Interdisciplinary Treatment of Breast Cancer After Mastectomy With Autologous Breast Reconstruction Using Abdominal Free Flaps in a University Teaching Hospital-A Standardized and Safe Procedure.

Dominik Steiner,Justus P Beier,Ingo Ludolph,Marweh Schmitz,Andreas Arkudas,Raymund E Horch

doi:10.3389/fonc.2020.00177

Abstract

Background: Breast cancer is the most common malignancy in women. The interdisciplinary treatment is based on the histological tumor type, the TNM classification, and the patient's wishes. Following tumor resection and (neo-) adjuvant therapy strategies, breast reconstruction represents the final step in the individual interdisciplinary treatment plan. Although manifold flaps have been described, abdominal free flaps, such as the deep inferior epigastric artery perforator (DIEP) or the muscle-sparing transverse rectus abdominis myocutaneous (ms-TRAM) flap, are the current gold standard for autologous breast reconstruction. This retrospective study focuses on the safety of autologous breast reconstruction upon mastectomy using abdominal free flaps.Methods: From April 2012 until December 2018, 193 women received 217 abdominal free flaps for autologous breast reconstruction at the University Hospital of Erlangen. For perforator mapping, we performed computed tomography angiography (CTA). Venous anastomosis was standardized using a ring pin coupler system, and flap perfusion was assessed with fluorescence angiography. A retrospective analysis was performed based on medical records, the surgery report, and follow-up of outpatient course.Results: In most cases, autologous breast reconstruction was performed as a secondary reconstructive procedure after mastectomy and radiotherapy. In total, 132 ms1-TRAM, 23 ms2-TRAM, and 62 DIEP flaps were performed with 21 major complications (10%) during hospital stay including five free flap losses (2.3%). In all cases of free flap loss, we found an arterial thrombosis as the main cause. In 24 patients a bilateral breast reconstruction was performed without free flap loss. The majority of free flaps (96.7%) did not need additional supercharging or turbocharging to improve venous outflow. Median venous coupler size was 2.5 mm (range, 1.5–3.5 mm).Conclusion: Using CTA, intraoperative fluorescence angiography, titanized hernia meshes for rectus sheath reconstruction, and venous coupler systems, autologous breast reconstruction with DIEP or ms-TRAM free flaps is a safe and standardized procedure in high-volume microsurgery centers.

Highlights

Breast cancer is the most commonly diagnosed cancer type in women (24.2%) with an annual incidence and mortality of 11.6 and 15%, respectively [1]
The later ones experienced a further refinement starting from the transverse rectus abdominis myocutaneous (TRAM) over the muscle-sparing variants to the deep inferior epigastric artery perforator (DIEP) flap
Because of their low donor site morbidity, muscle-sparing transverse rectus abdominis myocutaneous (ms-TRAM) and DIEP flaps represent the gold standard in autologous breast reconstruction [6,7,8,9]

Summary

Introduction

Breast cancer is the most commonly diagnosed cancer type in women (24.2%) with an annual incidence and mortality of 11.6 and 15%, respectively [1]. The later ones experienced a further refinement starting from the TRAM over the muscle-sparing variants (msTRAM) to the deep inferior epigastric artery perforator (DIEP) flap Because of their low donor site morbidity, ms-TRAM and DIEP flaps represent the gold standard in autologous breast reconstruction [6,7,8,9]. Manifold flaps have been described, abdominal free flaps, such as the deep inferior epigastric artery perforator (DIEP) or the muscle-sparing transverse rectus abdominis myocutaneous (ms-TRAM) flap, are the current gold standard for autologous breast reconstruction. This retrospective study focuses on the safety of autologous breast reconstruction upon mastectomy using abdominal free flaps

Methods

Results

Conclusion