Comparison of Outcomes after Autologous Breast Reconstruction: Latissimus Dorsi with Immediate Fat Transfer versus Abdominally Based Free Flaps.

Autor:	Spoer DL; From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital.; Georgetown University School of Medicine., Berger LE; From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital.; Plastic and Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical School., Huffman SS; From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital.; Georgetown University School of Medicine., Lava CX; From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital.; Georgetown University School of Medicine., Dekker PK; Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California., Ko JA; Georgetown University School of Medicine., Truong BN; Georgetown University School of Medicine., Towfighi PN; Department of Surgery, UPMC Mercy Health Center., Ghyasi N; Georgetown University School of Medicine., Fan KL; From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital., Song DH; From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2024 Oct 01; Vol. 154 (4S), pp. 27S-40S. Date of Electronic Publication: 2024 Sep 20.
DOI:	10.1097/PRS.0000000000011400
Abstrakt:	Background: Autologous breast reconstruction confers favorable patient reports of satisfaction and quality of life compared with implant-based reconstruction over a lifetime. The latissimus dorsi with immediate fat transfer (LIFT) is an alternative approach to abdominally based free flaps (Ab-FF), which expands fully autologous reconstruction to nonmicrosurgeons. This study compared the 2 procedures concerning their clinical and patient-reported outcomes 1 year postoperatively. Methods: The authors conducted a retrospective review of LIFTs and Ab-FFs performed between March of 2017 and August of 2022. The primary outcomes were postoperative complications, reoperations, and longitudinal BREAST-Q scores. BREAST-Q modules included Satisfaction with Breasts, Satisfaction with Abdomen, Satisfaction with Back, Psychosocial Well-being, Physical Well-being: Chest, Physical Well-being: Abdomen, Physical Well-being: Back, and Sexual Well-being. Results: Of the 281 included patients (408 breasts), 211 received Ab-FF and 70 received LIFT. One-year follow-up (median [interquartile range], 12 [12] months) demonstrated that Ab-FF independently predicted dehiscence, reoperation procedures, and revisional surgery. LIFT independently increased the odds of seroma. Obesity predicted dehiscence, and bilateral reconstructions predicted revisional fat grafting. BREAST-Q scores fluctuated over time but were similar across all measured domains by 1 year postoperatively. Conclusions: Although Ab-FF is the standard approach for fully autologous reconstruction, LIFT procedures may be associated with a less complicated postoperative course while eliciting similar patient-reported outcomes. LIFT may be preferred to limit postoperative complications, particularly in patients with obesity. LIFT can be used by plastic surgeons who are not trained in microsurgical procedures or do not have an environment that fosters Ab-FF. Clinical Question/level of Evidence: Therapeutic, III. (Copyright © 2024 by the American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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