title: Long-term follow-up of changing practice patterns in breast reconstruction due to increased use of tissue expanders and perforator flaps.
abstract: BACKGROUND
  As the science of breast reconstruction evolves, significant changes in reconstruction strategies and outcomes are expected. The purpose of this study is to determine the changes in breast reconstruction trends and outcomes that occurred at a multidisciplinary academic institution during the last decade.
  
  
  METHODS
  We compared 265 patients over two distinct 6-month intervals separated by 5 years (2002 vs. 2007) and performed long-term follow-up (4.75 ± 3.38 years 2002, 2.99 ± 2.25 years 2007). We studied patients seeking prophylactic mastectomy, patients with early breast cancer, and patients with locally advanced disease. We analyzed demographic data, breast cancer history and treatment, type and timing of reconstruction, and complications.
  
  
  RESULTS
  Implant to flap reconstruction ratio was 48:49 in 2002 and 76:102 in 2007. Use of transverse rectus abdominis myocutaneous flap declined from 57 to 4%; conversely, deep inferior epigastric perforator flap increased from 27 to 91% (P < 0.001). Correspondingly, donor site chronic pain (4 vs. 0, P = 0.012) and postoperative abdominal wall bulge (9 vs. 3, P = 0.004) rates decreased. Timing of reconstruction showed increased staged cases in 2007 compared to 2002 (P = 0.045). Post-final reconstruction radiation therapy was reduced in 2007 (P = 0.016), with subsequent lower rates of implant rupture (P < 0.001).
  
  
  CONCLUSIONS
  At our institution and over the last decade, increasing staged reconstructions have successfully reduced the rates of post-final reconstruction radiotherapy with optimized outcomes. Contrary to national trends, the rates of autologous flap reconstructions have increased with reduced donor site morbidity. This suggests that academic breast reconstruction trends are independent from national trends.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Michele A
authors.initials: MA
authors.lastname: Manahan
authors.forename: Roni B
authors.initials: RB
authors.lastname: Prucz
authors.forename: Sachin M
authors.initials: SM
authors.lastname: Shridharani
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Baltodano
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008408:Mastectomy; D008875:Middle Aged; D061525:Perforator Flap; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013997:Time Factors; D015625:Tissue Expansion Devices