Abdominal perforator flap (DIEP) and autologous latissimus dorsi in breast reconstruction. A retrospective comparative study about the first 60 cases of a same surgeon

Introduction. - Autologous techniques for breast reconstruction get the best cosmetic results. Aesthetic satisfaction with breast reconstruction is an important evaluation criterion. The indication is based on technical criteria (morphological, medical history) and the wishes of the patient. A rigorous evaluation of the results is necessary to assist the patients in their choice of reconstruction. Methods. - Thirty-three DIEP and 27 latissimus dorsi were involved. A satisfaction questionnaire was sent to patients to collect the aesthetic evaluation of their reconstructed breast, sequelae at the donor site of the flap as well as their overall satisfaction. Post-operative photographs of the patients were subject to aesthetical evaluation by two groups of observers. Complications were analyzed. Results. - The DIEP tends to get higher aesthetic satisfaction regarding the symmetry of the breasts and the volume of the reconstructed breast (P = 0.05), and a better overall satisfaction (P = 0.02). The uniformity of the colour of the reconstructed breast was considered superior by observers in the latissimus dorsi group (P = 0.005). Donor site scar of DIEP was considered more unsightly while the latissimus dorsi was considered more painful (P = 0.04) and uncomfortable, with more frequently contour abnormalities (P = 0.03). We noted two total flap necrosis and three partial necrosis in the group DIEP, and two partial flap necrosis in the group latissimus dorsi. Conclusion. - This study provides evidence that can guide the patient and the surgeon in the complex process of therapeutic decision, without exempting the latter from a careful selection of indications. (C) 2013 Elsevier Masson SAS. All rights reserved.