The online version of this article (https://doi.org/10.1007/s10549-018-4695-0) contains supplementary material, which is available to authorized users.
As more breast cancer patients opt for immediate breast reconstruction, the incidence of complications should be evaluated. The aim of this study was to analyze the recipient-site complications and flap re-explorations of immediate compared to delayed deep inferior epigastric artery perforator (DIEP) flap breast reconstructions.
For this multicenter retrospective cohort study, the medical records of all patients who underwent DIEP flap breast reconstruction in three hospitals in the Netherlands between January 2010 and June 2017 were reviewed. Patient demographics, risk factors, timing of reconstruction, recipient-site complications, and flap re-explorations were recorded.
A total of 910 DIEP flap breast reconstructions (n = 397 immediate and n = 513 delayed reconstructions) in 737 patients were included. There were no significant differences in major complications or flap re-explorations between immediate and delayed reconstructions. The total flap failure rate was 1.5 and 2.5% in the immediate and delayed group, respectively. Significantly more hematomas (OR 2.91; 95% CI 1.59–5.30; p = 0.001) and seromas (OR 3.60; 95% CI 1.14–11.4; p = 0.029) occurred in immediate reconstructions, whereas wound problems were more frequently observed in delayed reconstructions (OR 1.99; 95% CI 1.27–3.11; p = 0.003). Correction for potential confounders still showed significant differences for hematoma and seroma, but no longer for wound problems (p = 0.052).
This study demonstrated similar incidences of major recipient-site complications and flap re-explorations between immediate and delayed DIEP flap breast reconstructions. However, hematoma and seroma occurred significantly more often in immediate reconstructions, while wound problems were more frequently observed in delayed reconstructions.
Supplementary material 1 (PDF 146 kb)10549_2018_4695_MOESM1_ESM.pdf
Boughey JC, Attai DJ, Chen SL, Cody HS, Dietz JR, Feldman SM, Greenberg CC, Kass RB, Landercasper J, Lemaine V, MacNeill F, Song DH, Staley AC, Wilke LG, Willey SC, Yao KA, Margenthaler JA (2016) Contralateral Prophylactic Mastectomy (CPM) Consensus Statement from the American Society of Breast Surgeons: Data on CPM Outcomes and Risks. Ann Surg Oncol 23(10):3100–3105. https://doi.org/10.1245/s10434-016-5443-5 CrossRefPubMedPubMedCentral
Boughey JC, Attai DJ, Chen SL, Cody HS, Dietz JR, Feldman SM, Greenberg CC, Kass RB, Landercasper J, Lemaine V, MacNeill F, Margenthaler JA, Song DH, Staley AC, Wilke LG, Willey SC, Yao KA (2016) Contralateral Prophylactic Mastectomy Consensus Statement from the American Society of Breast Surgeons: Additional Considerations and a Framework for Shared Decision Making. Ann Surg Oncol 23(10):3106–3111. https://doi.org/10.1245/s10434-016-5408-8 CrossRefPubMedPubMedCentral
Hunt KK, Euhus DM, Boughey JC, Chagpar AB, Feldman SM, Hansen NM, Kulkarni SA, McCready DR, Mamounas EP, Wilke LG, Van Zee KJ, Morrow M (2016) Society of Surgical Oncology Breast Disease Working Group Statement on Prophylactic (Risk-Reducing) Mastectomy. Ann Surg Oncol. https://doi.org/10.1245/s10434-016-5688-z
Albornoz CR, Bach PB, Mehrara BJ, Disa JJ, Pusic AL, McCarthy CM, Cordeiro PG, Matros E (2013) A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg 131(1):15–23. https://doi.org/10.1097/PRS.0b013e3182729cde CrossRefPubMed
Cemal Y, Albornoz CR, Disa JJ, McCarthy CM, Mehrara BJ, Pusic AL, Cordeiro PG, Matros E (2013) A paradigm shift in U.S. breast reconstruction: part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg 131(3):320e–326e. https://doi.org/10.1097/PRS.0b013e31827cf576 CrossRefPubMed
Crosby MA, Garvey PB, Selber JC, Adelman DM, Sacks JM, Villa MT, Lin HY, Park SJ, Baumann DP (2011) Reconstructive outcomes in patients undergoing contralateral prophylactic mastectomy. Plast Reconstr Surg 128(5):1025–1033. https://doi.org/10.1097/PRS.0b013e31822b6682 CrossRefPubMed
Jagsi R, Jiang J, Momoh AO, Alderman A, Giordano SH, Buchholz TA, Kronowitz SJ, Smith BD (2014) Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol 32(9):919–926. https://doi.org/10.1200/JCO.2013.52.2284 CrossRefPubMedPubMedCentral
Nelson JA, Tchou J, Domchek S, Sonnad SS, Serletti JM, Wu LC (2012) Breast reconstruction in bilateral prophylactic mastectomy patients: factors that influence decision making. J Plast Reconstr Aesthet Surg 65(11):1481–1489. https://doi.org/10.1016/j.bjps.2012.05.001 CrossRefPubMed
Alderman AK, Storey AF, Nair NS, Chung KC (2009) Financial impact of breast reconstruction on an academic surgical practice. Plast Reconstr Surg 123(5):1408–1413. https://doi.org/10.1097/PRS.0b013e3181a0722d CrossRefPubMedPubMedCentral
Dasari CR, Gunther S, Wisner DH, Cooke DT, Gold CK, Wong MS (2015) Rise in microsurgical free-flap breast reconstruction in academic medical practices. Ann Plast Surg 74(Suppl 1):S62–65. https://doi.org/10.1097/SAP.0000000000000483 CrossRefPubMed
Yueh JH, Slavin SA, Adesiyun T, Nyame TT, Gautam S, Morris DJ, Tobias AM, Lee BT (2010) Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg 125(6):1585–1595. https://doi.org/10.1097/PRS.0b013e3181cb6351 CrossRefPubMed
Hu ES, Pusic AL, Waljee JF, Kuhn L, Hawley ST, Wilkins E, Alderman AK (2009) Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship Period. Plast Reconstr Surg 124(1):1–8. https://doi.org/10.1097/PRS.0b013e3181ab10b2 CrossRefPubMed
Rogers NE, Allen RJ (2002) Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap. Plast Reconstr Surg 109(6):1919–1924; discussion 1925–1916
Kronowitz SJ, Robb GL (2009) Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg 124(2):395–408. https://doi.org/10.1097/PRS.0b013e3181aee987 CrossRefPubMed
Kronowitz SJ (2012) Current status of autologous tissue-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 130(2):282–292. https://doi.org/10.1097/PRS.0b013e3182589be1 CrossRefPubMedPubMedCentral
Neyt MJ, Blondeel PN, Morrison CM, Albrecht JA (2005) Comparing the cost of delayed and immediate autologous breast reconstruction in Belgium. Br J Plast Surg 58(4):493–497. https://doi.org/10.1016/j.bjps.2004.12.002 CrossRefPubMed
Zhong T, Hu J, Bagher S, Vo A, O’Neill AC, Butler K, Novak CB, Hofer SO, Metcalfe KA (2016) A comparison of psychological response, body image, sexuality, and quality of life between immediate and delayed autologous tissue breast reconstruction: a prospective long-term outcome study. Plast Reconstr Surg 138(4):772–780. https://doi.org/10.1097/PRS.0000000000002536 CrossRefPubMed
Habermann EB, Thomsen KM, Hieken TJ, Boughey JC (2014) Impact of availability of immediate breast reconstruction on bilateral mastectomy rates for breast cancer across the United States: data from the nationwide inpatient sample. Ann Surg Oncol 21(10):3290–3296. https://doi.org/10.1245/s10434-014-3924-y CrossRefPubMed
Nelson JA, Fischer JP, Radecki MA, Pasick C, McGrath J, Serletti JM, Wu LC (2013) Delayed autologous breast reconstruction: factors which influence patient decision making. J Plast Reconstr Aesthet Surg 66(11):1513–1520. https://doi.org/10.1016/j.bjps.2013.06.020 CrossRefPubMed
Beugels J, Hoekstra LT, Tuinder SM, Heuts EM, van der Hulst RR, Piatkowski AA (2016) Complications in unilateral versus bilateral deep inferior epigastric artery perforator flap breast reconstructions: a multicentre study. J Plast Reconstr Aesthet Surg 69(9):1291–1298. https://doi.org/10.1016/j.bjps.2016.04.010 CrossRefPubMed
Chang EI, Chang EI, Soto-Miranda MA, Zhang H, Nosrati N, Ghali S, Chang DW (2015) Evolution of bilateral free flap breast reconstruction over 10 years: optimizing outcomes and comparison to unilateral reconstruction. Plast Reconstr Surg 135(6):946e–953e. https://doi.org/10.1097/PRS.0000000000001233 CrossRefPubMed
Ochoa O, Chrysopoulo M, Nastala C, Ledoux P, Pisano S (2012) Abdominal wall stability and flap complications after deep inferior epigastric perforator flap breast reconstruction: does body mass index make a difference? Analysis of 418 patients and 639 flaps. Plast Reconstr Surg 130(1):21e–33e. https://doi.org/10.1097/PRS.0b013e3182547d09 CrossRefPubMed
Lam G, Weichman KE, Reavey PL, Wilson SC, Levine JP, Saadeh PB, Allen RJ, Choi M, Karp NS, Thanik VD (2017) Analysis of Flap weight and postoperative complications based on flap weight in patients undergoing microsurgical breast reconstruction. J Reconstr Microsurg 33(3):186–193. https://doi.org/10.1055/s-0036-1594298 CrossRefPubMed
- Complications following immediate compared to delayed deep inferior epigastric artery perforator flap breast reconstructions
S. M. J. van Kuijk
S. S. Qiu
S. M. H. Tuinder
E. M. Heuts
R. R. W. J. van der Hulst
- Springer US
Neu im Fachgebiet Onkologie
Mail Icon II