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Long-term Surgical and Patient-Reported Outcomes Comparing Skin-Preserving, Staged Versus Delayed Microvascular Breast Reconstruction.

Publication ,  Journal Article
Hassan, AM; Ray, N; Govande, JG; Paidisetty, P; Largo, RD; Chu, CK; Mericli, AF; Schaverien, MV; Clemens, MW; Hanasono, MM; Chang, EI ...
Published in: Ann Surg Oncol
September 2023

BACKGROUND: Skin-preserving, staged, microvascular, breast reconstruction often is preferred in patients requiring postmastectomy radiotherapy (PMRT) but may lead to complications. We compared the long-term surgical and patient-reported outcomes between skin-preserving and delayed microvascular breast reconstruction with and without PMRT. METHODS: We conducted a retrospective, cohort study of consecutive patients who underwent mastectomy and microvascular breast reconstruction between January 2016 and April 2022. The primary outcome was any flap-related complication. The secondary outcomes were patient-reported outcomes and tissue-expander complications. RESULTS: We identified 1002 reconstructions (672 delayed; 330 skin-preserving) in 812 patients. Mean follow-up was 24.2 ± 19.3 months. PMRT was required in 564 reconstructions (56.3%). In the non-PMRT group, skin-preserving reconstruction was independently associated with shorter hospital stay (β - 0.32, p = 0.045) and lower odds of 30-days readmission (odds ratio [OR] 0.44, p = 0.042), seroma (OR 0.42, p = 0.036), and hematoma (OR 0.24, p = 0.011) compared with delayed reconstruction. In the PMRT group, skin-preserving reconstruction was independently associated with shorter hospital stay (β - 1.15, p < 0.001) and operative time (β - 97.0, p < 0.001) and lower odds of 30-days readmission (OR 0.29, p = 0.005) and infection (OR 0.33, p = 0.023) compared with delayed reconstruction. Skin-preserving reconstruction had a 10.6% tissue expander loss rate and did not differ from delayed reconstruction in terms of patient-reported satisfaction with breast, psychosocial well-being, or sexual well-being. CONCLUSIONS: Skin-preserving, staged, microvascular, breast reconstruction is safe regardless of the need for PMRT, with an acceptable tissue expander loss rate, and is associated with improved flap outcomes and similar patient-reported quality of life to that of delayed reconstruction.

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Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

September 2023

Volume

30

Issue

9

Start / End Page

5711 / 5722

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Radiotherapy, Adjuvant
  • Quality of Life
  • Postoperative Complications
  • Patient Reported Outcome Measures
  • Oncology & Carcinogenesis
  • Mastectomy
  • Mammaplasty
  • Humans
 

Citation

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Hassan, A. M., Ray, N., Govande, J. G., Paidisetty, P., Largo, R. D., Chu, C. K., … Selber, J. C. (2023). Long-term Surgical and Patient-Reported Outcomes Comparing Skin-Preserving, Staged Versus Delayed Microvascular Breast Reconstruction. Ann Surg Oncol, 30(9), 5711–5722. https://doi.org/10.1245/s10434-023-13470-y
Hassan, Abbas M., Nicholas Ray, Janhavi G. Govande, Praneet Paidisetty, Rene D. Largo, Carrie K. Chu, Alexander F. Mericli, et al. “Long-term Surgical and Patient-Reported Outcomes Comparing Skin-Preserving, Staged Versus Delayed Microvascular Breast Reconstruction.Ann Surg Oncol 30, no. 9 (September 2023): 5711–22. https://doi.org/10.1245/s10434-023-13470-y.
Hassan AM, Ray N, Govande JG, Paidisetty P, Largo RD, Chu CK, et al. Long-term Surgical and Patient-Reported Outcomes Comparing Skin-Preserving, Staged Versus Delayed Microvascular Breast Reconstruction. Ann Surg Oncol. 2023 Sep;30(9):5711–22.
Hassan, Abbas M., et al. “Long-term Surgical and Patient-Reported Outcomes Comparing Skin-Preserving, Staged Versus Delayed Microvascular Breast Reconstruction.Ann Surg Oncol, vol. 30, no. 9, Sept. 2023, pp. 5711–22. Pubmed, doi:10.1245/s10434-023-13470-y.
Hassan AM, Ray N, Govande JG, Paidisetty P, Largo RD, Chu CK, Mericli AF, Schaverien MV, Clemens MW, Hanasono MM, Chang EI, Garvey PB, Phillips BT, Selber JC. Long-term Surgical and Patient-Reported Outcomes Comparing Skin-Preserving, Staged Versus Delayed Microvascular Breast Reconstruction. Ann Surg Oncol. 2023 Sep;30(9):5711–5722.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

September 2023

Volume

30

Issue

9

Start / End Page

5711 / 5722

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Radiotherapy, Adjuvant
  • Quality of Life
  • Postoperative Complications
  • Patient Reported Outcome Measures
  • Oncology & Carcinogenesis
  • Mastectomy
  • Mammaplasty
  • Humans