Perioperative Considerations to Maximize Aesthetic Outcomes in the Setting of Autologous Microsurgical Breast Reconstruction
Irena Karanetz, M.D.1, Waqqas N. Jalil, M.D., FRCSC1, Brian Bassiri-Tehrani, M.D.2, Oren Z. Lerman, M.D.3.
1Hofstra Northwell School of Medicine, New Hyde Park, NY, USA, 2Lenox Hill Hospital, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA, 3Lenox Hill Hospital, Hofstra Northwell School of Medicine, New York, NY, USA.
The major hurdle in autologous microsurgical breast reconstruction is no longer technical success. Instead, achieving optimal breast aesthetics has become the paramount objective for patients and surgeons. Secondary revisions are often necessary to restore breast volume, contour, position and symmetry. The authors aim to investigate the role and incidence of second stage procedures or revisions for aesthetic refinements following autologous microsurgical breast reconstruction.
A retrospective review of all consecutive patients undergoing autologous breast reconstruction at a single institution during a six-year period was performed. Patient demographic data, number of additional operations, perioperative details, and complications were evaluated.
During the study period, 311 microvascular breast reconstructions were performed in 196 patients (160 immediate, 36 delayed). The mean age of patients was 51.4 (SD 4.9) with a mean BMI of 26.1. The mean patient follow-up was 11.7 months (range, 4 to 25 months). The majority of patients underwent reconstruction with deep inferior epigastric perforator flaps (n=177). There was one flap loss during the study period. A total of 144 (73.4%) patients underwent at least one additional revision surgery following initial reconstruction with a median time to procedure of 5.5 months. Secondary operations for aesthetic refinements encompassed those performed on the reconstructed breast, contralateral breast, or abdominal donor site. These procedures included breast mound revision with liposuction, fat grafting, skin envelope refinements with mastopexy or reduction techniques, implant placement, nipple-areola reconstruction, contralateral symmetrizing surgery, and abdominal dog-ear correction.
The current study demonstrates that autologous breast reconstruction should no longer be thought of as a single-stage procedure, and that secondary operations play an integral role in achieving optimal aesthetic results. For success in revision surgery one needs to start planning at the pre-operative stage of the initial reconstruction, and utilize the tools of cosmetic breast enhancement to achieve superior aesthetic results that patients expect.
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