title: Patients' Aesthetic Concerns After Horizontally Placed Abdominal Free Flap Breast Reconstruction.
abstract: OBJECTIVE
  The present study aimed to analyze patients' aesthetic concerns after breast reconstruction with abdominal free flap by reporting secondary cosmetic procedures performed based on the patients' request, and analyzed the effect of adjuvant therapies and other variables on such outcomes.
  
  
  METHODS
  All patients who underwent unilateral immediate reconstruction were enrolled prospectively. Free abdominal flaps were placed horizontally with little manipulation. Secondary procedures were actively recommended during the follow-up period to meet the patients' aesthetic concerns. The numbers and types of the secondary procedures and the effects of various factors were analyzed.
  
  
  RESULTS
  150 patients met the eligibility criteria. The average number of overall secondary surgeries per patient was 1.25. Patients with skin-sparing mastectomy required significantly higher number of secondary surgeries compared with those who underwent nipple-areolar skin-sparing mastectomy. When confined to the cosmetic procedures, 58 (38.7 %) patients underwent 75 operations. The most common procedures were flank dog ear revision, fat injection of the reconstructed breast, and breast liposuction. None of the radiated patients underwent liposuction of the flap. Most commonly liposuctioned regions were the central-lateral and lower-lateral, while fat was most commonly injected to the upper-medial and upper-central part of the breast.
  
  
  CONCLUSIONS
  The present study delineated the numbers and types of the secondary operations after horizontally placed abdominal free flap transfer with analysis of the influence of various factors. Addressing such issues during the primary reconstruction would help to reduce the need and extent of the secondary operations and to maximize aesthetic outcome.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic ro 43 Gil, Songpa gu, Seoul, 138-736, Korea, nicekek@korea.com.
authors.forename: Eun Key
authors.initials: EK
authors.lastname: Kim
authors.forename: Young Chul
authors.initials: YC
authors.lastname: Suh
authors.forename: Andrés A
authors.initials: AA
authors.lastname: Maldonado
authors.forename: Jiyoung
authors.initials: J
authors.lastname: Yun
authors.forename: Taik Jong
authors.initials: TJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000601:surgery; D015331:Cohort Studies; D016208:Databases, Factual; D004954:Esthetics; D019317:Evidence-Based Medicine; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000379:methods; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000098:blood supply* / Q000637:transplantation*; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology