by Razzano,
Sergio; Marongiu, Francesco; Wade, Ryckie; Figus, Andrea
Background: To
improve the aesthetic outcome of deep inferior epigastric perforator (DIEP)
flap breast reconstruction, flaps should be tailored to the patient’s
characteristics. A single method of DIEP flap insetting will not suffice for
all women seeking breast reconstruction. The authors share the outcomes of a
prospective longitudinal study on DIEP flap insetting and present an algorithm
for reconstruction.
Methods: Over
4 years, 70 consecutive immediate unilateral DIEP flap breast reconstructions
were prospectively evaluated. DIEP insetting was based on the characteristics
of the donor site and contralateral breast, according to the authors’
algorithm. Baseline and outcome data were collected. Aesthetic outcomes were
evaluated by a panel of three independent assessors, and patient-reported
outcomes were quantified using the BREAST-Q at 1 year after reconstruction.
Results:
Seventy women underwent reconstruction. There were no total or partial flap
failures, four cases of fat necrosis, and 14 revision operations. Women
reported a mean overall BREAST-Q score of 82 of 100, representing excellent
satisfaction but poor satisfaction with sexual well-being. BREAST-Q scores were
not associated with age or body mass index. Fat necrosis reduced satisfaction
with the chest (absolute mean reduction, 13; 95 percent CI, 8 to 18; p =
0.002). Independent assessors scored the outcomes favorably, but there was no
agreement between surgeons, nurses, and lay assessors. Conclusions: The authors’ algorithm can support surgeons in
selecting individually tailored DIEP flap insetting to achieve excellent aesthetic
outcomes. Further research is needed as to the relevance of scores from
BREAST-Q in relation to interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
