A. A. Azizi1,5, A. T. Mohan2,3,4, T. Tomouk5, E. Conci5, E. B. Brickley6, C. M. Malata2,7 1Royal Free Hospital NHS Foundation Trust,London, LONDON, United Kingdom 2Addenbrooke’s University Hospital,Plastic And Reconstructive Surgery Department,Cambridge, CAMBRIDGESHIRE, United Kingdom 3Mayo Clinic,Rochester, MN, USA 4Restoration Of Appearance And Function Charitable Trust (RAFT),Research Fellow,London, LONDON, United Kingdom 5University Of Cambridge,School Of Clinical Medicine,Cambridge, CAMBRIDGESHIRE, United Kingdom 6University Of Cambridge,Department Of Public Health And Primary Care,Cambridge, CAMBRIDGESHIRE, United Kingdom 7Postgraduate Medical Institute At Anglia Ruskin University,Cambridge And Chelmsford, CAMBRIDGESHIRE, United Kingdom
Introduction: Reduced post-operative pain has been shown to decrease complications, accelerate discharge from hospital and improve patient experience. Although perforator flaps can reduce donor site morbidity in comparison to their muscle flap counterparts for breast reconstruction, they are still associated with considerable, local pain which has recently been the subject of various methods of control, such as TAP blocks. There has hitherto been no study of the pain associated with different perforator flap types. We therefore reviewed Deep Inferior Epigastric Artery Perforator (DIEP) flaps used for post-mastectomy breast reconstruction and compared pain and clinical outcomes based on surgical procedure type: unilateral uni-pedicled, unilateral bi-pedicled and bilateral breast reconstructions.
Methods: A 7-year retrospective study (2008-2015) was conducted at a single University Hospital of all women who underwent post-mastectomy DIEP breast reconstruction by as single surgeon using the rib preservation technique for intermammary vessel exposure. Data were collected on patient demographics, operative details, patient pain scores, analgesia requirements, postoperative course and complications. A literature review of pain and morbidity of DIEP breast reconstruction was conducted.
Results:The 177 patients (207 FLAPS) included in the study were categorized into four DIEP groups: unilateral unipedicled (N=85 flaps), unilateral bi-pedicled (N=26 flaps), total unilateral (N=147) and bilateral (N=60 flaps) reconstructions. There were no significant differences in morphine patient controlled analgesic (PCA) requirements over 24 and 48 hours, PCA duration, patient reported pain scores and time to catheter removal across all four groups. Bilateral reconstructions had an increased hospital stay by 2 days (P<0.01). 86% of patients reported their maximum pain scores in the first 24 hours.
Conclusion:This is the first study to compare the clinical outcomes and immediate postoperative morbidity of unipedicled, bipedicled and bilateral DIEP breast reconstructions. PCA requirements, time to catheter removal and pain scores were comparable across all 4 subgroups. Our study showed that there were no clinically significant differences in outcomes between unilateral and bilateral reconstructions or unipedicled against bipedicled unilateral reconstructions attributable to differences in post-operative pain.