Advantages of the Delayed–Immediate Microsurgical Breast Reconstruction: Extending the Choice

Eric Pittelkow; Will DeBrock; Laura Christopher; Raphael Mercho; Lily Ji-Yun Suh; Carla S. Fisher; Brett Hartman; Mary Lester; Aladdin H. Hassanein

doi:10.1055/s-0041-1742240

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2022; 38(07): 579-584
DOI: 10.1055/s-0041-1742240

Original Article

Advantages of the Delayed–Immediate Microsurgical Breast Reconstruction: Extending the Choice

Autor*innen

Eric Pittelkow

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
Will DeBrock

²Divison of Surgical Oncology, Indiana University School of Medicine, Indianapolis, Indiana
Laura Christopher

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
Raphael Mercho

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
Lily Ji-Yun Suh

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
Carla S. Fisher

²Divison of Surgical Oncology, Indiana University School of Medicine, Indianapolis, Indiana
Brett Hartman

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
Mary Lester^*

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
Aladdin H. Hassanein^*

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

Abstract

Background Deep inferior epigastric perforator (DIEP) reconstruction can be performed in an immediate (at time of mastectomy), delayed–immediate (immediate tissue expander followed by staged DIEP), or delayed timing following mastectomy. Avoiding flap radiation is a known benefit of the delayed–immediate approach. The purpose of this study is to evaluate patients who chose DIEP flap as the reconstructive method during initial consultation and compared characteristics of surgery in relation to their final reconstructive choice.

Methods Consecutive patients having breast reconstruction from 2017 to 2019 were divided into three groups: immediate DIEP after mastectomy (Group I); delayed–immediate DIEP with tissue expander first followed by DIEP (Group II); and patients who initially chose delayed–immediate DIEP but later decided on implants for the second stage of reconstruction (Group III). Exclusion criteria were patients that had delayed DIEP (no immediate reconstruction) or had initially chose implant-based reconstruction.

Results The study included 59 patients. Unilateral free flaps in Group II had shorter operative times (318 minutes) compared with Group I unilateral free flaps (488 minutes) (p = 0.024). Eleven patients (30.6%) had prophylactic mastectomies in Group I compared with none in Group II (p = 0.004). Patients who had immediate tissue expansion frequently changed their mind from DIEP to implant for second stage reconstruction frequently (52.2%).

Conclusion Delayed–immediate DIEP reconstruction has several advantages over immediate DIEP flap including shorter free flap operative times. Patients commonly alter their preference for second stage reconstruction. A patient-centered advantage of delayed–immediate reconstruction is prolonging the time for patients to make their choice for the final reconstruction.

Keywords

DIEP - breast reconstruction - breast anatomy - tissue expander - PMRT

Volltext

Referenzen

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