Surgical and Patient Reported Outcomes After DIEP Breast Reconstruction at a Low-Volume Community Hospital Without Microvascular Fellowship Training.

Background: Microsurgical breast reconstruction is typically performed at large, academic centers by fellowship-trained surgeons. This study examines surgical and patient-reported outcomes (PROs) after deep inferior epigastric perforator (DIEP) flap breast reconstruction at a community hospital by surgeons without fellowship training. Methods: A prospective clinical database and BREAST-Q results were obtained from 33 patients after 45 DIEP flaps performed between 2016 and 2020. PROs and complications were compared to normative data and multi-institutional series. Regression analysis of patient and surgical factors with BREAST-Q scores was performed. Results: Thirty-one patients completed BREAST-Q (response rate = 94%). Overall flap survival was 97.8%. Complications were not statistically different from larger published series (P > 0.05). Patients reported excellent outcomes after breast reconstruction: satisfaction with breasts (80.6 ± 4.3), satisfaction with outcome (88.3 ±17.7), psychosocial well-being (80.74 ± 17.4), sexual well-being (68.2 ± 24.1), physical well-being - chest (73.8 ± 16.1), and physical well-being - abdomen (73.3 ± 17.4). PROs were not statistically different from published multicenter data with the exception of superior scores in sexual well-being (P < 0.05) and breast satisfaction (P < 0.0001). Satisfaction with outcome varied by patient age and was 20.7 points higher for patients over 55 compared to patients 46 to 55 years of age (P < 0.05). Satisfaction with breasts was 29 points lower after total flap loss (P < 0.005). Psychosocial well-being scores were 26.98 points lower after a takeback (P < 0.05). Sexual well-being and physical well-being - chest scores were negatively related to increasing body mass index (BMI) (P < 0.05). Conclusion: DIEP flap breast reconstruction can be performed with high quality and excellent PROs at a community hospital by surgeons without microvascular fellowship training.

Head and Neck Tumor Resection and Free Flap Reconstruction in Low-Volume Center.

OBJECTIVE: To determine the surgical outcomes of free tissue transfer surgery following head and neck tumor extirpation in a low-volume medical center. METHODS: Retrospective chart review of patients who underwent free tissue transfer surgery for head and neck cancer at Moanalua Medical Center from 2015 to 2018. MAIN OUTCOME OF MEASURE: Free flap failure rate and free flap-related complications. RESULTS: From 2015 to 2018, there were 27 free tissue transfer surgery (mean 6.75 flap surgery/year). There were 2 events of partial flap necrosis, and no cases of total flap loss. One patient required leech therapy for venous congestion. One patient required additional free flap surgery. Two patients developed orocutaneous fistula that resolved with local wound care. One patient developed malocclusion following mandible reconstruction using fibular free flap. Overall free flap success rate was 96%. CONCLUSION: This study supports the ability of small-volume centers to produce positive outcomes with few complications in head and neck cancer free flap reconstructive surgery. While the data are limited to a single surgical team in one care center, it provides additional support for the idea that there are factors beyond the surgical volume that determine outcome.