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Sumeet S. Teotia, lead author of the study and associate professor of plastic surgery at UT Southwestern Medical Center and director of the breast-reconstruction program at UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center, in a statement said, “Now we use the CTA results to have a conversation with the patient in clinic. Reviewing the scans helps the patient see what we may encounter in surgery and gives them confidence going into the procedure. Potentially, we can reduce and even avoid long-term complications.”
They explained that single breast reconstruction, using the tissues from the abdomen has been a challenge because the tissues often fail to recreate the normal shape and size of the breast. Those with inadequate abdominal tissues, or scars over the abdomen are also difficult candidates for such reconstructive surgeries say experts. In these cases there is not enough tissue to recreate the breast. If the other normal breast sags or is large, the reconstruction of the single breast with available abdominal tissue becomes more of a challenge. Despite these, one of the biggest problems till date wrote the researchers, is the likelihood of getting inadequate blood supply to the reconstructed breast. This often results in failure of the surgery.
For this study they looked at free flap surgical reconstructions of the breast performed on patients at UT Southwestern between 2009 and 2017. They could find 512 such patients and 150 of these patients were included in this study and followed up for results of the surgery. These women were of an average age of 57 years and had an average Body Mass Index (BMI) of 27. They found that 75 of these women had undergone single breast reconstruction while 75 underwent “conjoined, stacked double-pedicle flap reconstruction”. They also noted that 81 percent had to undergo delayed reconstruction of the breast.
The results showed of all of these cases that the women who had undergone conjoined stacked double-pedicle flap reconstruction needed lesser number of blood vessels for their flap and also had a lower risk of fat necrosis (at 2.7 percent cases). Among women who underwent a single flap reconstruction, the risk of fat necrosis was as high as 14.4 percent, the team found.
Teotia said, “The CTA scan allows us to visuospatially create a model of the breast in advance so we can be faster in the operating room. The surgeons still visually confirm the scan results during surgery, assuring a high degree of reliability.” He added, “Our algorithm allows us to be anatomically strategic in choosing the best blood supply for that particular tissue; it is important to have optimal blood supply for the best results, which ultimately translates into an improved outcome and breast shape.” Journal reference:
Min-Jeong Cho, Sumeet S. Teotia, Nicholas T. Haddo, Classification and Management of Donor-Site Wound Complications in the Profunda Artery Perforator Flap for Breast Reconstruction, J reconstr Microsurg 2020; 36(02): 110-115, DOI: 10.1055/s-0039-1697903, https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0039-1697903
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