By O’Connell, Rachel L.;
Di Micco, Rosa; Khabra, Komel; Kirby, Anna M.; Harris, Paul A.; James, Stuart
E.; Power, Kieran; Ramsey, Kelvin W. D.; Rusby, Jennifer E.
Background: The
authors investigated aesthetic outcome and patient satisfaction in women who
have undergone deep inferior epigastric artery perforator (DIEP) flap
reconstruction in the setting of postmastectomy radiotherapy. Patients who
underwent DIEP flap reconstruction without postmastectomy radiotherapy were the
control group.
Methods:
Participants who had undergone DIEP flap reconstruction between September 1,
2009, and September 1, 2014, were recruited, answered the BREAST-Q, and
underwent three-dimensional surface-imaging. A panel assessed the aesthetic
outcome by reviewing these images. Results: One hundred sixty-seven women
participated. Eighty women (48 percent) underwent immediate DIEP flap
reconstruction and no postmastectomy radiotherapy; 28 (17 percent) underwent
immediate DIEP flap reconstruction with postmastectomy radiotherapy; 38 (23
percent) underwent simple mastectomy, postmastectomy radiotherapy, and DIEP
flap reconstruction; and 21 (13 percent) underwent mastectomy with temporizing
implant, postmastectomy radiotherapy, and DIEP flap reconstruction. Median
satisfaction scores were significantly different among the groups (p <
0.05). Post hoc comparison demonstrated that women who had an immediate DIEP
flap reconstruction were significantly less satisfied if they had
postmastectomy radiotherapy. In women requiring radiotherapy, those undergoing
delayed reconstruction after a simple mastectomy were most satisfied, but there
was no significant difference between the immediate DIEP flap and temporizing
implant groups. Median panel scores differed among groups, being significantly
higher if the immediate reconstruction was not subjected to radiotherapy. There
was no significant difference in panel assessment among the three groups of
women who had received radiotherapy.
Conclusions:
Patients who avoid having their immediate DIEP flap reconstruction irradiated
are more satisfied and have better aesthetic outcome than those who undergo
postmastectomy radiotherapy. In women requiring radiotherapy and who wish to
have an immediate or “delayed-immediate” reconstruction, there were no
significant differences in panel or patient satisfaction. Therefore, immediate DIEP flap reconstruction or
mastectomy with temporizing implant then DIEP flap surgery are acceptable
treatment pathways in the context of post-mastectomy radiotherapy.
