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J Reconstr Microsurg 2023; 39(03): 209-213
DOI: 10.1055/a-1885-1540
Original Article

Flap to Mastectomy Mass: Are Higher Ratios Associated with Greater Breast Reconstruction Satisfaction?

Aaron S. Long‡   *
1   Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Ann H. Ching‡   *
1   Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Sacha C. Hauc
1   Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Mohammad Ali Mozaffari 
1   Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Adam H. Junn
1   Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Jean Carlo Rivera
1   Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Mariana N. Almeida
1   Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
,
David P. Alper
1   Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Omar Allam
1   Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Michael Alperovich
1   Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Abstract

Background Autologous breast reconstruction is associated with superior patient-reported outcomes compared with prosthetic techniques, but little is known about the relationship between autologous flap mass and patient satisfaction. We hypothesized that a higher differential mass (ratio of flap mass to mastectomy mass) would be associated with greater satisfaction with reconstruction.

Methods In this retrospective study, patients who underwent autologous breast reconstruction between 2015 and 2020 with a deep inferior epigastric perforator (DIEP) flap completed the BREAST-Q survey. Multivariate linear regression models were used to examine the relationship between differential mass and patient satisfaction. Models controlled for body mass index (BMI), age at surgery, reconstruction size preference, number of surgeries, previous surgery failure, whether the patient underwent radiation therapy, and whether reconstruction was unilateral or bilateral.

Results Overall, 45 patients (70 breasts) completed the BREAST-Q survey. Mean age at reconstruction was 52.2 years and mean time to survey completion following surgery was 21.1 months. Most patients (59.4%) desired a smaller breast after reconstruction. The mean differential mass was +26.3% (flap mass greater than mastectomy mass). Differential mass was positively associated with all satisfaction measures with results being significant for satisfaction with breasts scores (p=0.032).

Conclusion In this preliminary study, a higher ratio of autologous flap mass to mastectomy mass was associated with overall higher patient-reported satisfaction. A 1:1 flap to mastectomy mass ratio may not adequately reapproximate desired breast size or shape. Larger autologous flap mass may be favorable for long-term patient satisfaction, and future studies should investigate the relationship between differential mass and breast esthetics.

Keywords

breast reconstruction - deep inferior epigastric perforator flap - patient reported outcome measure - BREAST-Q

* Both authors contributed equally warranting first authorship.


Supplementary Material



Publication History

Received: 23 February 2022

Accepted: 29 May 2022

Accepted Manuscript online:
25 June 2022

Article published online:
12 September 2022

© 2022. Thieme. All rights reserved.

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