Postmastectomy breast reconstruction in the irradiated breast: a comparative study of DIEP and latissimus dorsi flap outcome.

BACKGROUND: Autologous tissue transfer is often indicated to achieve improved tissue quality during breast reconstruction after radiotherapy. The authors evaluated satisfaction with postmastectomy breast reconstruction among irradiated patients. The aim was to compare deep inferior epigastric perforator (DIEP) and latissimus dorsi flaps regarding satisfaction with aesthetic outcome between patients and plastic surgeons.

METHODS: Patients who underwent reconstruction with 24 consecutive DIEP flaps and 21 consecutive latissimus dorsi flaps in combination with prostheses were reviewed retrospectively. They received the Michigan Outcomes Study 36-Item Short Form Health Survey and a complementary form regarding patient satisfaction. They were photographed, and aesthetic results were evaluated by an independent board of plastic surgeons.

RESULTS: There was no significant difference between the groups regarding demographic data or 36-Item Short Form Health Survey results. Plastic surgeons found the DIEP flap superior regarding size (p = 0.024) and shape (p = 0.039), whereas patients were more satisfied with the size (p = 0.046) and shape (p = 0.017) of the latissimus dorsi flap when patients' and surgeons' opinions were compared. Discrepancy between patients' and surgeons' opinions was verified with weighted kappa analysis. Regarding the donor scar, the latissimus dorsi flap was favored compared with DIEP flap reconstruction by both patients (p = 0.036) and surgeons (p = 0.001).

CONCLUSIONS: There is a difference between patients' and plastic surgeons' opinions regarding breast reconstruction outcomes in the irradiated breast. The patients were more satisfied with latissimus dorsi flap reconstruction, which may relate to the donor-site scar. Surgeons favored DIEP flap reconstruction with regard to the size and shape of the breast.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.