PDF icon Download PDF
J Reconstr Microsurg
DOI: 10.1055/a-2616-4258
Original Article

Chronological Changes in Breast and Nipple Position After Autologous Reconstruction in an Asian Population

Suphalerk Lohasammakul
1   Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Johyun Yoon
2   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Chaiyawat Suppasilp
3   Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Jin Sup Eom
2   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Hyun Ho Han 
2   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
› Author Affiliations
Funding None.
› Further Information
Also available atMedOne
   Permissions and Reprints
Preview

Abstract

Background

The breast shape changes between reconstructed and native breasts in autologous reconstruction, which is important to achieve symmetry. This study was conducted to clarify chronological changes in the shape and nipple position of the reconstructed breast compared with the contralateral breast in the Asian population.

Methods

Photographic assessments were conducted at baseline and during annual visits of patients who underwent immediate free flap breast reconstruction following unilateral nipple-sparing mastectomy at our institution between June 2017 and December 2019. Univariate and multivariate analyses were performed to identify factors associated with the change in shape and nipple position. This observation was most marked at 1-year postsurgery.

Results

Among the 170 patients (mean age, 48.04 ± 7.55 years), 164 (96.47%) had a deep inferior epigastric perforator flap and 8 (4.71%) required further surgery on the contralateral breast for correction of asymmetry. The chronological changes in the breast shape and nipple position significantly differed between the native and the reconstructed breast, with the latter showing a higher degree of retraction. Grading of breast ptosis (grades 0–2) and exposure to radiotherapy were associated with an increased degree of retraction.

Conclusion

Retraction may occur after free flap breast reconstruction, particularly in patients with ptosis or those receiving radiotherapy. These findings support careful planning, including volume adjustment and contralateral procedures. While based on an Asian population, the results may inform surgical decisions in similar patient groups.

Keywords

autologous breast reconstruction - DIEP - breast retraction - breast ptosis - contralateral symmetry procedure - nipple position

Supplementary Material



Publication History

Received: 01 May 2025

Accepted: 12 May 2025

Accepted Manuscript online:
21 May 2025

Article published online:
20 June 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Khoo A, Kroll SS, Reece GP. et al. A comparison of resource costs of immediate and delayed breast reconstruction. Plast Reconstr Surg 1998; 101 (04) 964-968 , discussion 969–970
    Search in Google Scholar
  • 2 Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 2000; 26 (01) 17-19
    Search in Google Scholar
  • 3 D'Souza N, Darmanin G, Fedorowicz Z. Immediate versus delayed reconstruction following surgery for breast cancer. Cochrane Database Syst Rev 2011; 2011 (07) CD008674
    Search in Google Scholar
  • 4 Howes BH, Watson DI, Xu C, Fosh B, Canepa M, Dean NR. Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: a case-controlled cohort study. J Plast Reconstr Aesthet Surg 2016; 69 (09) 1184-1191
    Search in Google Scholar
  • 5 Ng SK, Hare RM, Kuang RJ, Smith KM, Brown BJ, Hunter-Smith DJ. Breast reconstruction post mastectomy: patient satisfaction and decision making. Ann Plast Surg 2016; 76 (06) 640-644
    Search in Google Scholar
  • 6 Filip CI, Jecan CR, Raducu L, Neagu TP, Florescu IP. Immediate versus delayed breast reconstruction for postmastectomy patients. Controversies and solutions. Chirurgia (Bucur) 2017; 112 (04) 378-386
    Search in Google Scholar
  • 7 Yoon AP, Qi J, Brown DL. et al. Outcomes of immediate versus delayed breast reconstruction: results of a multicenter prospective study. Breast 2018; 37: 72-79
    Search in Google Scholar
  • 8 Prantl L, Moellhoff N, von Fritschen U. et al. Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study. Arch Gynecol Obstet 2020; 302 (06) 1451-1459
    Search in Google Scholar
  • 9 Yueh JH, Houlihan MJ, Slavin SA, Lee BT, Pories SE, Morris DJ. Nipple-sparing mastectomy: evaluation of patient satisfaction, aesthetic results, and sensation. Ann Plast Surg 2009; 62 (05) 586-590
    Search in Google Scholar
  • 10 Moyer HR, Ghazi B, Daniel JR, Gasgarth R, Carlson GW. Nipple-sparing mastectomy: technical aspects and aesthetic outcomes. Ann Plast Surg 2012; 68 (05) 446-450
    Search in Google Scholar
  • 11 Pittman TA, Abbate OA, Economides JM. The P1 method: prepectoral breast reconstruction to minimize the palpable implant edge and upper pole rippling. Ann Plast Surg 2018; 80 (05) 487-492
    Search in Google Scholar
  • 12 Choi M, Frey JD. Optimizing aesthetic outcomes in breast reconstruction after nipple-sparing mastectomy. Aesthet Surg J 2020; 40 (Suppl. 02) S13-S21
    Search in Google Scholar
  • 13 Han WY, Han SJ, Eom JS, Kim EK, Han HH. A comparative study of wrap-around versus anterior coverage placement of acellular dermal matrix in prepectoral breast reconstruction. Plast Reconstr Surg 2023; 10: 1097
    Search in Google Scholar
  • 14 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42 (06) 645-648
    Search in Google Scholar
  • 15 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32 (01) 32-38
    Search in Google Scholar
  • 16 Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 1999; 52 (02) 104-111
    Search in Google Scholar
  • 17 Duncan AM, Al Youha S, Joukhadar N, Konder R, Stecco C, Wheelock ME. Anatomy of the breast fascial system: a systematic review of the literature. Plast Reconstr Surg 2022; 149 (01) 28-40
    Search in Google Scholar
  • 18 Han HH, Kang MK, Choe J. et al. Estimation of contralateral perfusion in the DIEP flap by scoring the midline-crossing vessels in computed tomographic angiography. Plast Reconstr Surg 2020; 145 (04) 697e-705e
    Search in Google Scholar
  • 19 Min K, Oh SM, Kim EK, Eom JS, Han HH. Analysis of perfusion in the DIEP flap: role of the location of the perforator, umbilicus, and midline crossing-over vessel. Plast Reconstr Surg 2023; 151 (06) 1146-1155
    Search in Google Scholar
  • 20 Jeong WS, Han W, Eom JS. Comparison of aesthetic outcomes between vertical and horizontal flap insets in breast reconstruction with the TRAM or DIEP flaps. Aesthetic Plast Surg 2017; 41 (01) 19-25
    Search in Google Scholar
  • 21 Reporting BI. Data System atlas (BI-RADS atlas). Reston, VA: American College of Radiology; 2003: 98
    Search in Google Scholar
  • 22 Regnault P. Breast ptosis. Definition and treatment. Clin Plast Surg 1976; 3 (02) 193-203
    Search in Google Scholar
  • 23 Han HH, Choi JM, Eom JS. Objective photographic assessments and comparisons of immediate bilateral breast reconstruction using deep inferior epigastric perforator flaps and implants. Arch Plast Surg 2021; 48 (05) 473-482
    Search in Google Scholar
  • 24 Fitzmaurice GM, Laird NM, Ware JH. Applied Longitudinal Analysis. John Wiley & Sons; 2012
    Search in Google Scholar
  • 25 Enoch S, Leaper DJ. Basic science of wound healing. Surgery (Oxf) 2005; 23 (02) 37-42
    Search in Google Scholar
  • 26 Hsu A, Mustoe TA. The principles of wound healing. Plastic Surgery Secrets Plus 2010; 2: 3-7
    Search in Google Scholar
  • 27 Gonzalez ACdO, Costa TF, Andrade ZdA, Medrado ARAP. Wound healing-a literature review. An Bras Dermatol 2016; 91: 614-620
    Search in Google Scholar
  • 28 Visha M, Karunagaran M. A review on wound healing. International Journal of Clinicopathological Correlation. 2019; 3 (02) 50-59
    Search in Google Scholar
  • 29 DiBernardo BE. Randomized, blinded split abdomen study evaluating skin shrinkage and skin tightening in laser-assisted liposuction versus liposuction control. Aesthet Surg J 2010; 30 (04) 593-602
    Search in Google Scholar