BREAST-Q and Donor Site Comparison in Bilateral Stacked Autologous Breast Reconstruction

Abstract

Introduction: Patients undergoing bilateral autologous breast reconstruction may benefit from increased flap volume using bilateral stacked deep inferior epigastric perforator (DIEP) and profunda artery perforator (PAP) flaps. Our aim was to characterize the donor site morbidity and patient reported outcomes in four-flap breast reconstruction. Materials and Methods: Retrospective review was performed for all patients undergoing four-flap breast reconstruction by two surgeons between January 2010 – September 2021. Outcome measures including the BREAST-Q reconstructive module, the Lower Extremity Functional Scale (LEFS), inpatient surgical site pain scores by Numeric Pain Rating Scale (NPRS), and a post-operative subjective survey comparing donor sites were obtained. Four-flap BREAST-Q scores were compared to bilateral DIEP and to bilateral PAP patients. Results: A total of 79 patients undergoing four-flap breast reconstruction were identified. Four-flap BREAST-Q scores (n=56) were similar to bilateral DIEP and bilateral PAP reconstruction patients. Long term survey outcomes from the LEFS demonstrated improved score trend after 6 months. Mean instances of donor site pain location recorded at the abdomen were significantly higher than the thigh during the post-operative admission. Subjective survey data revealed more long-term donor site pain at the PAP site, a patient preference for the DIEP donor site, and easier post-operative care for the DIEP donor site. Conclusion: This is the largest consecutive series of four-flap breast reconstruction outcomes reported to date. BREAST-Q scores in four-flap patients demonstrate overall patient satisfaction that is similar to both bilateral DIEP and bilateral PAP reconstruction patients. The DIEP donor site appears to be preferred by patients than the PAP donor site.