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J Reconstr Microsurg 2021; 37(03): 208-215
DOI: 10.1055/s-0040-1716348
Original Article

Fat-Augmented Latissimus Dorsi versus Deep Inferior Epigastric Perforator Flap: Comparative Study in Delayed Autologous Breast Reconstruction

Efterpi C. Demiri
1   Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
,
Antonios Tsimponis
1   Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
,
Anastasios Pagkalos
1   Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
,
Eleni Georgiadou
1   Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
,
Olga-Christina Goula
1   Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
,
Georgia-Alexandra Spyropoulou
1   Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
,
Dimitrios Dionyssiou
1   Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
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Abstract

Background The use of autologous tissues is considered the mainstay for delayed breast reconstruction. Aside the free abdominal flaps, which are most commonly used, the fat-augmented latissimus-dorsi (FALD) flap has been recently shown a reliable alternative option for pure autologous breast reconstruction. In this retrospective study, we aim to compare outcomes of autologous breast reconstructions using the extended FALD and deep inferior epigastric perforator flap (DIEP) flap, with an emphasis on patients' characteristics, demographic data, complications, and patients' satisfaction after a minimum 12-month follow-up.

Methods Our series consists of 135 women who underwent a delayed postmastectomy unilateral autologous breast reconstruction from 2011 to 2017: 36 patients (Group A) had an extended FALD flap and 99 (Group B) a free DIEP flap performed by the same surgeons. Demographic data, breast volume, medical history, smoking, complications, and patients' satisfaction were recorded and analyzed. Student's t-test for independent variables, Mann–Whitney U-test, and Chi-squared test were used to compare the reported variables.

Results Patients' age, body mass index (BMI), and pregnancy history were statistically different between groups (p < 0.001, p = 0.004, p < 0.001, respectively); younger age (35.1 vs. 41.2 years), lower BMI (25.6 vs. 28.4), and fewer pregnancies were recorded in Group A. Breast volume was also found significantly smaller in Group A patients (p = 0.009). Past medical history using the ASA physical status classification score, previous radiation therapy, history of smoking, and incidence of overall complications were similar in both groups. Overall satisfaction scores were found slightly higher, but not statistically significant, in the free-flap group (p = 0.442).

Conclusion The use of the FALD flap may provide comparable outcome to the DIEP flap in delayed breast reconstruction in terms of complications and patients' satisfaction; it should be considered a good reconstructive option for young and thin nulliparous patients, with small to medium size opposite breast.

Keywords

free tissue transfer - DIEP delayed breast reconstruction - autologous latissimus dorsi flap


Publication History

Received: 09 May 2020

Accepted: 26 July 2020

Article published online:
06 September 2020

© 2020. Thieme. All rights reserved.

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