An evaluation of the efficacy of microvascular breast reconstruction techniques

The aim of the study was to evaluate the efficacy of different microvascular techniques in breast reconstruction with the analysis of postoperative complications. The additional goal of the study is to analyze the quality of life of patients after microvascular breast reconstruction in comparison to the control group of patients who underwent only mastectomy without any reconstructive procedures. Also the algorithm of breast reconstruction is presented as the result of own experiences.

Clinical material contain 2 groups of patients - women after surgical treatment in Department of Oncological and Reconstructive Surgery, Cancer Center in Gliwice in the year 2004-2009 where in 53 cases immediate and in 26 delayed breast microvascular reconstruction were performed. In all cases the diagnosis of cancer was proved by histopathological biopsy before the treatment. The type of radical resection (mastectomy) depended on histopathological type of cancer and its localization. The reconstruction - immediate vs delayed was carefully planned together with oncological treatment of the cases. Everywhere this plan was established based on carefully examinations of inferior epigastric vessels and theirs perforators. The choice between immediate and delayed microvascular reconstruction was based on prognosis and predictive factors. The QOL was analyzed due to own questionnaire when functional, aesthetics and social effects were evaluated.

Free flap survival rate for all types of free flap was 95%. In cases where classic TRAM was used the rate was 85%, in cases where muscle sparring TRAM was chosen the survival rate was 100% and in remaining cases of DIEP reconstructions the rate was 89%. Generally the complications after microvascular reconstruction occurred in 13 cases (16%). In 9 cases the problems with flaps perfusion were notified. Total flap necrosis was observed in 2 TRAM and in 2 DIEP cases. In all those cases salvage surgery was administered in which the microanastomoses were explored and repaired. In 5 cases the cause of the complications was venous thrombosis, in 2 cases the vascular pedicle was kinked, and in remaining 1 the arterial thrombosis was found. The second type of complication was fat necrosis (<25% of flap volume) which was observed in 5 cases between 1 and 4 months after surgery, and it request minor plastic surgery. Donor site complications were noted in 4 cases. In two of those hernia in cicatrices was diagnosed (both were classic TRAM's), in remaining 2 in which also fully muscle TRAM was classic the weakness of abdominal wall was observed. In group were msTRAM and DIEP were used no donor site complications occurred.