title: Delayed versus Delayed-Immediate Autologous Breast Reconstruction: A Blinded Evaluation of Aesthetic Outcomes.
abstract: BACKGROUND
  The technique of delayed-immediate breast reconstruction includes immediate insertion of a tissue expander, post-mastectomy radiation, followed by reconstruction. The aesthetic benefits of delayed-immediate reconstruction compared to delayed reconstruction are postulated but remain unproven. The purpose of this study was to compare aesthetic outcomes in patients following delayed and delayed-immediate autologous breast reconstruction.
  
  
  METHODS
  A retrospective analysis was performed of all patients who underwent delayed or delayed-immediate autologous breast reconstruction by the senior author from 2005 to 2011. Postoperative photographs were used to evaluate aesthetic outcomes: skin quality, scar formation, superior pole contour, inferior pole contour, and overall aesthetic outcome. Ten non-biased reviewers assessed outcomes using a 5-point Likert scale. Fisher's Exact and Wilcoxon-Mann-Whitney tests were used for comparative analysis.
  
  
  RESULTS
  Patient age and body mass index were similar between delayed (n=20) and delayed-immediate (n=20) cohorts (P>0.05). Skin and scar quality was rated significantly higher in the delayed-immediate cohort (3.74 vs. 3.05, P<0.001 and 3.41 vs. 2.79, P<0.001; respectively). Assessment of contour-related parameters, superior pole and inferior pole, found significantly improved outcomes in the delayed-immediate cohort (3.67 vs. 2.96, P<0.001 and 3.84 vs. 3.06, P<0.001; respectively). Delayed-immediate breast reconstruction had a significantly higher overall score compared to delayed breast reconstructions (3.84 vs. 2.94, P<0.001). Smoking and the time interval from radiation to reconstruction were found to affect aesthetic outcomes (P<0.05).
  
  
  CONCLUSIONS
  Preservation of native mastectomy skin may allow for improved skin/scar quality, breast contour, and overall aesthetic outcomes following a delayed-immediate reconstructive algorithm as compared to delayed breast reconstruction.
authors.affiliation: Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Albino
authors.affiliation: Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA.
authors.forename: Ketan M
authors.initials: KM
authors.lastname: Patel
authors.affiliation: Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA.
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Smith
authors.affiliation: Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA.
authors.forename: Maurice Y
authors.initials: MY
authors.lastname: Nahabedian
keywords: Breast implantation; Cosmetic techniques; Mammaplasty; Mastectomy