The impact of autologous breast reconstruction using DIEP flap on the oncologic efficacy of radiation therapy

Background Although autologous breast reconstruction is technically quite demanding, it offers the best outcomes in terms of durable results, patient perceptions, and postoperative pain. Many studies have focused on clinical outcomes and technical aspects of such procedures, but few have addressed the impact of various flaps on patient recovery times. This particular investigation entailed an assessment of commonly used flaps, examining the periods of time required to resume daily activities. Methods Multiple choice questionnaires were administered to 121 patients after recovery from autologous reconstruction to determine the times required in returning to specific physical activities. To analyze results, the analysis of variance F-test was applied, and odds ratios (ORs) were determined. Results Among the activities surveyed, recovery time was not always a function of free-flap surgery. Additional treatments and psychological effects also contributed. Adjuvant chemotherapy increased average downtime by 2 weeks, and postoperative irradiation prolonged recovery as much as 4 weeks. Patient downtime was unrelated to flap type, ranging from 2.9 to 21.3 weeks for various activities in question. Deep inferior epigastric perforator (DIEP) flaps yielded the highest OR and transverse upper gracilis (TUG) flaps the lowest. Conclusion Compared with superior gluteal artery perforator and TUG flaps, the DIEP flap was confirmed as the gold standard in autologous breast reconstruction, conferring the shortest recovery times. All adjuvant therapies served to prolong patient recovery as well. Surgical issues, patient lifestyles, and donor-site availability are other important aspects of flap selection.

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An Assessment of the Risks and Benefits of Immediate Autologous Breast Reconstruction in Patients Undergoing Postmastectomy Radiation Therapy

Annals of Plastic Surgery ◽

10.1097/sap.0b013e31824b3dcc ◽

2013 ◽

Vol 71 (2) ◽

pp. 149-155 ◽

Cited By ~ 29

Author(s):

Michael N. Mirzabeigi ◽

James M. Smartt ◽

Jonas A. Nelson ◽

Joshua Fosnot ◽

Joseph M. Serletti ◽

...

Keyword(s):

Radiation Therapy ◽

Breast Reconstruction ◽

Autologous Breast Reconstruction ◽

Risks And Benefits ◽

Postmastectomy Radiation ◽

Postmastectomy Radiation Therapy

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Refractory Donor-Site Seroma Following DIEP Breast Reconstruction

Plastic Surgery Case Studies ◽

10.1177/2513826x19898831 ◽

2020 ◽

Vol 6 ◽

pp. 2513826X1989883

Author(s):

Trina V. Stephens ◽

Nancy Van Laeken ◽

Sheina A. Macadam

Keyword(s):

Literature Review ◽

Breast Reconstruction ◽

Donor Site ◽

Diep Flap ◽

First Line ◽

Percutaneous Aspiration ◽

Autologous Breast Reconstruction ◽

History Of ◽

Deep Inferior Epigastric Perforator ◽

Latissimus Dorsi Flaps

Donor-site seroma formation is a complication of autologous breast reconstruction reported most commonly with the use of latissimus dorsi flaps. First-line treatment is percutaneous aspiration which leads to resolution in the majority of cases. Those that persist may progress to a chronic, refractory seroma, which can prove challenging in terms of treatment. The aim of this article is to provide an updated literature review of interventions for chronic donor-site seroma and present the case of a 65-year-old female with a recalcitrant abdominal seroma following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Literature review revealed a single article that reported 2 cases of persistent donor-site seroma after DIEP flap breast reconstruction. The patient presented here underwent repeat aspiration, drain placement, and multiple surgical procedures to achieve resolution. In total, the post-reconstruction seroma history of the patient extended over approximately 14 months. We conclude with evidence-based suggestions for chronic, donor-site seroma prevention and treatment.

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The Impact of Radiation on Surgical Outcomes of Immediate Breast Reconstruction

The American Surgeon ◽

10.1177/000313481107701017 ◽

2011 ◽

Vol 77 (10) ◽

pp. 1349-1352

Author(s):

Tuan Tran ◽

Tu Tran ◽

Duncan Miles ◽

Michael Hill ◽

Sharon S. Lum

Keyword(s):

Radiation Therapy ◽

Breast Reconstruction ◽

Surgical Outcomes ◽

Immediate Breast Reconstruction ◽

Partial Mastectomy ◽

Breast Diseases ◽

Adjuvant Radiation ◽

Total Mastectomy ◽

Reconstructive Operations ◽

The Impact

We sought to determine the differences in surgical outcomes associated with adjuvant radiation versus no radiation in patients undergoing concurrent breast oncologic and reconstructive operations. A retrospective review of patients who underwent combined oncologic and plastic surgeries for breast diseases from January 2005 to June 2010 was compared for demographic factors and outcomes by receipt of radiation therapy. During the study period, 175 patients were identified; 25.7 per cent received radiation therapy. Mean patient age was 51 years and median follow-up was 355 days. Overall, 80.2 per cent of patients underwent mastectomy; 19.8 per cent partial mastectomy; 42.1 per cent autologous tissue reconstruction; and 54.8 per cent implant-based reconstruction. There were no significant differences between radiated and nonradiated patients in rates of overall or oncoplastic-specific complications. Lymphedema was the only complication seen more frequently in the radiated arm ( P = 0.03). In our series of carefully selected patients undergoing a variety of reconstructive techniques for repair of partial or total mastectomy defects, radiation was not associated with worse outcomes in patients undergoing immediate breast reconstruction. With careful collaboration among plastic surgeons, breast surgeons, and radiation oncologists, patients requiring breast surgery may safely be considered for reconstruction of partial or total mastectomy defects when adjuvant radiation is required.

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