Comparison of Outcomes After Autologous Breast Reconstruction: Latissimus Dorsi with Immediate Fat Transfer vs. Abdominally Based Free Flaps
Parhom Towfighi*1, Daisy L. Spoer1, Lauren E. Berger2, Samuel S. Huffman1, Paige Dekker2, Jimin A. ko1, Brian N. Truong2, Niloofar Ghyasi1, Kenneth L. Fan2, David H. Song2
1Georgetown University School of Medicine, Washington DC, ; 2Plastic and Reconstructive Surgery, MedStar Georgetown University, Washington DC,
Autologous breast reconstruction confers favorable patient reports of satisfaction and quality of life compared to implant-based reconstruction over a lifetime. The latissimus dorsi with immediate fat transfer (LIFT) is an alternative approach to abdominally based free flaps (Ab-FF) which expands fully autologous reconstruction to non-microsurgeons. This study aims to compare the two procedures concerning their clinical and patient-reported outcomes one year postoperatively.
We conducted a retrospective review of LIFTs and Ab-FFs performed between March 2017 and August 2022. The primary outcomes were postoperative complications, reoperations, and longitudinal BREAST-Q scores. BREAST-Q modules included Satisfaction with Breasts, Abdomen, Back, Psychosocial Well-being, Physical Well-being: Chest, Abdomen, Back, and Sexual Well-being.
Of the 281 included patients (408 breasts), 211 received Ab-FF, and 70 received LIFT. One-year follow-up (12.0, IQR: 12.8 months) demonstrated that Ab-FF independently predicted dehiscence, secondary procedures, and breast revision surgery. Elevated BMI and comorbidities predicted dehiscence, while laterality of reconstruction and comorbidities predicted revisional surgery. Radiation predicted postoperative fat grafting. BREAST-Q scores fluctuated over time but were similar across all measured domains by one year postoperatively.
Although Ab-FF is the current gold-standard approach for fully autologous reconstruction, LIFT procedures may be associated with a less complicated postoperative course while eliciting similar patient-reported outcomes. LIFT may subsequently be preferred in patients with elevated BMI and comorbidity burdens to limit postoperative complications. LIFT also can be utilized by more plastic surgeons who are either not microsurgically trained or do not have an environment that fosters Ab-FF.
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