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DOI: 10.1055/s-0038-1641711
How Does Autologous Breast Reconstruction Impact Downtime?
Publication History
11 September 2017
22 February 2018
Publication Date:
13 April 2018 (online)
![](https://www.thieme-connect.de/media/jrm/201807/lookinside/thumbnails/10-1055-s-0038-1641711_170268-1.jpg)
Abstract
Background Although autologous breast reconstruction is technically quite demanding, it offers the best outcomes in terms of durable results, patient perceptions, and postoperative pain. Many studies have focused on clinical outcomes and technical aspects of such procedures, but few have addressed the impact of various flaps on patient recovery times. This particular investigation entailed an assessment of commonly used flaps, examining the periods of time required to resume daily activities.
Methods Multiple choice questionnaires were administered to 121 patients after recovery from autologous reconstruction to determine the times required in returning to specific physical activities. To analyze results, the analysis of variance F-test was applied, and odds ratios (ORs) were determined.
Results Among the activities surveyed, recovery time was not always a function of free-flap surgery. Additional treatments and psychological effects also contributed. Adjuvant chemotherapy increased average downtime by 2 weeks, and postoperative irradiation prolonged recovery as much as 4 weeks. Patient downtime was unrelated to flap type, ranging from 2.9 to 21.3 weeks for various activities in question. Deep inferior epigastric perforator (DIEP) flaps yielded the highest OR and transverse upper gracilis (TUG) flaps the lowest.
Conclusion Compared with superior gluteal artery perforator and TUG flaps, the DIEP flap was confirmed as the gold standard in autologous breast reconstruction, conferring the shortest recovery times. All adjuvant therapies served to prolong patient recovery as well. Surgical issues, patient lifestyles, and donor-site availability are other important aspects of flap selection.
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References
- 1 Algaithy ZK, Petit JY, Lohsiriwat V. , et al. Nipple sparing mastectomy: can we predict the factors predisposing to necrosis?. Eur J Surg Oncol 2012; 38 (02) 125-129
- 2 Mallon P, Feron JG, Couturaud B. , et al. The role of nipple-sparing mastectomy in breast cancer: a comprehensive review of the literature. Plast Reconstr Surg 2013; 131 (05) 969-984
- 3 Cabral IV, Garcia ED, Sobrinho RN. , et al. Increased capacity for work and productivity after breast reduction. Aesthet Surg J 2017; 37 (01) 57-62
- 4 Colwell AS, Tessler O, Lin AM. , et al. Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends. Plast Reconstr Surg 2014; 133 (03) 496-506
- 5 Salgarello M, Visconti G, Barone-Adesi L. Nipple-sparing mastectomy with immediate implant reconstruction: cosmetic outcomes and technical refinements. Plast Reconstr Surg 2010; 126 (05) 1460-1471
- 6 De Vita R, Pozzi M, Zoccali G. , et al. Skin-reducing mastectomy and immediate breast reconstruction in patients with macromastia. J Exp Clin Cancer Res 2015; 34: 120
- 7 Taghizadeh R, Moustaki M, Harris S, Roblin P, Farhadi J. Does post-mastectomy radiotherapy affect the outcome and prevalence of complications in immediate DIEP breast reconstruction? A prospective cohort study. J Plast Reconstr Aesthet Surg 2015; 68 (10) 1379-1385
- 8 Bensimon RH, Bergmeyer JM. Improved aesthetics in breast reconstruction: modified mastectomy incision and immediate autologous tissue reconstruction. Ann Plast Surg 1995; 34 (03) 229-233 , discussion 233–235
- 9 Davies K, Allan L, Roblin P, Ross D, Farhadi J. Factors affecting postoperative complications following skin sparing mastectomy with immediate breast reconstruction. Breast 2011; 20 (01) 21-25
- 10 Weichman KE, Hamill JB, Kim HM, Chen X, Wilkins EG, Pusic AL. Understanding the recovery phase of breast reconstructions: Patient reported outcomes correlated to the type and timing of reconstruction. J Plast Reconstr Aesthet Surg 2015; 68 (10) 1370-1378
- 11 Davidge K, Armstrong KA, Brown M. , et al. Shifting autologous breast reconstruction into an ambulatory setting: patient-reported quality of recovery. Plast Reconstr Surg 2015; 136 (04) 657-665
- 12 Batdorf NJ, Lemaine V, Lovely JK. , et al. Enhanced recovery after surgery in microvascular breast reconstruction. J Plast Reconstr Aesthet Surg 2015; 68 (03) 395-402
- 13 Chang JM, Kosiorek HE, Dueck AC. , et al. Trends in mastectomy and reconstruction for breast cancer; a twelve year experience from a tertiary care center. Am J Surg 2016; 212 (06) 1201-1210
- 14 Aguiar IC, Veiga DF, Marques TF, Novo NF, Sabino Neto M, Ferreira LM. Patient-reported outcomes measured by BREAST-Q after implant-based breast reconstruction: a cross-sectional controlled study in Brazilian patients. Breast 2017; 31: 22-25
- 15 King MT, Winters ZE, Olivotto IA. , et al. Patient-reported outcomes in ductal carcinoma in situ: a systematic review. Eur J Cancer 2017; 71: 95-108
- 16 Zhong T, Hu J, Bagher S. , et al. 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 2016; 138 (04) 772-780
- 17 Eom JS, Kim DY, Kim EK, Lee TJ. The low DIEP flap: an enhancement to the abdominal donor site. Plast Reconstr Surg 2016; 137 (01) 7e-13e
- 18 Uda H, Tomioka YK, Sarukawa S. , et al. Abdominal morbidity after single- versus double-pedicled deep inferior epigastric perforator flap use. J Plast Reconstr Aesthet Surg 2016; 69 (09) 1178-1183
- 19 Penha TR, Botter B, Heuts EM, Voogd AC, von Meyenfeldt MF, van der Hulst RR. Quality of life in patients with breast cancer-related lymphedema and reconstructive breast surgery. J Reconstr Microsurg 2016; 32 (06) 484-490
- 20 Healy C, Allen Sr RJ. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg 2014; 30 (02) 121-125