Delayed versus Delayed-Immediate Autologous Breast Reconstruction: A Blinded Evaluation of Aesthetic Outcomes
Open Access
- 2 May 2014
- journal article
- Published by Georg Thieme Verlag KG in Archives of Plastic Surgery
- Vol. 41 (03), 264-270
- https://doi.org/10.5999/aps.2014.41.3.264
Abstract
Background The technique of delayed-immediate breast reconstruction includes immediate insertion of a tissue expander, post-mastectomy radiation, followed by reconstruction. The aesthetic benefits of delayed-immediate reconstruction compared to delayed reconstruction are postulated but remain unproven. The purpose of this study was to compare aesthetic outcomes in patients following delayed and delayed-immediate autologous breast reconstruction. Methods A retrospective analysis was performed of all patients who underwent delayed or delayed-immediate autologous breast reconstruction by the senior author from 2005 to 2011. Postoperative photographs were used to evaluate aesthetic outcomes: skin quality, scar formation, superior pole contour, inferior pole contour, and overall aesthetic outcome. Ten non-biased reviewers assessed outcomes using a 5-point Likert scale. Fisher's Exact and Wilcoxon-Mann-Whitney tests were used for comparative analysis. Results Patient age and body mass index were similar between delayed (n=20) and delayed-immediate (n=20) cohorts (P>0.05). Skin and scar quality was rated significantly higher in the delayed-immediate cohort (3.74 vs. 3.05, P<0.001 and 3.41 vs. 2.79, P<0.001; respectively). Assessment of contour-related parameters, superior pole and inferior pole, found significantly improved outcomes in the delayed-immediate cohort (3.67 vs. 2.96, P<0.001 and 3.84 vs. 3.06, P<0.001; respectively). Delayed-immediate breast reconstruction had a significantly higher overall score compared to delayed breast reconstructions (3.84 vs. 2.94, P<0.001). Smoking and the time interval from radiation to reconstruction were found to affect aesthetic outcomes (P<0.05). Conclusions Preservation of native mastectomy skin may allow for improved skin/scar quality, breast contour, and overall aesthetic outcomes following a delayed-immediate reconstructive algorithm as compared to delayed breast reconstruction.This publication has 23 references indexed in Scilit:
- Immediate Free Flap Reconstruction for Advanced-Stage Breast Cancer: Is It Safe?Plastic and Reconstructive Surgery, 2011
- A Multidisciplinary Protocol for Planned Skin-Preserving Delayed Breast Reconstruction for Patients with Locally Advanced Breast Cancer Requiring Postmastectomy Radiation Therapy: 3-Year Follow-UpPlastic and Reconstructive Surgery, 2011
- 10: OPTIMAL TIMING OF DELAYED FREE LOWER ABDOMINAL FLAP BREAST RECONSTRUCTION AFTER POST-MASTECTOMY RADIATION THERAPYPlastic and Reconstructive Surgery, 2011
- Immediate Placement of Implants in Breast Reconstruction: Patient Selection and OutcomesPlastic and Reconstructive Surgery, 2011
- Optimal Timing of Delayed Free Lower Abdominal Flap Breast Reconstruction after Postmastectomy Radiation TherapyPlastic and Reconstructive Surgery, 2011
- Predicting Out-of-Pocket Costs in the Surgical Management of Orofacial CleftsPlastic and Reconstructive Surgery, 2010
- Complication Rates of Radiation on Tissue Expander and Autologous Tissue Breast ReconstructionAnnals of Surgical Oncology, 2010
- Irradiated Autologous Breast Reconstructions: Effects of Patient Factors and Treatment VariablesPlastic and Reconstructive Surgery, 2010
- Radiation Therapy and Breast Reconstruction: A Critical Review of the LiteraturePlastic and Reconstructive Surgery, 2009
- Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fractionsRadiotherapy and Oncology, 2009