3D Assessment of Volume and Projection Changes in Patients undergoing Bilateral Delayed Immediate Breast Reconstruction with Unilateral Radiation
Anmol A. Patel, BA, BS, Katherine Chemakin, BS, Oren M. Tepper, MD, Katie E. Weichman, MD
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
Background: Delayed immediate breast reconstruction, defined as immediate tissue expander (TE) reconstruction followed by radiation and then delayed autologous reconstruction, has become the most popular paradigm in patients requiring post mastectomy radiation therapy. Despite radiation not being delivered to the final autologous reconstruction, breast asymmetry in bilateral reconstructions using this technique is a continued concern. The impact of post mastectomy radiation on final reconstruction symmetry have not previously been quantified using three-dimensional (3D) technology. Methods: All patients undergoing bilateral delayed immediate breast reconstruction with unilateral radiation by a single surgeon between January 2016 and June 2020 were included for analysis. Patients were excluded from analysis if they had prior breast reconstruction revision surgery and if they had failed TE reconstruction. VECTRA H2 system (Canfield Scientific, Fairfield, NJ) was used to take 3D photographs of breasts. Vectra software was used to analyze volumetric and projection differences for radiated and non-radiated breasts of each patient. Mastectomy weights, flap weights, and flap type were also included for analysis. Result:s A total of 20 patients were identified and 15 patients met inclusion criteria. Radiation was more commonly administered to the left breast at 67% (n=10). Comparing radiated breasts to non-radiated breasts, there was no difference in flap type with DIEP flap being the most common reconstruction at 86.6% (n=13) and 93.3% (n=14) respectively. The average of mastectomy weights for radiated breasts were significantly smaller at 912±438g compared to 983±440g for non-radiated breasts (p=0.03). Notably, there was no difference in mean flap weights when comparing radiated breasts (971.4±300g) to non-radiated breasts (971.9±309g) (p=0.98). When analyzing the postoperative breast volume, the radiated breasts were significantly smaller than non-radiated breasts at 647.2±245cc as compared to 715.7±244cc. (p=0.02). Additionally, radiated breasts had 0.33cm less projection than non-radiated breasts on average. Conclusion: Bilateral delayed immediate breast reconstruction in patients with unilateral post mastectomy radiation results in significant volumetric and projection changes despite equivalent flap and tissue expander volumes. On average, radiated breast reconstructions are 9.6% smaller by volume and are 0.33cm less projected. This data can help surgeons improve surgical planning and guide patient expectations.
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