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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Outpatient Microsurgical Breast Reconstruction
Carlos A Martinez1, Sean G Boutros1
1Houston Plastic Craniofacial and Sinus Surgery, Houston, Tex.
Plastic and Reconstructive Surgery. Global Open
|November 2, 2020
Summary
Outpatient breast reconstruction using perforator flaps, including DIEP flaps, is feasible with a modified technique. This approach enables early discharge and reduces complications, improving patient recovery and lowering healthcare costs.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Microsurgery
Background:
- Perforator-based breast reconstructions, such as DIEP flaps, traditionally involve lengthy hospitalizations due to extensive procedures and flap monitoring.
- Prolonged hospital stays are linked to increased risks of infection, deep vein thrombosis, patient dissatisfaction, and higher healthcare expenses.
Purpose of the Study:
- To demonstrate the feasibility and benefits of a modified surgical technique and recovery protocol for outpatient breast reconstruction using perforator flaps.
- To expand the application of this outpatient approach beyond DIEP flaps to include other perforator-based reconstructions like IGAP and PAP flaps.
Main Methods:
- Implementation of a protocol for autologous flap breast reconstruction focused on early mobilization and discharge.
- Key elements include intraoperative local anesthesia, microfascial DIEP flap harvest with rib preservation, and prophylactic anticoagulation.
- Multimodal pain management strategies were employed to reduce opioid requirements and improve postoperative comfort.
Main Results:
- Ninety-two patients underwent outpatient breast reconstruction with DIEP, IGAP, or PAP flaps, with no intraoperative complications.
- All patients were discharged within 23 hours post-surgery, showing no signs of flap compromise.
- Only one patient required reoperation for hematoma evacuation; no partial or total flap losses occurred.
Conclusions:
- Outpatient perforator-flap breast reconstruction is achievable with high success rates and low complication incidence.
- The modified technique, combined with multimodal pain control and anticoagulation, facilitates rapid recovery and early discharge.
- This approach offers a safe and effective alternative to traditional inpatient reconstructions, potentially reducing costs and improving patient outcomes.
