Breast and abdominal scarring after DIEP flap breast reconstruction: An exploration of patient-reported scar quality

Kristel E Everaars,Esther P.M Tjin,Erik H De Laat,Coralie R Arends,Stefan Hummelink,Dietmar J.O Ulrich

doi:10.1016/j.bjps.2021.12.003

Abstract

PurposeThis research aimed to explore factors associated with patient-reported breast and abdominal scar quality after deep inferior epigastric perforator (DIEP) flap breast reconstruction (BR). Material and MethodsThis study was designed as a descriptive cross-sectional survey in which women after DIEP flap BR were invited to complete an online survey on breast and abdominal scarring. The online survey was distributed in the Netherlands in several ways in order to reach a diverse population of women. Outcomes were assessed with the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS). Additional items were assessed with a numeric rating scale (NRS). ResultsA total of 248 women completed the survey. There was a statistically significant worse POSAS scar appraisal for the abdominal scar compared with the breast scar. The vast majority of women reported high scores on at least one scar characteristic of their breast scar or abdominal scar. Overall, color, stiffness, thickness, and irregularity scored higher than pain and itching. Women were only moderately positive about the size, noticeability, location, and the information provided regarding scarring. ConclusionIt is crucial to address the inevitability of scars in patient education before a DIEP flap BR, with a particular focus on the abdominal scar, as women experience abdominal scars significantly worse than their breast scars. Providing more information on the experience of other women and the expected appearance will contribute to having realistic expectations while allowing them to make well-informed decisions.

Highlights

The number of women who undergo breast reconstruction (BR) surgery after a mastectomy to restore psychological well‐being, body image, self‐esteem, and satisfaction with appearance, has grown increasingly [1,2]
This study was designed as a descriptive cross-sectional survey in which women after deep inferior epigastric perforator (DIEP) flap BR were invited to complete an online survey on breast and abdominal scarring
The online survey was distributed between February 17th and May 5th, 2019, in several ways in order to reach a diverse population of women who had undergone a DIEP flap BR

Summary

June 2021 19 December 2021

Please cite this article as: Kristel E. Everaars , Esther P.M. Tjin , Erik H. de Laat , Coralie R. Arends , Stefan Hummelink , Dietmar J.O. Ulrich , Breast and abdominal scarring after DIEP flap breast reconstruction: an exploration of patient-reported scar quality, Journal of Plastic, Reconstructive & Aesthetic Surgery (2022), doi: https://doi.org/10.1016/j.bjps.2021.12.003 This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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