Abstract
Background: A two center retrospective cohort study of simultaneous bilateral breast reconstructions using double deep inferior epigastric perforator (DIEP) flaps and double transverse myocutaneous/upper gracilis (TMG) flaps was conducted. The aim of this study was to compare surgical procedures, complications, and overall outcome. Patients and Methods: Two study groups, either receiving a simultaneous bilateral breast reconstruction, with double DIEP flaps (n = 152) in group 1, or double TMG flaps (n = 86) in group 2, were compared. A detailed risk and complication analysis was performed. Patient characteristics, operative time and the need for further operations were evaluated. Results: Double DIEP patients had donor site complications in 23.7% and double TMG patients in 16.3% (p = 0.9075, RR 1.45). Flap loss rates of 3.5% (double TMG) and 2.6% (double DIEP) were recorded (p = 0.7071, RR 1.33). The need for postoperative lipofilling was significantly higher in double TMG patients (65.1% vs. 38.2 %, p = 0.0047, RR 1.71). Conclusion: Complication analysis favors the double DIEP procedure. Donor site morbidity was lower and less severe in the double TMG group. Later fat grafting was more frequently needed after double TMG reconstructions. Further studies, preferably of prospective nature, are needed to evaluate the benefit of bilateral simultaneous breast reconstructions.
Highlights
With rising numbers of bilateral mastectomies for the treatment of ductal carcinoma in situ (DCIS), and with better understanding of genetic predisposition to breast cancer, as well as significant advancements and aesthetic improvements in postmastectomy reconstruction, the need for bilateral autologous tissue breast reconstruction has increased further in the last decade [1,2,3].In many cases of unilateral breast cancer or DCIS, in patients with BRCA-1, and BRCA-2 mutations or strong positive cancer family history, a prophylactic bilateral mastectomy is recommended
RPealtaietinvteagriesaknsdfoBrMcIoamrepslhicoawtnioinn eTvabelnet1s.wTheereavcearlacguelaatgeedo.fApalltisetnattsiasttitchaeltaimnaeloyfsseusrignertyhwisarseport were5p3eyrfeoarrms (esdtanbdyaurdsedoevf iSaoticoinal(SSDci)e1n0c.e0)S. tBaMtisI tvicaslu(ews wofwth.seogcsrociusptastdisitffiecrse.cdosmig)n. ificantly, due to the fact that in more adipose patients, a deep inferior epigastric perforator (DIEP) was more likely considered compared to slim patients, where a transverse myocutaneous/upper gracilis (TMG) flap was considered for reconstruction
BMI values of the groups differed significantly, due to the fact that in more adipose patients, a DIEP was more likely considered compared to slim patients, where a TMG flap was considered for reconstruction
Summary
With rising numbers of bilateral mastectomies for the treatment of ductal carcinoma in situ (DCIS), and with better understanding of genetic predisposition to breast cancer, as well as significant advancements and aesthetic improvements in postmastectomy reconstruction, the need for bilateral autologous tissue breast reconstruction has increased further in the last decade [1,2,3].In many cases of unilateral breast cancer or DCIS, in patients with BRCA-1, and BRCA-2 mutations or strong positive cancer family history, a prophylactic bilateral mastectomy is recommended. The deep inferior epigastric perforator (DIEP) flap became a gold standard [4] for breast reconstruction in patients with sufficient amounts of abdominal donor tissue [7]. In patients who do not offer enough abdominal donor tissue for reconstruction because of low body mass index or where the deep inferior epigastric vessels might have been damaged by prior abdominal surgeries, a vast number of alternative free flaps are available. A two center retrospective cohort study of simultaneous bilateral breast reconstructions using double deep inferior epigastric perforator (DIEP) flaps and double transverse myocutaneous/upper gracilis (TMG) flaps was conducted. Patients and Methods: Two study groups, either receiving a simultaneous bilateral breast reconstruction, with double DIEP flaps (n = 152) in group 1, or double TMG flaps (n = 86) in group 2, were compared. Preferably of prospective nature, are needed to evaluate the benefit of bilateral simultaneous breast reconstructions
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