Veränderung des Blickmusters in Abhängigkeit des Stadiums der Brustrekonstruktion mittels DIEP Lappenplastik – erste Daten einer Eye-Tracking-Analyse

Zusammenfassung

Hintergrund Die Brustrekonstruktion mittels autologem Gewebe ist fester Bestandteil eines ganzheitlichen Therapiekonzeptes bei Patientinnen mit Mammakarzinom. Während zahlreiche Studien den körperlichen und psychischen Gesundheitszustand von Patientinnen mit Brustkrebs nach Mastektomie und konsekutiver Brustrekonstruktion untersuchen, mangelt es an objektiven Daten zur Beurteilung des Einflusses von Ablatio und Brustrekonstruktion auf die Wahrnehmung von externen Beobachtern. Diese Studie untersucht die Blickmuster bei Betrachtung einer Brust in verschiedenen Stadien der Brustrekonstruktion mittels DIEP Lappenplastik.

Material und Methoden Mittels Eye-Tracking-Technologie wurden die Augenbewegungen von 58 Studienteilnehmer*in- nen beim Betrachten von 2D-Fotografien einer Patientin in den verschiedenen Stadien der Brustrekonstruktion (1. Ablatio, 2. Aufbau mittels DIEP Lappenplastik, 3. MAK Rekonstruktion) analysiert. Die Zeit bis zur ersten Fixierung und die Dauer der Fixierung wurde in jedem Bild für die rechte und linke Brust aufgezeichnet.

Ergebnisse Die Dauer der kompletten Fixierung der operierten Brust zeigte über die verschiedenen Stadien der Brustrekonstruktion insgesamt eine signifikante Abnahme mit p<0,001. Gleichzeitig zeigte sich keine statistisch signifikante Veränderung der Blickdauer auf der nicht-operierten Gegen- seite mit p=0,174. Die Zeit bis zur ersten Blickfixierung der betroffenen Brust zeigte eine signifikante Zunahme über die verschiedenen Rekonstruktionsschritte, mit p<0,001. Bei der Gegenseite zeigte sich kein statistisch signifikanter Unterschied in der Zeit bis zur ersten Fixierung, mit p=0,344.

Schlussfolgerung Die Ablatio mammae und die einzelnen Schritte der Brustrekonstruktion verändern die äußerliche Wahrnehmung von Patientinnen. Im Laufe der einzelnen re- konstruktiven Teilschritte kommt es zu einer zunehmenden Aufhebung der Blickdeviation in Richtung erkrankte Brust.

Abstract

Background Breast reconstruction using autologous tissue is an integral part of breast cancer treatment. While many studies have elucidated the impact of breast reconstruction on patients’ quality of life, self-esteem, sexuality and more, there is a lack of objective data regarding the effects on external observers. Aim of this study was to investigate the change in gaze pattern of independent observers depending on the stage of DIEP-flap breast reconstruction.

Materials and Methods Eye-tracking technology was utilized to analyze the eye movements of 58 study participants while viewing 2 D photographs of a patient after mastectomy and different stages of DIEP-flap breast reconstruction. Time until first fixation and total time of fixation were recorded and con- secutively analyzed for the right and left breast on each image.

Results Overall, the total time of fixation of the operated breast decreased significantly over the different stages of breast reconstruction, with p<0.001. At the same time, there was no statistically significant change in total time of fixation of the non-operated breast, with p=0.174. The time until first fixation showed a significant increase over the different stages of reconstruction for the reconstructed breast, with p<0.001, while no significant differences were found for the opposite breast, with p=0.344.

Conclusion Mastectomy and the individual steps of breast reconstruction alter the perception of breast cancer patients. Over the course of breast reconstruction, the deviation of gaze in the direction of the affected breast is reversed.

Schlüsselwörter

Eye-Tracking - Freie Lappenplastik - Mikrochirurgie

Key words

eye tracking - free flap - microsurgery

Publication History

Received: 26 February 2022

Accepted: 28 February 2022

Article published online:
09 August 2022

• Literatur

• 1 Holmstrom H. The free abdominoplasty flap and its use in breast reconstruction. An experimental study and clinical case report. Scand J Plast Reconstr Surg 1979; 13: 423-427 DOI: 10.3109/02844317909013092.
• 2 Pollhammer MS, Duscher D, Schmidt M. et al. Recent advances in microvascular autologous breast reconstruction after ablative tumor surgery. World J Clin Oncol 2016; 7: 114-121 DOI: 10.5306/wjco v7.i1.114.
• 3 Cai A, Suckau J, Arkudas A. et al. Autologous Breast Reconstruction with Transverse Rectus Abdominis Musculocutaneous (TRAM) or Deep Inferior Epigastric Perforator (DIEP) Flaps: An Analysis of the 100 Most Cited Articles. Med Sci Monit 2019; 25: 3520-3536 DOI: 10.12659/MSM.914665.
• 4 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42: 645-648 DOI: 10.1016/0007-1226(89)90075-1.
• 5 Nahabedian MY, Tsangaris T, Momen B. Breast reconstruction with the DIEP flap or the muscle-sparing (MS-2) free TRAM flap: is there a difference?. Plast Reconstr Surg 2005; 115: 436-444 discussion 445–436 DOI: 10.1097/01.prs.0000149404.57087.8e.
• 6 Eisenhardt SU, Momeni A, von Fritschen U. et al. [Breast reconstruc- tion with the free TRAM or DIEP flap – What is the current standard? Consensus Statement of the German Speaking Working Group for Microsurgery of the Peripheral Nerves and Vessels]. Handchir Mikrochir Plast Chir 2018; 50: 248-255 DOI: 10.1055/a-0631-9025.
• 7 Erdmann-Sager J, Wilkins EG, Pusic AL. et al. Complications and Patient-Reported Outcomes after Abdominally Based Breast Reconstruc- tion: Results of the Mastectomy Reconstruction Outcomes Consor- tium Study. Plast Reconstr Surg 2018; 141: 271-281 DOI: 10.1097/PRS.0000000000004016.
• 8 Lee BT, Agarwal JP, Ascherman JA. et al. Evidence-Based Clinical Practice Guideline: Autologous Breast Reconstruction with DIEP or Pedicled TRAM Abdominal Flaps. Plast Reconstr Surg 2017; 140: 651e-664e DOI: 10.1097/PRS.0000000000003768.
• 9 Macadam SA, Zhong T, Weichman K. et al. Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors: A Multicenter Comparison of Four Abdominally Based Autologous Reconstruction Methods. Plast Reconstr Surg 2016; 137: 758-771 DOI: 10.1097/01. prs.0000479932.11170.8f.
• 10 Schmauss D, Beier JP, Eisenhardt SU. et al. The „safe“ flap – Preoper- ative perforator-mapping and intraoperative perfusion assessment to reduce flap-associated morbidity – Consensus statement of the German Speaking Working Group for Microsurgery of the Peripheral Nerves and Vessels. Handchir Mikrochir Plast Chir 2019; 51: 410-417 DOI: 10.1055/a-0987-0118.
• 11 Fritschen UV, Grill B, Wagner J. et al. Quality assurance in breast reconstruction – Establishment of a prospective national online registry for microsurgical breast reconstructions. Handchir Mikrochir Plast Chir 2020; 52: 58-66 DOI: 10.1055/a-1075-2525.
• 12 Prantl L, Moellhoff N, von Fritschen U. et al. Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study. Archives of gynecology and obstetrics 2020; 302: 1451-1459 DOI: 10.1007/s00404-020-05779-w.
• 13 Prantl L, Moellhoff N, Fritschen UV. et al. Impact of Smoking Status in Free Deep Inferior Epigastric Artery Perforator Flap Breast Recon- struction: A Multicenter Study. Journal of reconstructive microsurgery 2020; 36: 694-702 DOI: 10.1055/s-0040-1714426.
• 14 Prantl L, Moellhoff N, von Fritschen U. et al. Effect of Radiation Therapy on Microsurgical Deep Inferior Epigastric Perforator Flap Breast Reconstructions: A Matched Cohort Analysis of 4577 Cases. Ann Plast Surg 2020; Publish Ahead of Print DOI: 10.1097/SAP.0000000000002628.
• 15 Heidekrueger P, von Fritschen U, Moellhoff N. et al. Comparison of venous couplers versus hand-sewn technique in 4577 cases of DIEP- flap breast reconstructions – A multicenter study. Microsurgery 2020; 42: 5-12 DOI: 10.1002/micr.30686.
• 16 Heidekrueger PI, Fritschen U, Moellhoff N. et al. Impact of body mass index on free DIEP flap breast reconstruction: A multicenter cohort study. J Plast Reconstr Aesthet Surg 2021; DOI: 10.1016/j. bjps.2020.12.043.
• 17 Moellhoff N, Prantl L, Fritschen U. et al. Uni-vs. bilateral DIEP flap reconstruction – A multicenter outcome analysis. Surgical oncology 2021; 38: 101605 DOI: 10.1016/j.suronc.2021.101605.
• 18 Heidekrueger PI, Moellhoff N, Horch RE. et al. Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany-A Multi-Center Analysis Based on the DGPRAC Prospective National Online Registry for Microsurgical Breast Reconstructions. J Clin Med 2021; 10: 1016 DOI: 10.3390/jcm10051016.
• 19 Giunta RE, Mollhoff N, Costa H. et al. Strengthening Plastic Surgery in Europe – ESPRAS Survey at ESPRAS European Leadership Forum (ELF). Handchir Mikrochir Plast Chir 2021; 53: 102-109 DOI: 10.1055/a- 1294-9992.
• 20 Giunta RE, Hansson E, Andresen C. et al. ESPRAS Survey on Breast Reconstruction in Europe. Handchir Mikrochir Plast Chir 2021; 53: 340-348 DOI: 10.1055/a-1424-1428.
• 21 Chen W, Lv X, Xu X. et al. Meta-analysis for psychological impact of breast reconstruction in patients with breast cancer. Breast Cancer 2018; 25: 464-469 DOI: 10.1007/s12282-018-0846-8.
• 22 Chao LF, Patel KM, Chen SC. et al. Monitoring patient-centered out- comes through the progression of breast reconstruction: a multi- centered prospective longitudinal evaluation. Breast Cancer Res Treat 2014; 146: 299-308 DOI: 10.1007/s10549-014-3022-7.
• 23 Ochoa O, Garza R, Pisano S. et al. Prospective Longitudinal Patient-Re- ported Satisfaction and Health-Related Quality of Life following DIEP Flap Breast Reconstruction: Relationship with Body Mass Index. Plast Reconstr Surg 2019; 143: 1589-1600 DOI: 10.1097/PRS.0000000000005616.
• 24 Al-Ghazal SK, Sully L, Fallowfield L. et al. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 2000; 26: 17-19
• 25 Elder EE, Brandberg Y, Bjorklund T. et al. Quality of life and patient sat- isfaction in breast cancer patients after immediate breast reconstruc- tion: a prospective study. Breast 2005; 14: 201-208 DOI: 10.1016/j. breast.2004.10.008.
• 26 Cordova LZ, Hunter-Smith DJ, Rozen WM. Patient reported outcome measures (PROMs) following mastectomy with breast reconstruction or without reconstruction: a systematic review. Gland Surg 2019; 8: 441-451 DOI: 10.21037/gs.2019.07.02.
• 27 Moellhoff N, Kandelhardt C, Ehrl D. et al. The Impact of Breast Symmetry on Eye Movement and Gaze Pattern: An Eye-Tracking Investigation. Aesthet Surg J 2021; 41: 1512-1518 DOI: 10.1093/asj/sjab285.
• 28 Frank K, Schuster L, Alfertshofer M. et al. How Does Wearing a Facecover Influence the Eye Movement Pattern in Times of COVID-19?. Aesthet Surg J 2021; 41: NP1118-NP1124 DOI: 10.1093/asj/sjab121.
• 29 Harbeck N, Penault-Llorca F, Cortes J. et al. Breast cancer. Nat Rev Dis Primers 2019; 5: 66 DOI: 10.1038/s41572-019-0111-2.
• 30 Andrzejczak E, Markocka-Maczka K, Lewandowski A.. Partner relationships after mastectomy in women not offered breast reconstruction. Psychooncology 2013; 22: 1653-1657 DOI: 10.1002/pon.3197.
• 31 Satteson ES, Brown BJ, Nahabedian MY. Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-anal- ysis. Gland Surg 2017; 6: 4-13 DOI: 10.21037/gs.2016.08.01.
• 32 Jabor MA, Shayani P, Collins DR. et al. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg 2002; 110: 457-463 discussion 464–455 DOI: 10.1097/00006534-200208000- 00013.