1. 'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps.
- Author
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Agrawal, A., Romics, L., Thekkinkattil, D., Soliman, M., Kaushik, M., Barmpounakis, P., Mortimer, C., Courtney, C.A., Goyal, A., Garreffa, E., Carmichael, A., Lane, R.A., Rutherford, C., Kim, B., Achuthan, R., Pitsinis, V., Goh, S., Ray, B., Grover, K., and Vidya, R.
- Subjects
PERFORATOR flaps (Surgery) ,MAMMAPLASTY ,ACCELERATED partial breast irradiation ,COHORT analysis ,SURGICAL complications ,REOPERATION ,LUMPECTOMY - Abstract
Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. STROBE-compliant protocol ascertained CWPF outcomes between March 2011–March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. Across 15 centres, 507 patients with median age (54 years, IQR; 48–62), body mass index (25.4 kg/m
2 , IQR; 22.5–29), tumour size (26 mm, IQR; 18–35), and specimen weight (62 g, IQR; 40–92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11–39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes. This is the analysis of the largest aggregated cohort of patients (n=507, 2011-2021, 15 UK centres) undergoing partial breast reconstruction with a pedicled chest wall perforator flap to avoid deformity following breast conservation. Data demonstrates its applicability in T1-T2 tumours (median size,26 mm, IQR;18-35) with re-excision rates of 15.9 (7.5% during the planned second stage) and 1.8% completion mastectomy. Postoperative complication rates were 4.3% haematoma, 4.3% wound infection, 2.8% delayed wound healing, and 0.2% total flap loss. This study demonstrates that CWPF is a valuable option for patients with a higher tumour-to-breast volume ratio who wish to pursue breast-conserving surgery. [Display omitted] • PartBreCon study : A retrospective cohort study of partial breast reconstruction. • 15 centres, n = 507; T2 (26 mm), Breast conservation in 73.4% A-C cups, BMI (25.4). • Chest Wall Perforator Flaps - LiCAP (54%), AiCAP (19%), LiCAP-LTAP (20%), TDAP (2%). • Shows acceptable complications (12%) - re-operations (2.6%), flap loss (0.6%). • Low Mastectomy (2%) & Low Symmetrisation (1%); FU (23 m), local recurrence (1%). [ABSTRACT FROM AUTHOR]- Published
- 2023
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