Photometric Comparison of Skin Color Match between Abdominal and Thigh-Based Free Flaps for Breast Reconstruction in White Patients.

Abstract

Background: With the increasing demand for autologous breast reconstruction, different surgical techniques have emerged to provide patients with the best possible result tailored to their individual needs. The upper thigh provides an alternative tissue resource in patients where abdominal based flaps are not feasible. Although surgical outcomes and donor-site morbidity demonstrate favorable results using abdominal and thigh-based free flaps for autologous breast reconstruction, the differences in skin constitution and color between the two flap donor sites have not been investigated.

Methods: From the authors' flap database, 60 patients who underwent unilateral secondary breast reconstruction with free deep inferior epigastric perforator (DIEP) or transverse myocutaneous gracilis (TMG) flaps where randomly selected. In both cohorts, postoperative pictures were used for photometric color evaluation of the reconstructed breast using the delta E (ΔE) 2000 score at time A (1.5 to 3 months), time B (6 to 8 months), and time C (12 to 20 months). Standard univariate descriptive statistics and group comparisons were performed.

Results: The DIEP flap demonstrated a better skin color match at time A ( P < 0.001), time B ( P = 0.003), and time C ( P = 0.009). Over time, both flaps showed improved ΔE 2000 values, and patient age was only associated with higher ΔE 2000 values in TMG flaps after 1.5 to 3 months ( P = 0.021).

Conclusions: The study provides the first objective analysis of skin color match in secondary autologous breast reconstruction. The DIEP flap reconstruction shows a preferable color match compared with the TMG flap. Both free flaps demonstrate an improved skin color match 12 to 20 months after secondary breast reconstruction.

Clinical question/level of evidence: Therapeutic, III.