Craig Elizabeth Stirling, Lentz Rachel, Srinivasa Dhivya, Chuang Carolyn, Walker Marc E, Higgins Susan A, Salomon Jeffrey, Fusi Stefano
Section of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA.
Department of Surgery, University of Texas, Houston, TX.
Ann Plast Surg. 2018 Aug;81(2):235-239. doi: 10.1097/SAP.0000000000001462.
The deep inferior epigastric perforator (DIEP) flap has gained popularity for autologous free flap breast reconstruction. Historically, patients receiving post mastectomy radiation therapy (PMRT) were not candidates for immediate autologous reconstruction due to concerns for flap volume depletion, fat necrosis, and flap failure. However, this literature is anecdotal and lacks case controls. We objectively analyzed the effects radiation imparts on immediate DIEP flap reconstruction using 3-dimensional software and inherent controls.
We performed a cohort study on breast cancer patients who underwent immediate bilateral DIEP flap reconstructions followed by PMRT between 2005 and 2014. Exclusion criteria included patients less than 6 months from PMRT completion and bilateral PMRT. Three-dimensional photographs were analyzed using Geomagic (Rock Hill, SC) software to compare flap position, projection, and volume between the irradiated and nonirradiated reconstructed breasts. Breast Q survey evaluated patients' satisfaction.
Eleven patients met inclusion criteria. Average time from PMRT completion to photo acquisition was 1.93 years. There was no statistical difference in average volume or projection in the irradiated versus nonirradiated side (P = 0.087 and P = 0.176, respectively). However, position of the irradiated flaps was significantly higher on the chest wall compared to controls (mean difference, 1.325 cm; P < 0.004).
Three-dimensional analysis exhibited no statistical differences in projection or volume between irradiated DIEP flaps and nonirradiated controls. However, irradiated DIEP flaps were positioned higher on the chest wall, similar to observations in irradiated tissue expanders/implants. Patients were satisfied as measured by Breast Q. Immediate bilateral DIEP flap reconstructions can safely be performed with PMRT with satisfactory results.
腹壁下深动脉穿支（DIEP）皮瓣已广泛应用于自体游离皮瓣乳房重建。从历史上看，接受乳房切除术后放疗（PMRT）的患者由于担心皮瓣体积减少、脂肪坏死和皮瓣失败，不适合立即进行自体重建。然而，这些文献多为轶事报道，缺乏病例对照。我们使用三维软件和内在对照，客观分析了放疗对即刻DIEP皮瓣重建的影响。
我们对2005年至2014年间接受即刻双侧DIEP皮瓣重建并随后接受PMRT的乳腺癌患者进行了队列研究。排除标准包括PMRT完成后不到6个月的患者和双侧PMRT患者。使用Geomagic（南卡罗来纳州罗克希尔）软件分析三维照片，以比较放疗侧和未放疗侧重建乳房的皮瓣位置、突出度和体积。乳房Q问卷调查评估患者的满意度。
11名患者符合纳入标准。从PMRT完成到照片采集的平均时间为1.93年。放疗侧与未放疗侧的平均体积或突出度无统计学差异（分别为P = 0.087和P = 0.176）。然而，与对照组相比，放疗皮瓣在胸壁上的位置明显更高（平均差异为1.325 cm；P < 0.004）。
三维分析显示，放疗的DIEP皮瓣与未放疗的对照皮瓣在突出度或体积上无统计学差异。然而，放疗的DIEP皮瓣在胸壁上的位置更高，这与放疗的组织扩张器/植入物的观察结果相似。根据乳房Q问卷调查，患者感到满意。即刻双侧DIEP皮瓣重建联合PMRT可以安全进行，效果令人满意。
