Thoracoabdominal advancement flap for definition of inframammary fold in delayed breast reconstruction: A retrospective cohort study assessing safety and patient-reported satisfaction using the BREAST-Q.

Abstract

Numerous inframammary fold reconstruction methods have been described. An update of the thoracoabdominal advancement flap technique has been proposed, enabling definition of the inframammary fold and significant skin recruitment. This study aimed to provide information on safety, patient management, and validated patient-reported outcomes, enabling a critical analysis of this technique. This single-centre retrospective cohort study included female patients, aged ≥18 years, with history of breast cancer treated by total mastectomy, and complete delayed breast reconstruction with thoracoabdominal advancement flap. The data collected included age, history of radiotherapy, surgical protocol, complications, reoperations of the inframammary fold, and BREAST-Q score at the end of reconstruction. The 100 patients included underwent 102 delayed breast reconstructions. Reconstructive methods were deep inferior epigastric artery perforator flap (n=50), muscle sparring latissimus dorsi flap (n=29), transverse myocutaneous gracilis flap (n=7), prosthesis (n=4), and adipose tissue transfers (n=12). Thoracoabdominal advancement flap was associated with 4 Clavien-Dindo Grade I complication (delayed wound healing); 42 patients underwent surgical revision of inframammary fold (IMF) placement. BREAST-Q results at the end of reconstruction were available for 63 patients; the mean±standard deviation score for Satisfaction with breast was 61.9±12.3, and for Physical well-being: chest this was 71.9±20.2. This IMF reconstructive technique is safe, with minimal complications, and compatible with all reconstructive methods. It ensures patient satisfaction, even in irradiated areas, and respects the aesthetic subunits of the breast, maintaining a single breast scar and providing skin similar to the thorax. The multistep reconstructive protocol allows for revision that further consolidates cosmetic results.