B. Di Pace1,2, F. Khan3, M. Patel3, G. Serlenga4, M. Sorotos5, C. Spain6, F. Santanelli di Pompeo5, C. Rubino7, C. M. Malata2,8,9 1Università degli Studi di Salerno,Department Of Medicine, Surgery And Dentistry “Scuola Medica Salernitana”, PhD School Of Translational Medicine Of Development And Active Aging,Salerno, , Italy 2Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust,Plastic & Reconstructive Surgery Department,Cambridge, , United Kingdom 3University of Cambridge,School Of Clinical Medicine,Cambridge, , United Kingdom 4San Giovanni di Dio e Ruggi D’Aragona University Hospital, Università degli Studi di Salerno,Plastic Surgery Unit, Department Of Medicine, Surgery And Dentistry “Scuola Medica Salernitana”,Salerno, , Italy 5“Sapienza” Università di Roma,Plastic Surgery Unit, Sant’Andrea Hospital, School Of Medicine And Psychology,Rome, , Italy 6Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust,Department Of Radiation Oncology,Cambridge, , United Kingdom 7Università degli Studi di Sassari,Plastic Surgery Unit, Department Of Surgery, Microsurgery And Medical Sciences, University Hospital Trust,Sassari, , Italy 8Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust,Cambridge Breast Unit,Cambridge, , United Kingdom 9Anglia Ruskin University,School Of Medicine,Cambridge & Chelmsford, , United Kingdom
Introduction:
Post-mastectomy breast reconstruction is a well-established component of breast cancer treatment. Thus, improving reconstruction outcomes is an ongoing oncological goal. The key element of the outcome is symmetry with the opposite breast by approximating the dimensions of the reconstructed breast to those of the mastectomy specimen.
Our study aims to compare the outcomes of immediate unilateral free flap breast reconstruction (FFBR) based on the relationship between mastectomy and free flap weights (wt) using the definitive endpoints of contralateral balancing and ipsilateral revision surgeries with subgroup analysis of the effect of adjuvant radiotherapy (RT).
Methods:
423 immediate abdominal FFBR patients (May 2004 – August 2018) were enrolled in a multicentre study (UK 141; Italy 282).They fell into Group A (flap wt < mastectomy wt, n = 163) and Group B (flap wt > mastectomy wt, n = 260). The group rates of contralateral balancing and ipsilateral revision surgeries were compared using Fisher’s Exact test. RT influence on the incidence of these adjustment procedures was also assessed.
Results:
Overall, the incidence of adjustment surgery was dominated by contralateral balancing procedures at 21% versus 10% for revisions of the reconstructed breasts. The rate of contralateral balancing procedures was 3 times higher in Group A than in Group B (37% vs 11%, p < 0.001). Similarly, the ipsilateral breast revision surgery rate in Group A was double that of Group B (14% vs 7%, p = 0.003). Adjuvant RT significantly increased the number of ipsilateral revisions compared with contralateral balancing surgeries (p = 0.048).
Conclusion:
A flap-to-mastectomy ratio of less than 1 (Group A) significantly increases subsequent adjustments on both contralateral and reconstructed breasts whilst irradiation predisposes to ipsilateral revisions. These findings are important in patient counselling and intraoperative flap contouring. Ideally flap weight should exceed mastectomy weight in immediate unilateral FFBR.