Autologous Breast Reconstructions with Abdominal-based Free Flaps and Latissimus Dorsi Flaps Have Similar One-year Patient Reported Outcomes
Summer E. Hanson, MD, PhD1, Jennifer B. Hamill, MPH2, Ji Qi, MS2, Hyungjin M. Kim, ScD2, Andrea L. Pusic, MD, MHS3, Edwin G. Wilkins, MD, MS2, Patrick B. Garvey, MD1, Mark W. Clemens, MD1.
1The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 2University of Michigan, Ann Arbor, MI, USA, 3Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Purpose: Breast reconstruction is uniquely personal with many options available for patients and surgeons to consider. Among the methods of autologous breast reconstruction, abdominal based free flaps (ABFFs) including the transverse rectus abdominis myocutaneous (TRAM), deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) flaps are the most common, with pedicled latissimus dorsi (LD) flaps as an alternative. While there is data to suggest that autologous tissue is advantageous, there are few studies directly comparing ABFFs and LD with an implant. The purpose of this study was to compare these methods of reconstruction in terms of post-operative outcomes and patient reported outcomes in a multi-centered cohort.
Methods: The patients included were part of the Mastectomy Reconstruction Outcomes Consortium (MROC) multicenter cohort study of 11 centers (57 providers). Those undergoing autologous-based reconstructions with either an ABFF (DIEP, TRAM or SIEA flaps) or LD flaps and had at least one year of follow up were included. Reconstructive procedure choice was based on patient and surgeon preferences. One-year post-operative complications and revision procedures were recorded. Pre-operative and one-year post-operative patient reported outcomes were measured using the BREAST-Q. Mixed effects regression models were used to control for a range of demographic and clinical covariates.
Results: A total of 834 patients undergoing autologous breast reconstruction were included (90.6% ABFF vs. 9.4% LD). In general, reconstruction was more likely to be immediate and unilateral. There was a significantly lower rate of major complications in the LD cohort compared to ABFFs (odds ratio 0.43, 95% confidence interval 0.2-0.92); there were no significant differences in the rates of overall complications (P=0.96) or revision procedures (P=0.07). There were no
differences in physical (P=0.34), psychosocial (P=0.82), sexual well being (P=0.66), or overall patient satisfaction (0.65) between the LD and ABFF patients. Delayed reconstruction and age were associated with significantly higher post-operative BREAST-Q scores regardless of type of reconstruction.
Conclusions: Although LD flap reconstruction has a lower risk of major complications, overall complications and revision rates were similar with ABFF reconstruction in this large, multi-center outcomes study. Patient reported outcomes at one year are comparable between the two cohorts.
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