Simultaneous Contralateral Breast Adjustment in Unilateral Deep Inferior Epigastric Perforator Breast Reconstruction

Abstract

Background Breast symmetry is a key factor in deep inferior epigastric perforator (DIEP) flap breast reconstruction, which necessitates in many cases contralateral breast adjustment, traditionally done at a second stage. We present our experience with simultaneous contralateral breast adjustment in unilateral DIEP breast reconstruction.

Methods We retrospectively reviewed all consecutive unilateral DIEP breast reconstructions done in our institution. The patients were divided into three groups according to contralateral breast surgery performed: simultaneous adjustment, late adjustment, and no contralateral breast adjustment surgery. The groups were compared by aesthetic outcome and patient satisfaction using the BREAST-Q questionnaire.

Results A total of 77 unilateral breast reconstructions were performed using the DIEP flap. Fifty-one eligible patients agreed to respond to the questionnaire by telephone and were enrolled in the study; 33 underwent simultaneous contralateral breast adjustment, eight underwent late adjustment procedure, and 10 had no contralateral surgery performed. Aesthetic outcome and patient satisfaction was comparable in the simultaneous and late adjustment groups, but was reduced during the latent period.

Conclusion Simultaneous contralateral breast adjustment in unilateral DIEP breast reconstruction is a safe and a worthwhile procedure that should be offered to the patient when appropriate.

Keywords

breast reconstruction - deep inferior epigastric perforator (DIEP) - breast cancer - breast asymmetry - BREAST-Q

• References

• 1 Saint-Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg 2009; 123: 132e-145e
• 2 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42: 645-648
• 3 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32: 32-38
• 4 Holmström H. The free abdominoplasty flap and its use in breast reconstruction. An experimental study and clinical case report. Scand J Plast Reconstr Surg 1979; 13: 423-427
• 5 Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 1982; 69: 216-225
• 6 Futter CM, Webster MH, Hagen S, Mitchell SL. A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap. Br J Plast Surg 2000; 53: 578-583
• 7 Blondeel N, Vanderstraeten GG, Monstrey SJ , et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg 1997; 50: 322-330
• 8 Kroll SS, Schusterman MA, Reece GP, Miller MJ, Robb G, Evans G. Abdominal wall strength, bulging, and hernia after TRAM flap breast reconstruction. Plast Reconstr Surg 1995; 96: 616-619
• 9 Nahabedian MY, Manson PN. Contour abnormalities of the abdomen after transverse rectus abdominis muscle flap breast reconstruction: a multifactorial analysis. Plast Reconstr Surg 2002; 109: 81-87 ; discussion 88–90
• 10 Nahabedian MY, Dooley W, Singh N, Manson PN. Contour abnormalities of the abdomen after breast reconstruction with abdominal flaps: the role of muscle preservation. Plast Reconstr Surg 2002; 109: 91-101
• 11 Kroll SS, Sharma S, Koutz C , et al; Evans GRD. Postoperative morphine requirements of free TRAM and DIEP flaps. Plast Reconstr Surg 2001; 107: 338-341
• 12 Losken A, Carlson GW, Bostwick III J, Jones GE, Culbertson JH, Schoemann M. Trends in unilateral breast reconstruction and management of the contralateral breast: the Emory experience. Plast Reconstr Surg 2002; 110: 89-97
• 13 Dinner MI, Dowden RV. Management of the contralateral breast. In: Gant TD, Vasconez LO, eds. Postmastectomy Reconstruction. Baltimore: Williams and Wilkins; 1988: 205-217
• 14 Petit JY, Rietjens M, Contesso G, Bertin F, Gilles R. Contralateral mastoplasty for breast reconstruction: a good opportunity for glandular exploration and occult carcinomas diagnosis. Ann Surg Oncol 1997; 4: 511-515
• 15 Stevenson TR, Goldstein JA. TRAM flap breast reconstruction and contralateral reduction or mastopexy. Plast Reconstr Surg 1993; 92: 228-233
• 16 Chung KC. Discussion. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124: 354
• 17 Hall-Findlay EJ. A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg 1999; 104: 748-759 ; discussion 760–763
• 18 Lejour M. Vertical mammaplasty and liposuction of the breast. Plast Reconstr Surg 1994; 94: 100-114
• 19 Granzow JW, Levine JL, Chiu ES, Allen RJ. Breast reconstruction with the deep inferior epigastric perforator flap: history and an update on current technique. J Plast Reconstr Aesthet Surg 2006; 59: 571-579
• 20 Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 1999; 52: 104-111
• 21 Hu ES, Pusic AL, Waljee JF , et al. Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship period. Plast Reconstr Surg 2009; 124: 1-8
• 22 Saulis AS, Mustoe TA, Fine NA. A retrospective analysis of patient satisfaction with immediate postmastectomy breast reconstruction: comparison of three common procedures. Plast Reconstr Surg 2007; 119: 1669-1676 ; discussion 1677–1678
• 23 Alderman AK, Wilkins EG, Lowery JC, Kim M, Davis JA. Determinants of patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg 2000; 106: 769-776
• 24 Gill PS, Hunt JP, Guerra AB , et al. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg 2004; 113: 1153-1160