Patient-Reported Outcomes and Complications Following Breast Reconstruction: A Comparison Between Biological Matrix-Assisted Direct-to-Implant and Latissimus Dorsi Flap.

Peng Gao,Yi Fang,Xiangyi Kong,Jing Wang,Jidong Gao,Ping Bai

doi:10.3389/fonc.2022.766076

Abstract

BackgroundImplant-based breast reconstruction is increasingly becoming the most common method of postmastectomy breast reconstruction in use today. As the traditional autologous reconstruction technique, latissimus dorsi flap (LDF) is employed by surgeons for reconstruction after breast cancer surgery, including partial mastectomy, modified radical mastectomy, and others. The authors aim to compare patient-reported outcomes (PROs) and complications between the SIS matrix-assisted direct-to-implant (DTI) breast reconstruction and the autologous LDF breast reconstruction.MethodsPatients undergoing the SIS matrix-assisted DTI reconstruction or mastectomy with LDF reconstruction or partial mastectomy with mini latissimus dorsi flap (MLDF) reconstruction were enrolled in a single institution from August 2010 to April 2019. Patients were included for analysis and divided into three groups: those who underwent LDF reconstruction, those who underwent MLDF reconstruction, and patients who underwent SIS matrix-assisted DTI breast reconstruction. PROs (using the BREAST-Q version 2.0 questionnaire) and complications were evaluated.ResultsA total of 135 patients met the inclusion criteria: 79 patients (58.5%) underwent SIS matrix-assisted DTI, 29 patients (21.5%) underwent LDF breast reconstruction, and 27 patients (20%) underwent MLDF breast reconstruction. PROs and complication rates between LDF reconstruction group and MLDF reconstruction group showed no statistically significant differences. Furthermore, BREAST-Q responses found that patients in the whole autologous LDF reconstruction group had better psychosocial well-being, showing a mean score of 84.31 ± 17.28 compared with SIS matrix-assisted DTI reconstruction, with a mean score of 73.52 ± 19.96 (p = 0.005), and expressed higher sexual well-being (69.65 ± 24.64 vs. 50.95 ± 26.47; p = 0.016). But there were no statistically significant differences between the two groups for postoperative complications.ConclusionThis retrospective study showed no statistically significant differences between LDF breast reconstruction and MLDF breast reconstruction. However, patients in the whole autologous LDF reconstruction group yielded superior PROs than patients in the SIS matrix-assisted DTI reconstruction group in the psychosocial well-being and sexual well-being domains.

Highlights

Reconstruction after mastectomy is increasingly becoming the mainstream approach for younger women who are diagnosed with breast cancer
For patients who underwent latissimus dorsi flap (LDF) breast reconstruction, 55.2% (n = 16) responded to the BREAST-Q version 2.0 survey, and 70.4% of patients (n = 19) undergoing mini latissimus dorsi flap (MLDF) breast reconstruction responded to the survey, whereas 86.1% of patients (n = 69) with SIS matrixassisted DTI breast reconstruction were responders
There was no statistical significance, patients who underwent MLDF breast reconstruction had a slightly larger body mass index at 25.51 ± 6.88 kg/m2 and slightly larger tumor size of 3.25 ± 1.60 cm compared with the body mass index at 22.76 ± 2.68 kg/m2 (p = 0.060) and tumor size of 2.76 ± 2.03 cm (p = 0.320) in the LDF breast reconstruction group

Summary

Introduction

Reconstruction after mastectomy is increasingly becoming the mainstream approach for younger women who are diagnosed with breast cancer. The therapeutic course following breast cancer and mastectomy affects their QOL in terms of psychosocial, physical, aesthetic, body image, and sexual issues [3, 4]. They need to evaluate different reconstruction approaches according to the characteristics of patients and to assess the time and economic costs for patients. As the traditional autologous reconstruction technique, latissimus dorsi flap (LDF) is employed by surgeons for reconstruction after breast cancer surgery, including partial mastectomy, modified radical mastectomy, and others. The authors aim to compare patient-reported outcomes (PROs) and complications between the SIS matrix-assisted direct-to-implant (DTI) breast reconstruction and the autologous LDF breast reconstruction

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Discussion

Conclusion