The influence of a previous implant-based breast reconstruction on postoperative sensation of the deep inferior epigastric artery perforator flap

• Published in: Breast cancer (Tokyo, Japan) Vol. 31; no. 3; pp. 456 - 466
• Main Authors: van Rooij, Joep A. F., Bijkerk, Ennie, van der Hulst, René R. J. W., Tuinder, Stefania M. H.
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01-05-2024
• Subjects: Adult; Aged; Breast - surgery; Breast Implantation - adverse effects; Breast Implantation - instrumentation; Breast Implantation - methods; Breast Implants - adverse effects; Breast Neoplasms - surgery; Cancer Research; Epigastric Arteries - surgery; Female; Humans; Mammaplasty - methods; Mastectomy - adverse effects; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article; Perforator Flap - blood supply; Postoperative Period; Sensation - physiology; Surgery; Surgical Oncology; DIEP flap; Breast sensation; Breast reconstruction; Implant-based breast reconstruction; Breast implants
• ISSN: 1340-6868; 1880-4233
• DOI: 10.1007/s12282-024-01558-6

Background
Implants and DIEP flaps have different outcomes regarding postoperative breast sensation. When compared to the preoperative healthy breast, implant-based breast reconstruction (IBBR) negatively influences postoperative breast sensation. However, it is currently unknown whether a prior IBBR also influences postoperative sensation of a replacing DIEP flap. The goal of this cohort study is to evaluate the influence of an IBBR on the postoperative sensation of a replacing DIEP flap.
Methods
Women were included if they received a DIEP flap reconstruction after mastectomy, with or without prior tissue expander (TE) and/or definitive breast implant. Sensation was measured at four intervals in 9 areas of the breast with Semmes–Weinstein monofilaments: T0 (preoperative, implant/no reconstruction), T1 (2–7 months postoperative, DIEP), T2 (± 12 months postoperative, DIEP), Tmax (maximum follow-up, DIEP). Linear mixed-effects models were used to investigate the relationship between an implant/TE prior to the DIEP flap and recovery of breast sensation.
Results
142 women comprising 206 breasts were included. 48 (23.3%) breasts did, and 158 (76.7%) breasts did not have a TE/IBBR prior to their DIEP. No statistically significant or clinically relevant relationships were found between a prior implant/TE and recovery of DIEP flap breast sensation for the flap skin, native skin, or total breast skin at T1, T2, or Tmax. There were also no relationships found after adjustment for the confounders radiation therapy, BMI, diabetes, age, flap weight, follow-up, and nerve coaptation.
Conclusions
An implant/TE prior to a DIEP flap does not influence the recovery of postoperative breast sensation of the DIEP flap.