Aim: The timing and aesthetic outcome of the breast reconstruction may be affected by the need for radiation therapy (RT). Autologous reconstruction is a novel surgical approach for patients in whom the need for adjuvant RT after mastectomy is preoperativ
Aesthetic outcomes and Patients satisfaction after
delay/imediate autologous breast reconstruction
Autors: Renata S.Brondi, Vilmar M. Oliveira, Fabio Bagnoli, José Francisco Rinaldi,
Evandro Mateus Falacci, Fabrício P. Brenelli
Instituição: Faculdade de Ciências Médicas Santa Casa de São Paulo/ UNICAMP
Aim: The timing and aesthetic outcome of the breast reconstruction
may be affected by the need for radiation therapy (RT). Autologous
reconstruction is a novel surgical approach for patients in whom the
need for adjuvant RT after mastectomy is preoperatively unknown. The
aim of this study was to evaluate the outcomes and satisfaction of breast
reconstruction using a fat-grafted latissimus dorsi flap in immediate and
late reconstruction. Method: A total of 18 patients were submitted to
autologous latissimu dorsi flap, with 11 immediate and 7 late
reconstructions. Patient demographics, surgical characteristics, and
complications were recorded. During outpatient follow-up, the
reconstruction was evaluated and compared to the contralateral breast
in relation to shape, volume and symmetry. Patients scored their
satisfaction using a like scale between 12-18 months after surgery, and
two surgeons performed their evaluations in that same time interval.
Results: Of the eleven patients submitted to immediate reconstruction,
ten performed neoadjuvant chemotherapy, and 9 performed adjuvant
radiotherapy. All patients who underwent late reconstruction had
undergone radiotherapy prior to reconstruction. All the flaps received
autologous fat only in a surgical time prior to the confection of the flap.
All flaps had 100% viability. In the subjective evaluation through the
like scale of the shape, volume and breast symmetry, it was evidenced
that the patients were more satisfied than the physicians in all
parameters analyzed, with good and excellent evaluation of greater than
80% in relation to the shape and symmetry, this evaluation proved to be
in agreement with the medical evaluation, and by the physicians the
evaluation was better in relation to the symmetry, 64% classified
between good and excellent. In the separate assessment of patient
groups, we can note that even after adjuvant radiotherapy patients who
underwent immediate reconstruction were more satisfied than patients
submitted to late reconstruction, concentrating the evaluation in
excellent in 77,8% in relation to the form, 55,6% volume and 44,4% in
symmetry. Radiotherapy does not seem to cause great damage to the
breast reconstructed by this technique. We conclude that the autologous
latissimu dorsi flat is an accessible procedure, with long-term and lowcost
results to the health system, and can be performed in small centers
and with a high patient satisfaction rate