Comparison of Upper Pole Between Immediate and Delayed Breast Reconstructions Using an Abdominal Free Flap

The deep inferior epigastric perforator flap has become the workhorse of autologous breast reconstruction (ABR). In delayed-immediate ABR, a tissue expander is placed during mastectomy and reconstruction is performed later. We compared the morphology of the upper pole after immediate ABR with that after delayed-immediate ABR using a deep inferior epigastric perforator flap.

Standardized lateral chest photographs were analyzed. The borderline was drawn through the top of the breast projection, horizontal to the floor. A line through the lower end of the breast was drawn parallel to the patient's upright stance. The upper end of the breast (U) was defined as the point at which the parallel line crossed the most proximal side of the breast. The upper pole length was measured between U and the point crossing the parallel and borderlines. The upper pole angle was defined as the angle between the parallel line and a line tangential to the upper pole through U.

The immediate and delayed groups comprised 95 and 75 patients, respectively. No significant difference in the preoperative data was observed between the 2 groups. However, the postoperative median length was significantly shorter (86.7 versus 82.8 mm, P = 0.02) and the postoperative median angle was significantly greater (31.1 versus 36.2 degrees, P < 0.001) in the delayed group than those in the immediate group.

In delayed-immediate ABR, the postoperative length of the upper pole decreased, whereas its postoperative angle increased.