101. Complications and Patient-Reported Outcomes after Abdominally Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study
- Author
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Yoon S. Chun, Edwin G. Wilkins, Ji Qi, Jessica Erdmann-Sager, Hyungjin Myra Kim, Andrea L. Pusic, Jennifer B. Hamill, and Gretchen Guldbrandsen
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Mammaplasty ,Rectus Abdominis ,Breast Neoplasms ,030230 surgery ,Transplant Donor Site ,Mean difference ,Superficial inferior epigastric artery ,Article ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Postoperative Complications ,medicine ,Humans ,Patient Reported Outcome Measures ,Mastectomy ,business.industry ,Fascia ,Middle Aged ,Epigastric Arteries ,Myocutaneous Flap ,Surgery ,Fasciotomy ,Tram flap ,medicine.anatomical_structure ,Treatment Outcome ,Clinical question ,Patient Satisfaction ,030220 oncology & carcinogenesis ,Female ,business ,Breast reconstruction ,Perforator Flap ,Follow-Up Studies - Abstract
Background Abdominal flap reconstruction is the most popular form of autologous breast reconstruction. The current study compared complications and patient-reported outcomes after pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) flaps. Methods Patients undergoing abdominally based breast reconstruction at 11 centers were prospectively evaluated for abdominal donor-site and breast complications. Patient-reported outcomes were measured by the BREAST-Q and Patient-Reported Outcomes Measurement Information System surveys. Mixed-effects regression models were used to assess the effects of procedure type on outcomes. Results Seven hundred twenty patients had 1-year follow-up and 587 had 2-year follow-up. Two years after reconstruction, SIEA compared with DIEP flaps were associated with a higher rate of donor-site complications (OR, 2.7; p = 0.001); however, SIEA flaps were associated with higher BREAST-Q abdominal physical well-being scores compared with DIEP flaps at 1 year (mean difference, 4.72, on a scale from 0 to 100; p = 0.053). This difference was not significant at 2 years. Abdominal physical well-being scores at 2 years postoperatively were lower in the pedicled TRAM flap group by 7.2 points (p = 0.006) compared with DIEP flaps and by 7.8 points (p = 0.03) compared with SIEA flaps, and in the free TRAM flap group, scores were lower by 4.9 points (p = 0.04) compared with DIEP flaps. Bilateral reconstruction had significantly lower abdominal physical well-being scores compared with unilateral reconstruction. Conclusions Although all abdominally based flaps are viable breast reconstruction options, DIEP and SIEA flaps are associated with higher abdominal physical well-being than pedicled and free TRAM flaps. Although SIEA flaps offer the advantage of not violating the fascia, higher rates of donor-site complications may diminish patient satisfaction. Clinical question/level of evidence Therapeutic, II.
- Published
- 2017