Safety analysis of immediate breast reconstruction with deep inferior epigastric perforator after neoadjuvant treatment

doi:10.16139/j.1007-9610.2023.02.11

Abstract

Abstract:

Objective To evaluate the safety of immediate breast reconstruction using deep inferior epigastric perforator (DIEP) flaps in the patients after neoadjuvant treatment. Methods From January 2019 to February 2021, the data of patients with breast cancer undergoing total mastectomy and immediate breast reconstruction using DIEP flap in Comprehensive Breast Health Center, Department of General Surgery, Ruijin Hospital were collected. Comparison of clinicopathological features was done between neoadjuvant treatment group and control group. Univariate analysis was used to compare the rate of surgical complications between two groups. Results A total of 110 patients were enrolled with 23 cases (20.9%) in neoadjuvant treatment group and 87 cases (79.1%) in control group. None of carcinoma in situ (0 vs. 19.5%, P=0.003) and higher pTNM stage (P<0.001) was present in neoadjuvant treatment group compared with those in control group. However, there were no significant differences in the number of flap perforator of DIEP (P=0.472), the proportion of bipedicled flaps (P=0.489), operative time (P=0.651) and hospital length of stay (P=0.275) between two groups. No significant difference was found in the incidence of postoperative complications between two groups. Breast seroma was the most common recipient complication (13.0%, 3 cases) without donor complication in neoadjuvant treatment group. The most common complication was fat necrosis (12.6%, 11 cases) in recipient site and abdominal seroma (3.4%, 3 cases) in donor site of control group. Reoperation was done in one case (4.3%) of neoadjuvant treatment group and 4 cases (4.6%) of control group. DIEP flap necrosis with total flap loss occurred in 2 cases (2.3%) in control group, but none in neoadjuvant treatment group. Conclusions The imme-diate breast reconstruction with epigastric free flap for breast cancer patients after neoadjuvant treatment would be a safe surgical scheme.

Key words: Breast cancer, Breast reconstruction, Neoadjuvant treatment, Deep inferior epigastric perforator

CLC Number:

R737.9

GAO Weiqi, ZHANG Xu, WANG Zheng, ZHU Yifei, HUANG Jiahui, HONG Jin, ZHU Siji, CHEN Xiaosong, HUANG Ou, HE Jianrong, CHEN Weiguo, LI Yafen, SHEN Kunwei, XU Hua, WU Jiayi. Safety analysis of immediate breast reconstruction with deep inferior epigastric perforator after neoadjuvant treatment[J]. Journal of Surgery Concepts & Practice, 2023, 28(02): 147-151.

Figures/Tables 2

Tab 1

Tab 2

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Characteristics	Control group (n =87)	Neoadjuvant group (n=23)	P value
Age			0.048
<50	79 (90.8)	23 (100.0)
≥50	8 (9.2)	0
BMI(kg/m²)			0.036
<25	10 (11.5)	7 (30.4)
≥25	77 (88.5)	16 (69.6)
Smoking history			1.000
No	87 （100.0）	23 (100.0)
Yes	0	0
Diabetes			0.330
No	85（97.7）	23 (100.0)
Yes	2 （2.3）	0
Histological type			0.003
Carcinoma in situ	17 (19.5)	0
Invasive carcinoma	70 (80.5)	23 (100.0)
pTNM stage			<0.001
0	17 (19.5)	2 (8.7) ^a)
Ⅰ	27 (31.0)	1 (4.3)
Ⅱ	36 (41.5)	6 (26.1)
Ⅲ	7 (8.0)	14 (60.9)
Molecular subtype			0.233
HR⁺?/HER2^-	58 (66.7)	12 (52.2)
HR⁺?/HER2⁺	16 (18.4)	3 (13.0)
HR^-?/HER2^-	4 (4.6)	3 (13.0)
HR^-?/HER2⁺	9 (10.3)	5 (21.8)
DIEP flap			0.489
Unipedicle flap	56 (64.4)	13 (56.5)
Bipedicle flap	31 (35.6)	10 (43.5)

Surgical complications	Control group (n =87)	Neoadjuvant group(n=23)	P value
Reconstructed breast site complications
Skin necrosis	1 (1.1)	1 (4.3)	0.131
Seroma	1 (1.1)	3 (13.0)	0.082
Hematoma	1 (1.1)	1 (4.3)	0.358
Infection	0	1 (4.3)	0.075
Fat necrosis	11 (12.6)	1 (4.3)	0.214
Loss and necrosis of flap	2 (2.3)	0	0.330
Donor site wound complications
Seroma	3 (3.4)	0	0.232
Hematoma	2 (2.3)	0	0.330
Fat liquefaction	0	0	/
Infection	1 (1.1)	0	0.492
Umbilicus necrosis	0	0	/
Hernia	0	0	/
Abdominal bulge	1 (1.1)	0	0.492

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