Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Divison of Surgical Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
J Reconstr Microsurg. 2022 Sep;38(7):579-584. doi: 10.1055/s-0041-1742240. Epub 2022 Feb 8.
Deep inferior epigastric perforator (DIEP) reconstruction can be performed in an immediate (at time of mastectomy), delayed-immediate (immediate tissue expander followed by staged DIEP), or delayed timing following mastectomy. Avoiding flap radiation is a known benefit of the delayed-immediate approach. The purpose of this study is to evaluate patients who chose DIEP flap as the reconstructive method during initial consultation and compared characteristics of surgery in relation to their final reconstructive choice.
Consecutive patients having breast reconstruction from 2017 to 2019 were divided into three groups: immediate DIEP after mastectomy (Group I); delayed-immediate DIEP with tissue expander first followed by DIEP (Group II); and patients who initially chose delayed-immediate DIEP but later decided on implants for the second stage of reconstruction (Group III). Exclusion criteria were patients that had delayed DIEP (no immediate reconstruction) or had initially chose implant-based reconstruction.
The study included 59 patients. Unilateral free flaps in Group II had shorter operative times (318 minutes) compared with Group I unilateral free flaps (488 minutes) ( = 0.024). Eleven patients (30.6%) had prophylactic mastectomies in Group I compared with none in Group II ( = 0.004). Patients who had immediate tissue expansion frequently changed their mind from DIEP to implant for second stage reconstruction frequently (52.2%).
Delayed-immediate DIEP reconstruction has several advantages over immediate DIEP flap including shorter free flap operative times. Patients commonly alter their preference for second stage reconstruction. A patient-centered advantage of delayed-immediate reconstruction is prolonging the time for patients to make their choice for the final reconstruction.
深下腹壁穿支皮瓣（DIEP）重建可在即刻（乳房切除术时）、延迟即刻（即刻组织扩张器后分期 DIEP）或乳房切除术后延迟进行。避免皮瓣放疗是延迟即刻方法的已知益处。本研究旨在评估在初次咨询时选择 DIEP 皮瓣作为重建方法的患者，并比较与最终重建选择相关的手术特征。
连续选择 2017 年至 2019 年行乳房重建的患者，分为三组：乳房切除术后即刻 DIEP（I 组）；延迟即刻 DIEP 加组织扩张器先行，再行 DIEP（II 组）；最初选择延迟即刻 DIEP 但后来决定二期重建采用植入物的患者（III 组）。排除标准为行延迟 DIEP（无即刻重建）或最初选择基于植入物的重建的患者。
研究纳入 59 例患者。与 I 组单侧游离皮瓣（488 分钟）相比，II 组单侧游离皮瓣（318 分钟）的手术时间更短（=0.024）。与 II 组相比，I 组有 11 例（30.6%）患者行预防性乳房切除术（=0.004）。行即刻组织扩张的患者常有 52.2%改变主意，二期重建从 DIEP 改为植入物。
与即刻 DIEP 皮瓣相比，延迟即刻 DIEP 重建具有几个优势，包括游离皮瓣手术时间更短。患者通常会改变对二期重建的偏好。延迟即刻重建的一个以患者为中心的优势是延长患者做出最终重建选择的时间。
