Autologous Breast Reconstruction Research Articles

ASO Author Reflections: Improving Patient Access to Autologous Breast Reconstruction.

ASO Author Reflections: Improving Patient Access to Autologous Breast Reconstruction.

Autologous Fat Breast Reconstruction with Implant Completion-Experience with 29 Consecutive Cases and 33 Breasts.

Implant-based breast reconstruction is the most prevalent form of breast reconstruction. Autologous fat grafting (AFG) was conceptualized as an alternative to implant-based breast reconstruction and was found to be a reliable reconstruction modality. However, usually, a few grafting rounds are required to create the desired shape and size of the breast. Current literature describes ample experience with AFG as an adjunct to implant-based breast reconstruction for improving appearance. However, the utilization of breast implants following initial AFG has been sparingly described. The primary advantage of this study is the creation of new fat tissue as a breast mound. The reconstruction is then concluded by inserting an implant into this new mound. This approach reduces the overall number of fat injections needed to achieve the desired outcome, as well as the total volume of the implant. This IRB-approved retrospective study was conducted between January 2015 and December 2021. All women who underwent delayed breast reconstruction with AFG during this timeframe and wanted to complete it with a silicone implant as a last stage were included in the study. A total of 29 patients (33 breasts) underwent delayed breast reconstruction with AFG and a silicone implant as the final stage. In all cases, the results were satisfying without any major complications. Minor complications were observed with one patient and included an infection. The findings of this study have demonstrated the effectiveness of this procedure together with patient satisfaction, thus highlighting the potential advantages that this approach offers. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Timing of Autologous Tissue Breast Reconstruction Does Not Affect Free Flap Failure.

This study aimed to determine whether there is a difference in free flap failure based on the decision to undergo immediate versus delayed autologous tissue breast reconstruction after mastectomy. The National Surgical Quality Improvement Program database was queried for breast free flap procedures performed between 2015 and 2020. This study demonstrates that the decision to undergo immediate versus delayed autologous tissue breast reconstruction does not have a significant association with free flap failure. This remains true regardless of whether patients undergo unilateral mastectomy with reconstruction or whether patients choose to also undergo contralateral prophylactic mastectomy with reconstruction.

The Breast-Pectoralis Flap: A New Advance in Autologous Breast Reconstruction: A Preliminary Report on 20 Cases.

In the past, several publications have described breast reconstruction techniques using the contralateral breast; however, interest has diminished because of technical difficulty, scarring, and poor aesthetic results. This study aimed to present a new breast reconstruction technique that uses a combination of the breast-pectoralis flap and abdominal advancement flap. This retrospective study analyzed the results and complications of 20 consecutive breast reconstructions with the breast-pectoralis flap technique. The authors present a series of 20 breast reconstructions using the breast-pectoralis flap. Delayed breast reconstruction was performed in 13 (65%) cases, breast reconstruction in 5 (25%) patients with Poland syndrome, sequela correction after a chest wall sarcoma in 1 (5%), and sequela correction after breast cystic lymphangioma resection in 1 (5%). One complication required surgical reintervention without long-term consequences. The outcomes were considered very good in 50% of the cases, good in 45%, and fair in 5%. Breast-pectoralis flap associated with the abdominal advancement flap is an interesting advance in breast reconstruction. After the evaluation of the presented cases, we are considering widening the indications of this technique in our current practice.

Summarizing the advantages of the intraflap versus cranial-caudal anastomoses in stacked free flap breast reconstruction.

Getting enough volume in autologous breast reconstruction can be difficult and transferring multiple free flaps to reconstruct a single breast can provide a solution to that problem. How to connect the free flaps pedicles to the recipient site has been a point of discussion in the literature and two main approaches have been described. The first one involves using the caudal stumps of the internal mammary (IM) vessels and is usually referred to “cranial-caudal” approach. The second one implies the anastomosis between one flap’s pedicle to a branch of the other one . This technique has been named in different ways in the literature: intraflap, flow-through, daisy-chain, chain-link and others. In the present letter we want to list what we think are all the advantages of the intraflap approach compared to the cranial-caudal one. To our knowledge, some of them have not been mentioned in the available literature.

Analysis of Vascular Anatomy in Deep Inferior Epigastric Perforator Flap

Abstract Objectives The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard in autologous breast reconstruction. One of the existing challenges of the procedure is maintaining a pedicle of suitable length and diameter for flap survival. In this study, we analyzed the vascular anatomy of bi-pedicle DIEP flap cases in terms of the vessel diameter, the rate of secondary venae comitantes, and pedicle length to determine the efficacy of microvascular anastomosis and venous drainage. Methods We retrospectively evaluated 108 patients who underwent immediate breast reconstruction using free bi-pedicle DIEP flaps between 2012 and 2019. The patient characteristics, diameters of the deep inferior epigastric artery (DIEA) and accompanying veins (DIEVs), DIEA pedicle length, vessel re-anastomosis rate, flap failure rate, and fat necrosis were recorded. Results Comparison of the right side and left side diameters and pedicle lengths obtained showed no significant differences (p > 0.05). A total of 148 sides (68.52%) of flaps had double venous drainage, whereas 68 sides (31.48%) of flaps had one. Vein congestion occurred in 5 cases, and all involved with just one DIEV anastomosis. No arterial occlusions were observed. Conclusions This is an analysis of extensive clinical data in terms of DIEA, DIEV, and pedicle length. The low vein congestion rate observed reveals adequate venous drainage was achieved in the DIEV system for DIEP reconstruction. Adequate deep inferior epigastric vessel pedicle length and vessel size, as well as greater than 60% of flaps with secondary DIEV, may allow comfortable microsurgery with reduced complications.

Abstract PO5-11-03: Associations among BMI and patient-reported body image dissatisfaction after breast reconstruction

Abstract INTRODUCTION Breast reconstruction surgery helps women restore their physical appearance and contributes to overall well-being. We assessed body image concerns in the context of breast reconstruction using patient-reported outcome measures: Body Image Scale (BIS), Brief Symptom Inventory (BSI), Appearance Schemas Inventory (ASI-R), and BREAST-Q. Since obesity is known to be associated with body image dissatisfaction1, body size may influence a patient’s adjustment to bodily changes arising from breast cancer and its treatment. Thus, we investigated the associations among BMI and patient-reported body image dissatisfaction after immediate autologous breast reconstruction. MATERIAL AND METHODS Patients undergoing breast reconstruction surgery were enrolled in an IRB approved study from 2011 to 2014 at The University of Texas MD Anderson Cancer Center. Participants (N=44) included patients who underwent immediate autologous (DIEP/TRAM) reconstruction and completed the BIS, BSI, ASI-R, and BREAST-Q, both preoperatively and postoperatively at 12+ months. Descriptive statistics including means, standard deviations, and medians were used to summarize continuous variables, while frequencies and percentages were used to summarize the categorical clinical and demographic characteristics. Univariate analyses were conducted to identify potential factors among preoperative variables for subsequent multivariable regression analysis: age, race, ethnicity, BMI, laterality, BIS, BSI, ASI-R, BREAST-Q psychosocial wellbeing score (PWBS), and BREAST-Q satisfaction with breast score (SWBS). Factors with a t test p-value≤0.2 were considered potential predictive variables for the postoperative dependent variables BIS, BREAST-Q PWBS, and BREAST-Q SWBS. Multivariable linear regression models were used to assess the relationship between the dependent and the selected predictive variables. A multivariable linear regression model was fitted using stepwise selection procedure, and the model with the highest adjusted R-squared value and the lowest Akaike information criterion (AIC) was chosen. All tests were two-sided with p-value< 0.05 considered statistically significant, and for each significant predictor, we report the unstandardized coefficient β. Analyses were performed using SPSS 29.0.0 and SAS 9.4. RESULTS Results from the selected models are summarized in Table 1. Age and BMI were significant predictors for postoperative BIS score. Older patients and those with BMI categorized as overweight and obese tend to feel less dissatisfied with their body image after immediate autologous breast reconstruction compared to patients with healthy BMI. Preoperative BSI anxiety was identified as significant predictor for postoperative BREAST-Q PWBS, i.e., patients with higher preoperative anxiety scores tend to have lower postoperative BREAST-Q PWBS. Preoperative BSI anxiety and laterality were significant predictors for postoperative BREAST-Q SWBS. Patients with higher preoperative anxiety scores tend to be less satisfied with their breasts after immediate autologous reconstruction and patients who underwent unilateral reconstruction tend to be less satisfied with their breasts postoperatively compared to patients with bilateral reconstruction. CONCLUSION Women with higher BMI may experience improved body image after undergoing immediate autologous breast reconstruction, as compared to women with healthy BMI. The use of BIS may provide more insight to plastic surgeons compared to relying solely on the body image correlates provided by the BREAST-Q. Moreover, body image counseling can be beneficial for individuals across all BMI categories, including those with healthy BMI. REFERENCES 1. Weinberger, N.A., et al., Body Dissatisfaction in Individuals with Obesity Compared to Normal-Weight Individuals: A Systematic Review and Meta-Analysis. Obes Facts, 2016. 9(6): p. 424-441. Table 1: Table for reporting selected multivariable linear regression models; (a) Postoperative BIS with explanatory variables age and BMI category, (b) Postoperative BREAST-Q PWBS with explanatory variable Preoperative BSI anxiety score, (c) Postoperative BREAST-Q SWBS with explanatory variables Preoperative BSI anxiety score and laterality. Citation Format: Sara Bouhali, Nassima Noufail, Tzuan Chen, Mary Catherine Bordes, Greg Reece, Mia Markey, Fatima Merchant, Deepti Chopra. Associations among BMI and patient-reported body image dissatisfaction after breast reconstruction [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-03.

Abstract PO1-22-06: Pre-operative radiotherapy followed by mastectomy and breast reconstruction – a systematic review of oncological and reconstructive outcomes

Abstract Background Pre-operative radiotherapy (PRT) followed by mastectomy and autologous breast reconstruction for locally advanced breast cancer has the potential to reduce the deleterious impact of radiotherapy on the reconstructed breast and expedite treatment without impact on oncologic control. The PRADA feasibility study (Lancet Oncol 2022; 23: 682-90) has previously demonstrated the technique is technically feasible and safe in modern breast oncology practice, however, there is a clear necessity for longer term outcome data to precisely determine clinical efficacy. In order to understand and appraise this evidence gap, we performed a systematic review focused on oncologic and reconstructive outcomes of PRT followed by mastectomy and breast reconstruction. Methods A prospectively registered search (PROSPERO ID: CRD42023349524) of Medline (Ovid), EMBASE (Ovid), EMCARE (Ovid) and CINAHL (EBSCO) databases was performed in August 2022 for studies reporting NART prior to mastectomy and breast reconstruction. Oncological and aesthetic outcomes were extracted with risk of bias (ROBINS-I) and methodological quality assessed (STROBE checklist) for each study. Results Twenty one published articles (18 papers and 3 abstracts) were identified reporting the outcomes of 1,126 patients with median follow-up between 19.0-212.4 months. Seventeen studies were non randomised single-centre cohort studies (12 retrospective and 5 prospective). Patients received neoadjuvant chemotherapy in 18 studies. The majority of studies were of low methodological quality and at serious risk of bias. Rates of locoregional recurrence and overall survival ranged between 0-21.7% and 79.8%-98.3% respectively. Rates of flap loss or necrosis ranged from 0-12.0%. Rates of revisional procedures ranged between 0-35.3%. Patient-reported outcomes were reported in 8 studies and were mostly ‘good’ or ‘excellent’. Conclusion The published literature described a heterogeneity of outcome for patients undergoing NART prior to mastectomy and breast reconstruction. This reflects a large number of small retrospective single-centre cohort studies of low methodological quality at risk of bias. There is a clear need for a prospective randomised controlled trial appraising the outcomes of PRT in the context of autologous breast reconstruction. Citation Format: Ken Ho, Joseph Ward, Chiugo Ike, Paul Thiruchelvam, Aadil Khan, Daniel Leff. Pre-operative radiotherapy followed by mastectomy and breast reconstruction – a systematic review of oncological and reconstructive outcomes [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-22-06.

Abstract PO4-27-02: Pandemic Shifts: How did elective breast cancer care change?

Abstract Introduction: As the COVID-19 pandemic began, concerns arose that timely utilization of elective breast cancer care would decrease due to state moratoriums, travel restrictions, or fear, resulting in poorer long-term outcomes. Advances in telemedicine provided a new avenue for care; however, rapid implementation brought concerns about variable uptake and disparities. To support longitudinal clinical and epidemiological studies, this analysis described elective breast cancer care utilization during the first year of the pandemic, including patient, hospital, and geographic barriers and facilitators. Methods: The Multidisciplinary Breast Reconstruction Research Program team reviewed all breast cancer surgeries and procedures at The University of Texas MD Anderson Cancer Center during the pre-pandemic (March 1, 2019 to February 29, 2020) and pandemic (March 1, 2020 to February 28, 2021) periods. The team identified procedures that were deemed elective or preference-sensitive, and summarized the timeline of pandemic milestones and changes, including the implementation of telemedicine appointments. A data analyst summarized the distributions of completed, canceled, rescheduled, and never completed procedures. T tests and analyses of variance tested differences between the pre-pandemic and pandemic year. Generalized linear models assessed patient, hospital, and geographic factors that correlated with successful access to, and completion of, procedures. Two focus groups reviewed data and informed the interpretation of results. Results: During the first pandemic year, 30 breast care procedures were identified that were postponed during March-April, July-August, and December-January. Surprisingly, no decrease in overall utilization of elective care procedures was observed; in fact, 19% more elective breast cancer care surgeries and procedures were scheduled (4752 pre-pandemic vs 4003 pandemic) in 13% more episodes of care (2723 pre-pandemic vs 2415 pandemic). As expected, rescheduling of procedures increased 98% (from 14% pre-pandemic to 27% pandemic); however, the majority of procedures were able to be completed by the end of the year (72% pre-pandemic, 73% pandemic). Telemedicine did not significantly mediate successful completion, as the majority of procedures were prophylactic or reconstructive surgeries. However, extended hours (p = 0.03) and proximity to the hospital facilitated access and successful completion of care (p< 0.01). The most common procedures that were not able to be performed within the first year of the pandemic were autologous breast reconstruction, revision, and mastopexy. Notably, patients reported slightly improved rates of anxiety and depression during the initial pandemic year (11% vs 14%, p = 0.04), possibly due to relative privation or comparison bias. Clinicians and patients/survivors noted several “lessons learned” that may inform access and preference-sensitive care delivery. Conclusions: Despite three periods of state-mandated discontinuation of elective care procedures, the majority of patients were able to access and successfully complete elective breast cancer care during the first year of the COVID-19 pandemic. Future studies and initiatives may use this information to explore innovations in care delivery and short- and long-term effects on health outcomes. Citation Format: Haoqi Wang, Greg Reece, Mary Catherine Bordes, Mia Markey, Aubri Hoffman. Pandemic Shifts: How did elective breast cancer care change? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-27-02.

Abstract PO2-22-09: The impact of blood loss and blood pressure management in DIEP flap surgery– a retrospective analysis of 206 patients

Abstract Introduction: Autologous breast reconstruction using the deep inferior epigastric perforator flap has excellent success rates and a natural aesthetic result. Therefore, this method and its management are of great importance in modern oncoplastic surgery. In particular, women who have undergone radiation therapy after mastectomy benefit from this satisfactory and usually uncomplicated method of breast reconstruction. To achieve a desirable outcome, the effects of blood loss and blood pressure management may play an important role. In this analysis, we hypothesize that neither postoperative blood pressure management (using catecholamines) nor the amount of blood loss (defined by the median hemoglobin level difference) will worsen the surgical outcome or increase the complication rate. Patients and Methods: We performed a multicenter, multisurgeon retrospective analysis with the following primary end points: intraoperative blood loss and postoperative blood pressure management. Secondary endpoints included serious complications including flap loss and minor complications. Patients (n=194) were included from 2014-2018 at St. Antonius Hospital in Eschweiler and from 2016 to July 2018 at the Cologne Municipal Breast Cancer Center in Holweide. Patients underwent either unilateral (n=180) or bilateral (n=13) breast reconstructions with DIEP flaps, resulting in a total of n=206 cases. The subgroup regarding blood pressure management was defined by cohorts with or without catecholamine administration and included all n=206 cases. Blood loss was defined by median hemoglobin level difference and could be calculated in n=199 cases. The cohorts of the two subgroups were comparable. Results: Six flap losses were detected in a total of 206 cases (2.9%). The distribution of flap losses in the blood pressure management subgroup was not statistically significant (p=.67), while the test was not available for the blood loss subgroup. Furthermore, the analysis showed that there were no significant differences in the rates of overall complications related to the amount of blood loss intraoperatively (p= .06) or blood pressure management postoperatively (p= .19). Conclusion: DIEP flap surgery is a safe method for autologous breast reconstruction, independent of blood loss and blood pressure management. Citation Format: Hanna Fritsch, Cosima Schreiber, Wolfram Malter, Matthias Warm, Max Zinser, Alexander Bach, Christian Eichler. The impact of blood loss and blood pressure management in DIEP flap surgery– a retrospective analysis of 206 patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-22-09.

Abstract PO5-23-06: Predictive Factors for Reconstructive Method and Outcomes in Mutation-Positive Breast Cancer Patients

Abstract Background: BRCA1 and BRCA2 mutations significantly increase the risk of breast cancer, and prophylactic mastectomy reduces the risk by around 90% in these patients. Previous studies have explored predictors of mastectomy type in high-risk genetic mutation patients, but further characterization is needed. This study aims to identify factors associated with resection and reconstruction methods and predictors of postoperative complications in mutation-positive (M+) patients. Methods: A multicenter retrospective cohort study included patients with a genetic predisposition for breast cancer undergoing breast surgery, seen between January 2016 and October 2022. Patient demographics, comorbidities, oncologic history, operative details, and postoperative outcomes were collected. Descriptive statistics and multivariate logistic regression were performed. Results: Among the 176 patients analyzed, 75 (42.6%) had BRCA1, 71 (40.3%) had BRCA2, 11 (6.3%) had PALB2, and 8 (4.5%) had CHEK2 mutations. Mean age and body mass index (BMI) were 41.0±17 years and 24.9±6.9 kg/m2, respectively. Among patients with prior breast reconstruction (n=86, 48.9%), augmentation mammoplasty (n=31, 17.6%) was the most common procedure, followed by oncologic resection (n=21, 11.9%) and reduction mammoplasty (n=15, 8.5%). Nipple-sparing mastectomy (NSM) (n=107, 60.8%) was the most frequent surgical approach, followed by skin-sparing mastectomy (SSM) (n=43, 24.4%), simple mastectomy (n=14, 8.0%), lumpectomy (n=4, 2.3%), and radical mastectomy (n=4, 2.3%). Tissue expander (n=77, 43.8%) was the most common reconstruction method. By a median follow-up duration of 23.9 months, 66 (37.5%) of patients experienced postsurgical complications. Operative complications recorded within 30 days included seroma (n=9, 5.1%), hematoma (n=8, 4.5%), cellulitis (n=10, 5.7%), dehiscence (n=13, 7.4%), surgical site infection (n=11, 6.3%), and delayed wound healing (DWH) (n=24, 13.6%). Other long-term complications included mastectomy flap necrosis (n=22, 12.5%), total reconstructive failure (n=9, 5.1%), red breast syndrome (n=2, 1.1%), and capsular contracture (n=12, 6.8%). The choice of autologous breast reconstruction was correlated with younger age (OR 0.81, 95% CI: 0.69-0.95, p = 0.012) and Hispanic or Latino race (OR 0.01, 95% CI: 0.001-0.25, p=0.007). BMI was significantly correlated with incidence of hematoma (OR 1.17, 95% CI: 1.02-1.33, p=0.024), DWH (OR=1.1, 95% CI: 1.01-1.20, p=0.030), and dehiscence (OR 1.25, 95% CI: 1.09-1.43, p=0.001). Choice of autologous reconstruction was positively correlated with DWH (OR 8.86, 95% CI: 2.25-34.86, p=0.002) and dehiscence (OR 18.24, 95% CI: 2.58-129.158, p=0.004). Conclusion: In this macroscopic study, the most common breast reconstruction method for M+ patients was tissue expander-based. However, only autologous reconstruction was found to have positive correlates, specifically younger age and Hispanic or Latino origin. Younger patients may pursue this method given less concern for short term complications, which are historically increased in autologous reconstruction. Minority distrust of foreign medical material implantation may play a role in Hispanic or Latino choice. Additionally, autologous reconstruction and BMI were associated with certain postoperative complications, particularly dehiscence, DWH, and hematoma, results consistent with general breast cancer surgery cohorts. This study helps better characterize the M+ population and contributes insight into the resection and reconstructive choice in this patient population. Citation Format: Shrayus Sortur, Jaytin Gupta, Christian Lava, Lauren Berger, Varsha Harish, Zoya Khan, Daisy Spoer, Lindy Rosal, Ian Greenwalt, Lucy De La Cruz, David Song, Kenneth Fan. Predictive Factors for Reconstructive Method and Outcomes in Mutation-Positive Breast Cancer Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-23-06.

Optimizing the Pedicled Latissimus Dorsi Myocutaneous Flap in Breast Reconstruction: Lessons Learned from 110 Consecutive Flaps

Background: The pedicled latissimus dorsi myocutaneous flap (LDMCF) in autologous breast reconstruction has been superseded by abdominal free tissue transfer. Common complaints of the LDMCF include the asymmetric back scar, need for prosthesis, and high seroma rates. We believe that the LDMCF remains versatile, with distinct advantages over other autologous options: the flap can be harvested unilaterally or bilaterally, not ‘burning any bridges’ for future reconstruction in unilateral breast reconstruction; the recovery is relatively easy, without complications such as risk of long-term abdominal wall weakness; and the aesthetic results are comparable, if not superior, leading to a more “youthful” result. Methods: We performed a retrospective review over an 8-year period. Results: A total of 106 patients underwent 110 breast reconstructions. Complications included four of 106 patients (3.8%) with seroma, three of 78 (3.8%) with periprosthetic implant infection, and one case of partial flap loss. Conclusions: We learned the following: (1) Direct-to-implant can be performed in most LDMCF patients, avoiding the use of tissue expanders; (2) High BMI patients may not require an implant; (3) Back donor site aesthetics can be improved using a “bra-line-back-lift” approach; (4) Use of liposomal bupivacaine intercostal blocks and modified enhanced recovery after surgery protocol can reduce length-of-stay to overnight; (5) We achieved low seroma rates using topical fibrin glue and closed suction drains; (6) Low and high BMI patients who may not qualify for free tissue transfer are usually still surgical candidates with LDMCF; and (7) Short and long-term recovery are faster than free tissue transfer, with minimal long-term deficit.

P4. The Continuum of Care in Autologous Breast Reconstruction: A Longitudinal Assessment of Revisional Procedures in 4,896 Free Flaps

P4. The Continuum of Care in Autologous Breast Reconstruction: A Longitudinal Assessment of Revisional Procedures in 4,896 Free Flaps

The Cost-effectiveness of Enhanced Recovery after Surgery Protocols in Abdominally Based Autologous Breast Reconstruction.

The purpose of this study was to conduct a systematic review on the cost-effectiveness of enhanced recovery after surgery (ERAS) protocols in abdominally based autologous breast reconstruction. Further, we reviewed the use of liposomal bupivacaine transversus abdominis plane (TAP) blocks in abdominal autologous reconstruction. PubMed, Embase, Cochrane, and Scopus were used for literature review, and PRISMA guidelines were followed. Included articles had full-text available, included cost data, and involved use of TAP block. Reviews, case reports, or comparisons between immediate and delayed breast reconstruction were excluded. Included articles were reviewed for data highlighting treatment cost and associated length of stay (LOS). Cost and LOS were further stratified by treatment group (ERAS versus non-ERAS) and method of postoperative pain control (TAP versus non-TAP). Incremental cost-effectiveness ratio (ICER) was used to compare the impact of the above treatments on cost and LOS. Of the 381 initial articles, 11 were included. These contained 919 patients, of whom 421 participated in an ERAS pathway. The average ICER for ERAS pathways was $1664.45 per day (range, $952.70-$2860). Average LOS of ERAS pathways was 3.12 days versus 4.57 days for non-ERAS pathways. The average ICER of TAP blocks was $909.19 (range, $89.64-$1728.73) with an average LOS of 3.70 days for TAP blocks versus 4.09 days in controls. The use of ERAS pathways and postoperative pain control with liposomal bupivacaine TAP block during breast reconstruction is cost-effective. These interventions should be included in comprehensive perioperative plans aimed at positive outcomes with reduced costs.

D120. Outcomes in Immediate, Delayed-Immediate, and Delayed Autologous Breast Reconstruction: A Fourteen-year National Database Analysis

D120. Outcomes in Immediate, Delayed-Immediate, and Delayed Autologous Breast Reconstruction: A Fourteen-year National Database Analysis

D153. Prepectoral Versus Subpectoral Tissue Expander Placement on Free Flap Outcomes in Delayed-immediate Autologous Breast Reconstruction

D153. Prepectoral Versus Subpectoral Tissue Expander Placement on Free Flap Outcomes in Delayed-immediate Autologous Breast Reconstruction

Lumbar flap in breast reconstruction (literature review)

Currently, there is an increasing number of innovations in reconstructive surgery, one of these was the use of alternative flaps in breast reconstruction. Due to certain contraindications for the use of the usual flaps, one of these has now become a flap on the perforant lumbar arteries or LAP flap. 23 articles describing the LAP flap and its use for breast reconstruction were analyzed.Five articles describe the experience of using a lumbar flap in breast reconstruction, two articles describe bilateral reconstruction using a LAP flap, five studies describe the technique of sampling and the topographic anatomy of the flap.The presented article concludes that the LAP flap is an alternative option for autologous breast reconstruction according to research data due to its anatomical features, the quality of subcutaneous fat and sampling techniques. However, for a more detailed study of the issue under consideration, it is necessary to conduct randomized clinical trials to identify the results, the number of complications and the applicability of the technique in clinical practice.

Evaluation of aesthetic results of microsurgical breast reconstruction with DIEP flap (literature review)

Purpose of a study: to explore the main methods of evaluating the aesthetic results of autologous breast reconstruction with a DIEP flap (deep inferior epigastric artery perforator), to identify the key factors influencing the aesthetic result of breast reconstruction.The scientific papers in the databases PubMed, Google Scholar, SCOPUS, Science Direct, RSCI for the period from 2013 to 2023 were analyzed. The systematic review includes articles evaluating the aesthetic result of breast reconstruction with a DIEP flap. The search was carried out by keywords: “breast”, “DIEP flap”, “aesthetic result”, “symmetry of breast”.As a result of the analysis, it was found that the evaluation of the aesthetic results of breast reconstruction is carried out using data of patient reported outcome measures, scales which is used to rate the surgeon’s perception of the aesthetic outcomes and quantitative objective measurements. The key factor influencing the aesthetic result of reconstruction is the symmetry of the breasts.Conclusion. The most commonly used methods for assessing the aesthetic results of breast reconstruction with a DIEP flap are: self-assessment of the results of reconstruction by patients (BREAST-Q questionnaire), evaluation of the results by surgeons (professional aesthetic assessment scales), quantitative objective methods for determining the degree of symmetry. According to many studies, symmetry is a critical factor affecting the aesthetics of the breasts and, consequently, patient satisfaction with the results of reconstruction, psychosocial well-being and quality of life in the long term.

The wide base bipedicled (WIBB) flap in nipple-sparing skin-reducing mastectomy

In this article, we present a modification of the NS/SRM technique in which the mastopexy design for skin reduction is undertaken with a wide-base bipedicled (WIBB) flap. The WIBB flap can be applied in both autologous and implant-based breast reconstruction. Our reconstructive algorithm is also presented. The clinical data of patients operated on from June 2017 to November 2022 were collected: 51 patients for a total of 71 breasts. Personal data, BMI, type and volume of implants used, and major and minor complications were analyzed by descriptive statistics. The mean age was 48.3 years. BMI ranged between 21.5 and 30.9 kg/m2. Thirty-one patients underwent unilateral mastectomy, while twenty patients underwent bilateral surgery. In 25 breasts, immediate reconstruction was performed with implants and ADM. In 40 breasts, reconstruction was performed with a subpectoral tissue expander, and in 6 breasts, reconstruction was performed with a DIEP flap. We observed only one case (1.4%) of periprosthetic infection requiring implant removal under general anesthesia. Minor complications occurred in 14.1% of patients. The use of both the WIBB flap and our algorithm maintained a low complication rate in our series, ensuring oncological radicality and a good aesthetic result at the same time.

PlasmaBlade versus Electrocautery for Deep Inferior Epigastric Perforator Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study.

(1) Background: DIEP-based breast reconstruction necessitates wide undermining at the abdominal donor site, creating large wound areas. Flap harvesting is usually conducted using electrosurgical dissection devices. This study sought to compare the clinical outcomes in patients after using the PEAK PlasmaBlade (PPB) versus monopolar electrocautery (MPE). (2) Methods: This retrospective cohort study included 128 patients with DIEP-based breast reconstruction. Patient characteristics and information on the postoperative course were collected and a comparative evaluation was conducted. (3) Results: The MPE group exhibited significantly (p* = 0.0324) higher abdominal drainage volume (351.11 ± 185.96 mL) compared to the PPB group (279.38 ± 183.38 mL). A subgroup analysis demonstrated that PPB significantly reduced postoperative wound fluid in patients with BMI > 30 kg/m2 (p* = 0.0284), without prior neoadjuvant chemotherapy (p** = 0.0041), and among non-smokers (p = 0.0046). Furthermore, postoperative pain was significantly (p**** < 0.0001) lower in the PPB cohort. (4) Conclusions: This study confirms the non-inferiority of the PEAK PlasmaBlade to conventional electrocautery for abdominal flap harvesting. The PPB demonstrated advantages, notably reduced drainage volume and lower postoperative pain levels. Recognizing patient subsets that benefit more from the PPB highlights the importance of personalized device selection based on patient characteristics.