Presentations

Abstract

Introduction: Breast reconstruction aims to restore a sense of normalcy and improve quality of life. Implant-based and Autologous Flap techniques remain the two main methods to achieve this goal. Autologous reconstruction uses the patient's own tissue and can be transferred using microvascular techniques (Free Flap) from different donor sites. Some of these include the abdomen (muscle sparing Transverse Rectus Abdominis Muscle flap [ms-TRAM], Deep Inferior Epigastric Artery Perforator flap [DIEP], and Superficial Inferior Epigastric Artery flap [SIEA]), the back (Latissimus Dorsi Myocutaneous flap [LD]), the hip area (Lateral Transverse thigh flap [LTT]), and the buttock (Superior Gluteal Artery Flap [SGA] and Inferior Gluteal Artery Flap [IGA]). The literature does not include long-term outcomes from these procedures as current literature on long-term outcomes is limited to 8 years. Our study will provide the longest-term outcomes of free-flap reconstruction (>20 years) which will help monitor its efficacy later in life. It is possible that over the >20-year period the overall cost of breast reconstruction is decreased when compared with implant-based reconstruction.

Methods: Consecutive electronic and written medical records of patients who had undergone free-flap breast reconstruction by a single surgeon from 1990-2004 were examined, and their demographics and surgical details were extracted from their written and electronic medical records. Patients were contacted by phone and email to complete the BREAST-Q survey to measure their Satisfaction and Quality of Life. Means, SD, and p-values were calculated by scoring Emotional, Physical, and Healthcare team satisfaction on a scale of 1-5. Donor-site complications, surgical history, and patient demographics were also recorded.

Results: 208 female patients were identified with an average age of 72 and an average age at surgery of 44 years. Of 167 patients with identifiable flaps, 148 (87%) were muscle-sparing free TRAM flaps, with the other flaps coming from the other donor sites mentioned (SIEA, LTT, SGA, IGA). 67% of patients had unilateral reconstruction, while the other third had bilateral breast reconstruction. 17 BreastQ survey responses were received with most of the responses being unilateral (14) flaps. There were 14 TRAMs, 2 LTGs, and 1 TRAM+LD flap. The average satisfaction rating was 3.6. Unilateral flap patients had a lower major complication rate of 24% compared to the bilateral flap group with a major complication rate of 67% (p-value=0.01). Unilateral flap patients had an overall satisfaction score of 3.5 compared to 3.8 for the bilateral group (p-value=0.34). TRAM flaps had a lower complication rate (27%) compared to the LTT (100%) and TRAM+LD (100%) (p-value = 0.02). TRAM flap patients had an overall satisfaction score of 3.8 compared to 3.5 for the LTT flap patients and 3.8 for TRAM+LD flap patients (p-value=0.29).

Conclusion: Autologous reconstruction after breast cancer may be performed using a variety of techniques. Overall, patients had good satisfaction scores following free flap breast reconstruction at 20-34 years from surgery. Further research with additional patients is needed to better assess the difference between unilateral and bilateral surgery, flap types, the incidence of abdominal hernia from abdominally based flaps, and other factors that may affect patient satisfaction.