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CC BY-NC 4.0 · Arch Plast Surg 2021; 48(05): 473-482
DOI: 10.5999/aps.2020.02362
Breast/Trunk
Original Article

Objective photographic assessments and comparisons of immediate bilateral breast reconstruction using deep inferior epigastric perforator flaps and implants

Hyun Ho Han 
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Jin Mi Choi 
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Jin Sup Eom 
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Background The increasing number of bilateral breast cancer patients has been accompanied by a growing need for bilateral mastectomy with immediate reconstruction. However, little research has investigated the complications and aesthetic outcomes related to bilateral reconstruction. Therefore, we analyzed retrospective data comparing the outcomes of bilateral reconstruction using deep inferior epigastric perforator (DIEP) flaps or implants.

Methods This study included 52 patients (24 DIEP group and 28 implant group) who underwent bilateral mastectomy with immediate reconstruction between 2010 and 2020. Patient demographics, surgical characteristics, and complications were recorded. The difference between the left and right position of the nipple-areolar complex with respect to the sternal notch point at the clavicle was measured, and breast symmetry was evaluated.

Results The average weight of breasts reconstructed with DIEP flaps (417.43±152.50 g) was higher than that of breasts with implants. The hospitalization period and operation time were significantly longer in the DIEP group. Early complications were significantly more common in the implant group (36.53%) than in the DIEP group. The angles between the nipples and the horizontal line were 1.09°±0.71° and 1.75°±1.45° in the DIEP and implant groups, respectively.

Conclusions Although the surgical burden is lower, breast reconstruction using implants requires greater attention with respect to implant positioning, asymmetry, and complications than DIEP flap reconstruction. DIEP flap reconstruction has a prolonged operation time and a high risk of flap failure, but yields excellent cosmetic results and does not require intensive follow-up. Patients should be consulted to determine the most suitable option for them.

Keywords

Breast reconstruction - Breast neoplasms - Perforator flaps - Free tissue flap - Breast implants


Publication History

Received: 28 November 2020

Accepted: 07 July 2021

Article published online:
19 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • REFERENCES

  • 1 Carbine NE, Lostumbo L, Wallace J. etal Risk-reducing mastectomy for the prevention of primary breast cancer. Cochrane Database Syst Rev 2018; 4: CD002748
    CrossrefPubMedSearch in Google Scholar
  • 2 Schneider 2nd AP, Zainer CM, Kubat CK. et al. The breast cancer epidemic: 10 facts. Linacre Q 2014; 81: 244-77
    CrossrefPubMedSearch in Google Scholar
  • 3 DeSantis CE, Ma J, Gaudet MM. et al. Breast cancer statistics, 2019. CA Cancer J Clin 2019; 69: 438-51
    CrossrefPubMedSearch in Google Scholar
  • 4 Nealon KP, Sobti N, Gadd M. et al. Assessing the additional surgical risk of contralateral prophylactic mastectomy and immediate breast implant reconstruction. Breast Cancer Res Treat 2020; 179: 255-65
    CrossrefPubMedSearch in Google Scholar
  • 5 Narod SA. Bilateral breast cancers. Nat Rev Clin Oncol 2014; 11: 157-66
    CrossrefPubMedSearch in Google Scholar
  • 6 Sakai T, Ozkurt E, DeSantis S. et al. National trends of synchronous bilateral breast cancer incidence in the United States. Breast Cancer Res Treat 2019; 178: 161-7
    CrossrefPubMedSearch in Google Scholar
  • 7 Taylor EM, Wilkins EG, Pusic AL. et al. Impact of unilateral versus bilateral breast reconstruction on procedure choices and outcomes. Plast Reconstr Surg 2019; 143: 1159e-1168e
    CrossrefPubMedSearch in Google Scholar
  • 8 Yueh JH, Slavin SA, Adesiyun T. et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg 2010; 125: 1585-95
    CrossrefPubMedSearch in Google Scholar
  • 9 Drazan L, Vesely J, Hyza P. Bilateral breast reconstruction with DIEP flaps: 4 years’ experience. J Plast Reconstr Aesthet Surg 2008; 61: 1309-15
    CrossrefPubMedSearch in Google Scholar
  • 10 Hu ES, Pusic AL, Waljee JF. Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship Period. Plast Reconstr Surg 2009; 124: 1-8
    PubMedSearch in Google Scholar
  • 11 Yun J, Jeong HH, Cho J. Weight analysis of mastectomy specimens and abdominal flaps used for breast reconstruction in Koreans. Arch Plast Surg 2018; 45: 246-52
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 King TA, Sakr R, Patil S. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol 2011; 29: 2158-64
    CrossrefPubMedSearch in Google Scholar
  • 13 Breast Cancer Linkage Consortium Cancer risks in BRCA2 mutation carriers. J Natl Cancer Inst 1999; 91: 1310-6
    CrossrefPubMedSearch in Google Scholar
  • 14 Isaksson K, Arver B, Bottai M. Bilateral risk-reducing mastectomies with implant-based reconstructions followed long term: a consecutive series of 185 patients. World J Surg 2019; 43: 2262-70
    CrossrefPubMedSearch in Google Scholar
  • 15 Rosson GD, Magarakis M, Shridharani SM. A review of the surgical management of breast cancer: plastic reconstructive techniques and timing implications. Ann Surg Oncol 2010; 17: 1890-900
    CrossrefPubMedSearch in Google Scholar
  • 16 Thorat MA, Balasubramanian R. Breast cancer prevention in high-risk women. Best Pract Res Clin Obstet Gynaecol 2020; 65: 18-31
    CrossrefPubMedSearch in Google Scholar
  • 17 Tuttle TM, Habermann EB, Grund EH. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol 2007; 25: 5203-9
    CrossrefPubMedSearch in Google Scholar
  • 18 Ozturk A, Alco G, Sarsenov D. Synchronous and metachronous bilateral breast cancer: a long-term experience. J BUON 2018; 23: 1591-600
    PubMedSearch in Google Scholar
  • 19 Penn J. Breast reduction. Br J Plast Surg 1955; 7: 357-71
    PubMedSearch in Google Scholar
  • 20 Clark K. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. J Insur Med 1999; 31: 41-3
    PubMedSearch in Google Scholar
  • 21 Liede A, Cai M, Crouter TF. Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect. Breast Cancer Res Treat 2018; 171: 435-42
    CrossrefPubMedSearch in Google Scholar
  • 22 Holoyda KA, Simpson AM, Ye X. Immediate bilateral breast reconstruction using abdominally based flaps: an analysis of the nationwide inpatient sample database. J Reconstr Microsurg 2019; 35: 594-601
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Guerra AB, Metzinger SE, Bidros RS. Bilateral breast reconstruction with the deep inferior epigastric perforator (DIEP) flap: an experience with 280 flaps. Ann Plast Surg 2004; 52: 246-52
    CrossrefPubMedSearch in Google Scholar
  • 24 Elswick SM, Harless CA, Bishop SN. Prepectoral implant-based breast reconstruction with postmastectomy radiation therapy. Plast Reconstr Surg 2018; 142: 1-12
    CrossrefPubMedSearch in Google Scholar
  • 25 Graziani C, Panico C, Botti G. Subperiosteal midface lift: its role in static lower eyelid reconstruction after chronic facial nerve palsy. Orbit 2011; 30: 140-4
    CrossrefPubMedSearch in Google Scholar
  • 26 Ardehali B, Morritt AN, Jain A. Systematic review: anastomotic microvascular device. J Plast Reconstr Aesthet Surg 2014; 67: 752-5
    CrossrefPubMedSearch in Google Scholar
  • 27 Anker AM, Prantl L, Strauss C. Assessment of DIEP flap perfusion with intraoperative indocyanine green fluorescence imaging in vasopressor-dominated hemodynamic support versus liberal fluid administration: a randomized controlled trial with breast cancer patients. Ann Surg Oncol 2020; 27: 399-406
    CrossrefPubMedSearch in Google Scholar
  • 28 Vargas CR, Koolen PG, Ho OA. Preoperative CT-angiography in autologous breast reconstruction. Microsurgery 2016; 36: 623-7
    CrossrefPubMedSearch in Google Scholar
  • 29 Lemaine V, Schilz SR, Van Houten HK. Autologous breast reconstruction versus implant-based reconstruction: how do long-term costs and health care use compare?. Plast Reconstr Surg 2020; 145: 303-11
    CrossrefPubMedSearch in Google Scholar
  • 30 van Veen MM, Dijkstra PU, Werker P. A higher quality of life with cross-face-nerve-grafting as an adjunct to a hypoglossal-facial nerve jump graft in facial palsy treatment. J Plast Reconstr Aesthet Surg 2017; 70: 1666-74
    CrossrefPubMedSearch in Google Scholar