Delayed versus Delayed-Immediate Autologous Breast Reconstruction: A Blinded Evaluation of Aesthetic Outcomes

被引:37
|
作者
Albino, Frank P. [1 ]
Patel, Ketan M. [1 ]
Smith, Jesse R. [1 ]
Nahabedian, Maurice Y. [1 ]
机构
[1] Georgetown Univ Hosp, Dept Plast Surg, 1st Floor PHC Bldg,3800 Reservoir Rd,NW, Washington, DC 20007 USA
来源
ARCHIVES OF PLASTIC SURGERY-APS | 2014年 / 41卷 / 03期
关键词
Mammaplasty; Breast implantation; Cosmetic techniques; Mastectomy;
D O I
10.5999/aps.2014.41.3.264
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background The technique of delayed-immediate breast reconstruction includes immediate insertion of a tissue expander, post-mastectomy radiation, followed by reconstruction. The aesthetic benefits of delayed-immediate reconstruction compared to delayed reconstruction are postulated but remain unproven. The purpose of this study was to compare aesthetic outcomes in patients following delayed and delayed-immediate autologous breast reconstruction. Methods A retrospective analysis was performed of all patients who underwent delayed or delayed-immediate autologous breast reconstruction by the senior author from 2005 to 2011. Postoperative photographs were used to evaluate aesthetic outcomes: skin quality, scar formation, superior pole contour, inferior pole contour, and overall aesthetic outcome. Ten non-biased reviewers assessed outcomes using a 5-point Likert scale. Fisher's Exact and Wilcoxon-Mann-Whitney tests were used for comparative analysis. Results Patient age and body mass index were similar between delayed (n=20) and delayed-immediate (n=20) cohorts (P > 0.05). Skin and scar quality was rated significantly higher in the delayed-immediate cohort (3.74 vs. 3.05, P < 0.001 and 3.41 vs. 2.79, P < 0.001; respectively). Assessment of contour-related parameters, superior pole and inferior pole, found significantly improved outcomes in the delayed-immediate cohort (3.67 vs. 2.96, P < 0.001 and 3.84 vs. 3.06, P < 0.001; respectively). Delayed-immediate breast reconstruction had a significantly higher overall score compared to delayed breast reconstructions (3.84 vs. 2.94, P < 0.001). Smoking and the time interval from radiation to reconstruction were found to affect aesthetic outcomes (P < 0.05). Conclusions Preservation of native mastectomy skin may allow for improved skin/scar quality, breast contour, and overall aesthetic outcomes following a delayed-immediate reconstructive algorithm as compared to delayed breast reconstruction.
引用
收藏
页码:264 / 270
页数:7
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