When Is the Deep Inferior Epigastric Artery Flap Indicated for Breast Reconstruction in Patients not Treated With Radiotherapy?
(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)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/3627910
- author
- Lundberg, Jonas ; Thorarinsson, Andri ; Karlsson, Per ; Ringberg, Anita LU ; Frisell, Jan ; Hatschek, Thomas ; Källström, Ann-Christine and Elander, Anna
- organization
- publishing date
- 2014
- 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
- pmid:23511739
- 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
- 2016-04-01 11:11:01
- date last changed
- 2022-03-12 20:26:57
@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}}, doi = {{10.1097/SAP.0b013e31826cafd0}}, volume = {{73}}, year = {{2014}}, }