Taj Tomouk1, Anita T Mohan2, Alex Azizi3, Elena Conci3, Elizabeth B Brickley4, Charles M Malata5. 1. School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, UK; Department of Plastic Surgery, John Radcliffe Hospital, Headley Way, Oxford, UK. 2. Department of Plastic and Reconstructive Surgery, Addenbrooke's University Hospital, Hills Rd, Cambridge, UK; Division of Plastic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, USA; Restoration of Appearance and Function charitable Trust (RAFT), Mount Vernon Hospital, Rickmansworth Rd, Middlesex, UK. 3. School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, UK. 4. Department of Public Health and Primary Care, University of Cambridge, Hills Rd, Cambridge, UK; Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Rope Ferry Rd, Lebanon, NH, USA. 5. Department of Plastic and Reconstructive Surgery, Addenbrooke's University Hospital, Hills Rd, Cambridge, UK; Faculty of Health Sciences, Postgraduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, UK; Cambridge Breast Unit, Addenbrooke's University Hospital, Hills Rd, Cambridge, UK. Electronic address: cmalata@hotmail.com.
Abstract
BACKGROUND: The use of abdominal tissue in post-mastectomy autologous breast reconstruction is a popular choice among reconstructive surgeons. This is the first study to evaluate donor complications comparing unilateral, bilateral, and bipedicled DIEP breast reconstructions. METHODS: A retrospective chart review was conducted of all women undergoing rib-preserving DIEP free flap breast reconstruction at a University Hospital between 2008 and 2015 by the senior surgeon (CMM). RESULTS: A total of 130 patients were included in this study and were divided into three groups: unipedicled unilateral (n = 93), unipedicled bilateral (n = 19), and bipedicled unilateral (n = 18). Relative to the unipedicled unilateral group, the age and BMI-adjusted odds of complication were almost two-fold higher in the bilateral group [Odds ratio (95% CI): 1.97 (0.63, 6.19)] and approximately halved in the bipedicled group [Odds ratio (95% CI): 0.59 (0.22, 1.61)]; however, these associations were not statistically significant. Overall, 75% of complications were managed conservatively. The majority of Clavien-Dindo grade 3 complications were observed in participants from the unipedicled unilateral group (84%), whereas no patients in the bipedicled group developed morbidity that required recourse to surgery or readmission to hospital. CONCLUSIONS: Although further research with greater statistical power will be valuable, the results of this investigation provide evidence that donor site morbidity of bipedicled DIEP free flap breast reconstructions does not increase when compared with those of unipedicled unilateral and unipedicled bilateral surgical procedure types.
BACKGROUND: The use of abdominal tissue in post-mastectomy autologous breast reconstruction is a popular choice among reconstructive surgeons. This is the first study to evaluate donor complications comparing unilateral, bilateral, and bipedicled DIEP breast reconstructions. METHODS: A retrospective chart review was conducted of all women undergoing rib-preserving DIEP free flap breast reconstruction at a University Hospital between 2008 and 2015 by the senior surgeon (CMM). RESULTS: A total of 130 patients were included in this study and were divided into three groups: unipedicled unilateral (n = 93), unipedicled bilateral (n = 19), and bipedicled unilateral (n = 18). Relative to the unipedicled unilateral group, the age and BMI-adjusted odds of complication were almost two-fold higher in the bilateral group [Odds ratio (95% CI): 1.97 (0.63, 6.19)] and approximately halved in the bipedicled group [Odds ratio (95% CI): 0.59 (0.22, 1.61)]; however, these associations were not statistically significant. Overall, 75% of complications were managed conservatively. The majority of Clavien-Dindo grade 3 complications were observed in participants from the unipedicled unilateral group (84%), whereas no patients in the bipedicled group developed morbidity that required recourse to surgery or readmission to hospital. CONCLUSIONS: Although further research with greater statistical power will be valuable, the results of this investigation provide evidence that donor site morbidity of bipedicled DIEP free flap breast reconstructions does not increase when compared with those of unipedicled unilateral and unipedicled bilateral surgical procedure types.
Authors: Laurenz Weitgasser; Karl Schwaiger; Fabian Medved; Felix Hamler; Gottfried Wechselberger; Thomas Schoeller Journal: J Clin Med Date: 2020-06-28 Impact factor: 4.241