Enhancing Aesthetics in Bilateral DIEP Flap Breast Reconstruction: the Role of Tissue Pre-Expansion.

Autor: Musmann RJ; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany. robert.jonathan@musmann.com., Andree C; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany.; Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany., Wolter A; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany.; Universität Witten-Herdecke, Alfred-Herrhausen-Straße 45, 58455, Witten, Germany., Hagouan M; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany., Munder B; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany., Janku D; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany., Daniels M; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany.; Universität Witten-Herdecke, Alfred-Herrhausen-Straße 45, 58455, Witten, Germany., Becker K; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany., Oramary A; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany., Bukowiecki J; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany., Bromba A; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany., Stockhausen N; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany., Seidenstücker K; Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Benrath, Urdenbacher Allee 83, D-40593, Düsseldorf, Germany., Fertsch S; Department of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625, Düsseldorf, Germany.; Universität Witten-Herdecke, Alfred-Herrhausen-Straße 45, 58455, Witten, Germany.
Jazyk: angličtina
Zdroj: Aesthetic plastic surgery [Aesthetic Plast Surg] 2024 Dec 18. Date of Electronic Publication: 2024 Dec 18.
DOI: 10.1007/s00266-024-04610-0
Abstrakt: Background: Achieving symmetrical outcomes in bilateral autologous breast reconstruction is challenging, particularly in cases of asymmetrical recipient sites. Tissue pre-expansion is proposed to improve aesthetics by enlarging the skin envelope for refined breast shaping. This study examines its efficacy in bilateral DIEP flap reconstructions.
Methods: This study systematically evaluated 43 patients that underwent bilateral DIEP flap breast reconstruction between 2004 and 2021. The efficacy of tissue pre-expansion in enhancing aesthetic outcomes, patient demographics, and complications were analysed. Aesthetic outcomes were measured using the aesthetic item score (AIS).
Results: Patients had an average age of 48.67 years (range: 29-79) and BMI of 27.08 (range: 23-36). Of these, 65.12% had undergone radiotherapy and 83.72% chemotherapy before reconstruction. Patients predominantly received secondary breast reconstruction (72.02%). Pre-expansion significantly improved breast symmetry and the overall aesthetic result (OAR) in cases of asymmetrical recipient-site conditions (3.76 vs. 3.16, p = 0.006 and 7.08 vs. 6.27, p = 0.03, respectively). There was a non-significant trend towards better breast form and volume, with no effect on scarring. For patients with symmetrical recipient-site conditions, pre-expansion did not significantly impact the aesthetic outcome. No significant differences in complication rates were observed.
Conclusion: Tissue pre-expansion significantly enhances aesthetic outcomes of bilateral autologous breast reconstruction, notably breast symmetry and OAR, in patients with asymmetrical recipient-site conditions. However, careful patient selection and preoperative planning are essential for leveraging pre-expansion's benefits, emphasizing the importance of informed decision-making and expectation management. This publication/study investigates the efficacy of tissue pre-expansion in enhancing aesthetic outcomes for bilateral DIEP flap breast reconstructions. Detailed analysis of 43 patients that received bilateral DIEP reconstruction with and without pre-expansion. Finds significant improvements in breast symmetry and overall aesthetic rating (OAR) for patients with asymmetrical recipient-site conditions.
Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Competing Interests: Declarations. Conflicts of interest: The authors declare that they have no conflicts of interest to disclose. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed Consent: For this type of study, informed consent is not required.
(© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)
Databáze: MEDLINE
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