by Black, Cara K.; Zolper, Elizabeth G.; Economides, James
M.; Abadeer, Andrew; Fan, Kenneth L.; Song, David H.
Plastic and
Reconstructive Surgery: August 2020 -
Volume 146 - Issue 2 - p 137e-146e
Background:
Abdominally based free tissue transfer (FTT) and latissimus
dorsi and immediate fat transfer (LIFT) procedures are both fully autologous
options for breast reconstruction. The former is specialized and requires
comfort with microsurgical technique, whereas LIFT combines a common set of
techniques familiar to all plastic surgeons. Comparing the two methods for
clinical effectiveness and complications for equivalency in outcomes may help
elucidate and enhance patient decision-making.
Methods:
A retrospective
review of a prospectively maintained database between March of 2017 and July of
2018 was performed to compare the LIFTs and FTTs performed by the senior
surgeon. Outcomes of interest included postoperative complications, flap
success, and follow-up revision and fat-grafting procedures.
Results:
Sixty-five breasts were reconstructed by FTT; and 31 breasts
were reconstructed with LIFT. Demographics were similar (p > 0.05). LIFT had
a shorter length of operation time (343 ± 128 minutes versus 49 ± 137 minutes)
(p < 0.0001) and a shorter length of stay (1.65 ± 0.85 days versus 3.83 ±
1.65 days) (p < 0.001). FTTs had a shorter time until drain removal (13.3 ±
4.3 days versus 24.0 ± 11.2 days) (p < 0.0001). The number of major
(requiring operation) and minor complications were not statistically different
(i.e., FTTs, 20.0 percent major and 27.7 percent minor; LIFT, 12.9 percent
major and 19.35 percent minor) (p > 0.05). The need for revisions (FTTs,
0.80 ± 0.71; LIFT, 0.87 ± 0.71) and fat grafting (FTTs, 41.54 percent; LIFT,
58.8 percent) was not statistically different (p > 0.05).
Conclusions:
Both the LIFT and abdominally based FTT have similar
outcomes and complication rates. However, LIFT may be preferred in patients who
require shorter operation times. The LIFT may be the fully autologous breast
reconstruction of choice for nonmicrosurgeons. CLINICAL QUESTION/LEVEL OF
EVIDENCE: Therapeutic, III.
