous breast reconstruction by the senior author from 2005-2011. Post-operative photographs were used to evaluate aesthetic outcomes: skin quality, scar formation, superior pole contour, inferior pole contour, and overall aesthetic outcome. Ten non-biased reviewers assessed outcomes using a 5-point Likert scale. Fisher’s Exact and Wilcoxon-Mann-Whitney tests were used for comparative analysis.
Results:
Patient age and BMI were similar between delayed (n=10) and delayed-immediate (n=10) cohorts (p>0.05). Skin and scar quality was rated significantly higher in the delayed-immediate cohort (3.74 v. 3.05; p<0.001 and 3.41 v. 2.79; p= p<0.001, respectively). Assessment of contour-related parameters, superior pole and inferior pole, found significantly improved outcomes in the delayed-immediate cohort (3.67 v. 2.96; p<0.001 and 3.84 v. 3.06; p<0.001, respectively). Delayed-immediate breast reconstruction had a significantly higher overall score compared to delayed breast reconstructions (3.84 v. 2.94; p<0.001). Smoking and the time interval from radiation to reconstruction were found to affect aesthetic outcomes (p <0.05.
Conclusions:
Preservation of native mastectomy skin allows for improved skin/scar quality, breast contour, and overall aesthetic outcomes following a delayed-immediate reconstructive algorithm as compared to delayed breast reconstruction.


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