JPRAS open · 2026
DIEP flap breast reconstruction at a low-volume center: bringing high-quality autologous breast reconstruction to the community.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Kao Kenneth K, Faringer Paul D, Nishikawa Scott M, Romanchak Dorien R
Аннотация
BACKGROUND: This study presents surgical and patient reported outcomes (PRO) after deep inferior epigastric perforator (DIEP) flap breast reconstruction at a community hospital to determine if high-quality care can be delivered despite low surgical volume.
METHODS: A prospective database and BREAST-Q were obtained from 87 patients (137 DIEP flaps). Pre/post-operative PRO and complications were compared with published normative data, and multi-institutional series. Regression analysis using BREAST-Q scores was performed.
RESULTS: BREAST-Q response rates were 57.5% and 93.1% for pre-operative and post-operative surveys. Flap survival was 97.8%. Breast and donor site complications (14.6%, 13.1%) were lower than larger published series (p < 0.05).PRO were excellent: satisfaction with breasts (82.6 ± 15.2), satisfaction with outcome (88.8 ± 16.4), psychosocial well-being (82.7 ± 16.4), sexual well-being (68.5 ± 20.8), physical well-being -chest (76.3 ± 15.3), physical well-being -abdomen (74.8 ± 18.2). PRO were superior to multi-center data (p < 0.0001), except abdominal scores (p = 0.1610). Pre-operative versus post-operative PRO demonstrated improved psychosocial well-being (+22.4 ± 19.9, P < 0.0001), sexual-well-being (+18.1 ± 22.6, P < 0.0001), and satisfaction with breasts (+39.1 ± 23.7, P < 0.0001). Physical well-being -chest was unchanged; physical well-being -abdomen was lower (-12.8 ± 22.1 P = 0.0002). Cup size > D improved sexual well-being (+33.80 p = 0.003). Delayed breast reconstruction (20.99, p = 0.0065) and post-mastectomy radiation therapy (21, p = 0.0379) increased satisfaction with breasts. Prior radiation improved psychosocial well-being (16.9, p = 0.0348).Increased operative time decreased satisfaction with outcome (-1.15/30 min, p = 0.0008) and psychosocial well-being (-0.71/30 min, p = 0.037). Major complications lowered sexual well-being (-16.36, p = 0.0067).
CONCLUSION: DIEP breast reconstruction at a low-volume center can be performed with high quality and patient satisfaction.
METHODS: A prospective database and BREAST-Q were obtained from 87 patients (137 DIEP flaps). Pre/post-operative PRO and complications were compared with published normative data, and multi-institutional series. Regression analysis using BREAST-Q scores was performed.
RESULTS: BREAST-Q response rates were 57.5% and 93.1% for pre-operative and post-operative surveys. Flap survival was 97.8%. Breast and donor site complications (14.6%, 13.1%) were lower than larger published series (p < 0.05).PRO were excellent: satisfaction with breasts (82.6 ± 15.2), satisfaction with outcome (88.8 ± 16.4), psychosocial well-being (82.7 ± 16.4), sexual well-being (68.5 ± 20.8), physical well-being -chest (76.3 ± 15.3), physical well-being -abdomen (74.8 ± 18.2). PRO were superior to multi-center data (p < 0.0001), except abdominal scores (p = 0.1610). Pre-operative versus post-operative PRO demonstrated improved psychosocial well-being (+22.4 ± 19.9, P < 0.0001), sexual-well-being (+18.1 ± 22.6, P < 0.0001), and satisfaction with breasts (+39.1 ± 23.7, P < 0.0001). Physical well-being -chest was unchanged; physical well-being -abdomen was lower (-12.8 ± 22.1 P = 0.0002). Cup size > D improved sexual well-being (+33.80 p = 0.003). Delayed breast reconstruction (20.99, p = 0.0065) and post-mastectomy radiation therapy (21, p = 0.0379) increased satisfaction with breasts. Prior radiation improved psychosocial well-being (16.9, p = 0.0348).Increased operative time decreased satisfaction with outcome (-1.15/30 min, p = 0.0008) and psychosocial well-being (-0.71/30 min, p = 0.037). Major complications lowered sexual well-being (-16.36, p = 0.0067).
CONCLUSION: DIEP breast reconstruction at a low-volume center can be performed with high quality and patient satisfaction.