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

IF 3.2 2区医学 Q1 SURGERY Plastic and reconstructive surgery Pub Date : 2024-10-01 Epub Date: 2024-09-20 DOI:10.1097/PRS.0000000000011400

Daisy L Spoer, Lauren E Berger, Samuel S Huffman, Christian X Lava, Paige K Dekker, JiMin A Ko, Brian N Truong, Parhom N Towfighi, Niloofar Ghyasi, Kenneth L Fan, David H Song

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Abstract

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.

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"自体乳房再造术后效果比较：背阔肌立即脂肪转移与腹部游离皮瓣的效果比较"。

背景：与假体重建相比，自体乳房重建在患者满意度和生活质量方面更胜一筹。背阔肌立即脂肪转移（LIFT）是腹部游离皮瓣（Ab-FF）的替代方法，它将全自体重建扩展到非显微外科医生。本研究旨在比较两种手术术后一年的临床和患者报告结果：我们对2017年3月至2022年8月期间实施的LIFT和Ab-FF进行了回顾性审查。主要结果是术后并发症、再次手术和纵向 BREAST-Q 评分。BREAST-Q 模块包括对乳房、腹部、背部、社会心理健康、身体健康的满意度：结果：在纳入的 281 名患者（408 个乳房）中，211 人接受了 Ab-FF，70 人接受了 LIFT。一年的随访（中位数[IQR]：12 [12]个月）表明，Ab-FF可独立预测开裂、再次手术和翻修手术。LIFT 可单独增加血清肿的几率。此外，肥胖也预示着开裂，而双侧重建预示着再次脂肪移植。BREAST-Q评分随着时间的推移而波动，但术后一年时所有测量领域的评分相似：结论：尽管Ab-FF是全自体重建的黄金标准方法，但LIFT手术的术后并发症较少，同时患者报告的结果相似。为了限制术后并发症，尤其是肥胖症患者的术后并发症，LIFT可能是首选。更多没有接受过显微外科培训或环境不适合 Ab-FF 的整形外科医生也可以使用 LIFT。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

期刊介绍： For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.