Patient-Reported Abdominal Well Being Following Abdominal Free Flap Breast Reconstruction: A Comparison by Flap Types
Aadit R. Patel, MD, Nikhil Sobti, Robert J. Allen, Jr., MD, Evan Matros, MD, Colleen M. McCarthy, MD, Joseph H. Dayan, MD, Joseph J. Disa, MD, Peter G. Cordeiro, MD, Babak J. Mehrara, MD, Andrea L. Pusic, MD, Jonas A. Nelson, MD.
Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Background: Objective differences in function exist following abdominally based autologous breast reconstruction comparing perforator flaps to muscle flaps. However, to date, there is a limited understanding of the impact such procedures have from the patient perspective. We aim to better understand the long-term functional impact of abdominally based autologous reconstruction by examining patient reported donor site satisfaction compared by flap type.
Methods: An IRB approved investigation was conducted to evaluate patients undergoing autologous breast reconstruction at a tertiary academic medical center. Since 2009, patients have completed the BREAST-Q as part of their standard of care in reconstruction. In the present study, the reconstruction module was used to assess patient-reported outcomes between deep inferior epigastric perforator (DIEP) or transverse rectus abdominus myocutaneous (TRAM) free flap reconstructions, with primary focus on abdominal well-being.
Results: Of 402 total patients that met our inclusion criteria, 232 underwent unilateral reconstruction (136 DIEP, 96 TRAM) and 170 underwent bilateral reconstruction (101 DIEP/DIEP, 35 TRAM/TRAM, and 34 mixed DIEP/TRAM). In unilateral reconstructions, the average preoperative abdominal well-being score was 92.9 and 92.0 (p = 0.39) for DIEP and TRAM, respectively. Scores did not differ between the cohorts at 1 and 2 year follow up (p = 0.92 and p = 0.192). At 3 years, scores were 89.6 and 79.7 (p = 0.12), a difference between the groups of 9.9 points. In the bilateral cohorts, the preoperative abdominal well-being scores for DIEP, TRAM, and DIEP/TRAM were 91.3, 97.5, and 95.8 (p = 0.29), respectively. Scores did not different at 1 and 2-years (p = 0.98 and p = 0.51). At 3 years, the average DIEP score was 82.4, TRAM 64.7, and DIEP/TRAM 81.0 (p = 0.2). Although not statistically significant, the mean difference between bilateral DIEP and TRAM groups was 17.7 points. There were no differences across the cohorts in donor-site hernia, bulge or delayed healing.
Conclusion: These results demonstrate acceptable patient-reported abdominal well-being following free flap breast reconstruction with no significant differences noted comparing unilateral or bilateral reconstruction flap types at 1, 2 and 3 years postoperatively. Non-significant trends suggest that a continued focus for larger, higher powered studies may help solidify our understanding of the long term impact of autologous breast reconstruction using abdominal tissue.
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