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When Is the Deep Inferior Epigastric Artery Flap Indicated for Breast Reconstruction in Patients not Treated With Radiotherapy?

Lundberg, Jonas; Thorarinsson, Andri; Karlsson, Per; Ringberg, Anita LU ; Frisell, Jan; Hatschek, Thomas; Källström, Ann-Christine and Elander, Anna (2014) In Annals of Plastic Surgery 73(1). p.105-113
Abstract
BACKGROUND: It is controversial whether breast reconstruction with a microvascular free flap should be done without restrictions in patients who have not had radiotherapy. Many regard it as too expensive, but some consider it better and more economically advantageous than an implant reconstruction. METHODS: Databases of publications were searched to find out under what conditions is it suitable to offer a deep inferior epigastric perforator (DIEP) or a transverse rectus abdominis myocutaneous flap to normalize the body's appearance in a woman whose breast(s) had been removed for cancer or to prevent the development of breast cancer. The effect of breast reconstruction with DIEP flaps was analyzed, taking account of the following factors:... (More)
BACKGROUND: It is controversial whether breast reconstruction with a microvascular free flap should be done without restrictions in patients who have not had radiotherapy. Many regard it as too expensive, but some consider it better and more economically advantageous than an implant reconstruction. METHODS: Databases of publications were searched to find out under what conditions is it suitable to offer a deep inferior epigastric perforator (DIEP) or a transverse rectus abdominis myocutaneous flap to normalize the body's appearance in a woman whose breast(s) had been removed for cancer or to prevent the development of breast cancer. The effect of breast reconstruction with DIEP flaps was analyzed, taking account of the following factors: general satisfaction (quality of life), aesthetic satisfaction (cosmesis), and morbidity. To find out which factors were of potential importance, we recorded age, hypertension, whether scars from previous abdominal surgery were present, microcirculation, whether the patient was overweight or obese, and costs of the procedure. RESULTS: Patients planning to have DIEP flaps should be willing to stop smoking at least 4 weeks before and after the procedure and have a body mass index of less than 30 kg/m to avoid a higher risk of complications. Because of the paucity of papers, it is difficult to recommend one approach over the other when considering general satisfaction, aesthetic satisfaction, and health economics. However, economical long-term outcome is highly dependent on the initial costs of each procedure and the cumulative costs of complications for each reconstruction method. CONCLUSIONS: The scientific foundation of assessment of methods of techniques of breast reconstruction is weak. Therefore, it is important that future studies should present more comparable series, highlight the long-term effects in high-quality studies, to provide the patients with optimal results without undue risks and to avoid financial burdens on society. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Plastic Surgery
volume
73
issue
1
pages
105 - 113
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:23511739
  • wos:000338342000024
  • scopus:84902546534
ISSN
1536-3708
DOI
10.1097/SAP.0b013e31826cafd0
language
English
LU publication?
yes
id
51875799-f7ca-46d2-9c1b-f6658431718e (old id 3627910)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/23511739?dopt=Abstract
date added to LUP
2013-04-07 15:18:56
date last changed
2017-08-27 03:43:42
@article{51875799-f7ca-46d2-9c1b-f6658431718e,
  abstract     = {BACKGROUND: It is controversial whether breast reconstruction with a microvascular free flap should be done without restrictions in patients who have not had radiotherapy. Many regard it as too expensive, but some consider it better and more economically advantageous than an implant reconstruction. METHODS: Databases of publications were searched to find out under what conditions is it suitable to offer a deep inferior epigastric perforator (DIEP) or a transverse rectus abdominis myocutaneous flap to normalize the body's appearance in a woman whose breast(s) had been removed for cancer or to prevent the development of breast cancer. The effect of breast reconstruction with DIEP flaps was analyzed, taking account of the following factors: general satisfaction (quality of life), aesthetic satisfaction (cosmesis), and morbidity. To find out which factors were of potential importance, we recorded age, hypertension, whether scars from previous abdominal surgery were present, microcirculation, whether the patient was overweight or obese, and costs of the procedure. RESULTS: Patients planning to have DIEP flaps should be willing to stop smoking at least 4 weeks before and after the procedure and have a body mass index of less than 30 kg/m to avoid a higher risk of complications. Because of the paucity of papers, it is difficult to recommend one approach over the other when considering general satisfaction, aesthetic satisfaction, and health economics. However, economical long-term outcome is highly dependent on the initial costs of each procedure and the cumulative costs of complications for each reconstruction method. CONCLUSIONS: The scientific foundation of assessment of methods of techniques of breast reconstruction is weak. Therefore, it is important that future studies should present more comparable series, highlight the long-term effects in high-quality studies, to provide the patients with optimal results without undue risks and to avoid financial burdens on society.},
  author       = {Lundberg, Jonas and Thorarinsson, Andri and Karlsson, Per and Ringberg, Anita and Frisell, Jan and Hatschek, Thomas and Källström, Ann-Christine and Elander, Anna},
  issn         = {1536-3708},
  language     = {eng},
  number       = {1},
  pages        = {105--113},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Annals of Plastic Surgery},
  title        = {When Is the Deep Inferior Epigastric Artery Flap Indicated for Breast Reconstruction in Patients not Treated With Radiotherapy?},
  url          = {http://dx.doi.org/10.1097/SAP.0b013e31826cafd0},
  volume       = {73},
  year         = {2014},
}