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J Reconstr Microsurg 2021; 37(09): 753-763
DOI: 10.1055/s-0041-1726397
Original Article

A Comparison of Patient-Reported Outcomes in Bipedicled Total Abdominal versus Unipedicled Hemiabdominal Free Flaps for Unilateral Breast Reconstruction

Amanda R. Sergesketter
1   Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
,
Ronnie L. Shammas
1   Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
,
Mahsa Taskindoust
1   Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
,
Adam D. Glener
1   Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
,
Bryan J. Pyfer
1   Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
,
Kristen Rezak
1   Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
,
Brett T. Phillips
1   Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
,
Scott T. Hollenbeck
1   Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
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Abstract

Background While bipedicled free flaps enable increased soft tissue volume and potential for contralateral symmetry in unilateral breast reconstruction, the influence of bipedicled flap reconstruction on patient-reported outcomes remains unclear.

Methods Patients undergoing unilateral free flap breast reconstruction at a single institution from 2014 to 2019 were retrospectively reviewed and sent the BREAST-Q and Decision Regret Scale. Complication rates and the BREAST-Q and Decisional Regret Scale scores (0–100) were compared between patients receiving bipedicled total abdominal and unipedicled hemiabdominal free flaps.

Results Sixty-five patients undergoing unilateral breast reconstruction completed the BREAST-Q and Decision Regret Scale with median (interquartile range [IQR]) follow-up time of 32 [22–55] months. Compared with bipedicled flaps, patients receiving unipedicled hemiabdominal flaps had higher mean body mass index (BMI; p = 0.009) and higher incidence of fat grafting (p = 0.03) and contralateral reduction mammaplasties (p = 0.03). There was no difference in incidence of major or minor complications, abdominal hernias or bulges, or total operative time between bipedicled and unipedicled flaps (p > 0.05). Overall, BREAST-Q scores for satisfaction with breast, sexual wellbeing, psychosocial wellbeing, physical wellbeing (chest), and physical wellbeing (abdomen) and the Decision Regret Scale scores did not significantly vary between bipedicled and unipedicled reconstructions (all p > 0.05). However, among large-breasted patients (≥C cup), mean (standard deviation [SD]) sexual wellbeing was significantly higher after bipedicled total abdominal free flap reconstruction ([60.2 (23.3) vs. 46.2 (22.0)]; p = 0.04), though this difference did not reach significance after multivariate adjustment.

Conclusion Unilateral breast reconstruction with bipedicled total abdominal free flaps results in similar complication risk, patient satisfaction, and decisional regret without the need for as many contralateral reduction procedures.

Keywords

breast reconstruction - patient-reported outcomes - reconstruction - breast cancer - BREAST-Q

Supplementary Material



Publication History

Received: 11 December 2020

Accepted: 27 January 2021

Article published online:
14 April 2021

© 2021. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Nelson JA, Allen Jr. RJ, Polanco T. et al. Long-term patient-reported outcomes following postmastectomy breast reconstruction: an 8-year examination of 3268 patients. Ann Surg 2019; 270 (03) 473-483
    CrossrefPubMedGoogle Scholar
  • 2 Schwartz JC. Unilateral reconstruction of the large breast: combining prosthetic and autologous methods for improved symmetry. Plast Reconstr Surg Glob Open 2019; 7 (02) e2154
    CrossrefPubMedGoogle Scholar
  • 3 Smith ML, Clarke-Pearson EM, Vornovitsky M, Dayan JH, Samson W, Sultan MR. The efficacy of simultaneous breast reconstruction and contralateral balancing procedures in reducing the need for second stage operations. Arch Plast Surg 2014; 41 (05) 535-541
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Chang EI, Lamaris G, Chang DW. Simultaneous contralateral reduction mammoplasty or mastopexy during unilateral free flap breast reconstruction. Ann Plast Surg 2013; 71 (02) 144-148
    CrossrefPubMedGoogle Scholar
  • 5 Glener AD, Suresh V, Shammas RL. et al. Volumetric symmetry after unilateral autologous breast reconstruction: a reasonable goal. Plast Reconstr Surg Glob Open 2019; 7 (09) e2362
    CrossrefPubMedGoogle Scholar
  • 6 Enajat M, Smit JM, Rozen WM. et al. Aesthetic refinements and reoperative procedures following 370 consecutive DIEP and SIEA flap breast reconstructions: important considerations for patient consent. Aesthetic Plast Surg 2010; 34 (03) 306-312
    CrossrefPubMedGoogle Scholar
  • 7 Spear SL, Travaglino-Parda RL, Stefan MM. The stacked transverse rectus abdominis musculocutaneous flap revisited in breast reconstruction. Ann Plast Surg 1994; 32 (06) 565-571
    CrossrefPubMedGoogle Scholar
  • 8 Ishii Jr. CH, Bostwick III J, Raine TJ, Coleman III JJ, Hester TR. Double-pedicle transverse rectus abdominis myocutaneous flap for unilateral breast and chest-wall reconstruction. Plast Reconstr Surg 1985; 76 (06) 901-907
    CrossrefPubMedGoogle Scholar
  • 9 Wagner DS, Michelow BJ, Hartrampf Jr CR. Double-pedicle TRAM flap for unilateral breast reconstruction. Plast Reconstr Surg 1991; 88 (06) 987-997
    CrossrefPubMedGoogle Scholar
  • 10 Haddock NT, Cho MJ, Teotia SS. Comparative analysis of single versus stacked free flap breast reconstruction: a single-center experience. Plast Reconstr Surg 2019; 144 (03) 369e-377e
    CrossrefPubMedGoogle Scholar
  • 11 Murray A, Wasiak J, Rozen WM, Ferris S, Grinsell D. Stacked abdominal flap for unilateral breast reconstruction. J Reconstr Microsurg 2015; 31 (03) 179-186
    PubMedGoogle Scholar
  • 12 Angrigiani C, Rancati A, Artero G, Khouri Jr. RK, Walocko FM. Stacked thoracodorsal artery perforator flaps for unilateral breast reconstruction. Plast Reconstr Surg 2016; 138 (06) 969e-972e
    CrossrefPubMedGoogle Scholar
  • 13 DellaCroce FJ, Sullivan SK, Trahan C. Stacked deep inferior epigastric perforator flap breast reconstruction: a review of 110 flaps in 55 cases over 3 years. Plast Reconstr Surg 2011; 127 (03) 1093-1099
    CrossrefPubMedGoogle Scholar
  • 14 Haddock NT, Cho MJ, Gassman A, Teotia SS. Stacked profunda artery perforator flap for breast reconstruction in failed or unavailable deep inferior epigastric perforator flap. Plast Reconstr Surg 2019; 143 (03) 488e-494e
    CrossrefPubMedGoogle Scholar
  • 15 Patel NG, Rozen WM, Chow WT. et al. Stacked and bipedicled abdominal free flaps for breast reconstruction: considerations for shaping. Gland Surg 2016; 5 (02) 115-121
    PubMedGoogle Scholar
  • 16 Stalder MW, Lam J, Allen RJ, Sadeghi A. Using the retrograde internal mammary system for stacked perforator flap breast reconstruction: 71 breast reconstructions in 53 consecutive patients. Plast Reconstr Surg 2016; 137 (02) 265e-277e
    CrossrefPubMedGoogle Scholar
  • 17 Sultan SM, Seth AK, Lamelas AM, Greenspun DT, Erhard HA. Bipedicle-conjoined deep inferior epigastric perforator flaps for unilateral breast reconstruction in overweight and obese patients: do the benefits outweigh the risks?. J Reconstr Microsurg 2020; 36 (05) 346-352
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Cho MJ, Haddock NT, Teotia SS. Clinical decision making using CTA in conjoined, bipedicled DIEP and SIEA for unilateral breast reconstruction. J Reconstr Microsurg 2020; 36 (04) 241-246
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Seth AK, Koolen PGL, Sultan SM, Lee BT, Erhard HA, Greenspun DT. Unilateral autologous breast reconstruction with bi-pedicled, conjoined deep inferior epigastric perforator flaps. J Reconstr Microsurg 2019; 35 (02) 145-155
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124 (02) 345-353
    CrossrefPubMedGoogle Scholar
  • 21 Brehaut JC, O'Connor AM, Wood TJ. et al. Validation of a decision regret scale. Med Decis Making 2003; 23 (04) 281-292
    CrossrefPubMedGoogle Scholar
  • 22 Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Breast cancer and reconstruction: normative data for interpreting the BREAST-Q. Plast Reconstr Surg 2017; 139 (05) 1046e-1055e
    CrossrefPubMedGoogle Scholar
  • 23 The Ottawa Hospital. Decision regret scale. Accessed March 1, 2021 at: https://decisionaid.ohri.ca/eval_regret.html
    PubMedGoogle Scholar
  • 24 Jensen JA. Is double pedicle TRAM flap reconstruction of a single breast within the standard of care?. Plast Reconstr Surg 1997; 100 (06) 1592-1593
    CrossrefPubMedGoogle Scholar
  • 25 Agarwal JP, Gottlieb LJ. Double pedicle deep inferior epigastric perforator/muscle-sparing TRAM flaps for unilateral breast reconstruction. Ann Plast Surg 2007; 58 (04) 359-363
    CrossrefPubMedGoogle Scholar
  • 26 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
    CrossrefPubMedGoogle Scholar
  • 27 Kerr-Valentic MA, Gottlieb LJ, Agarwal JP. The retrograde limb of the internal mammary vein: an additional outflow option in DIEP flap breast reconstruction. Plast Reconstr Surg 2009; 124 (03) 717-721
    CrossrefPubMedGoogle Scholar
  • 28 Mundy LR, Rosenberger LH, Rushing CN. et al. The evolution of breast satisfaction and well-being after breast cancer: a propensity-matched comparison to the norm. Plast Reconstr Surg 2020; 145 (03) 595-604
    CrossrefPubMedGoogle Scholar