‘PartBreCon’ study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps
A. Agrawal,
L. Romics,
D. Thekkinkattil,
M. Soliman,
M. Kaushik,
P. Barmpounakis,
C. Mortimer,
C.A. Courtney,
A. Goyal,
E. Garreffa,
A. Carmichael,
R.A. Lane,
C. Rutherford,
B. Kim,
R. Achuthan,
V. Pitsinis,
S. Goh,
B. Ray,
K. Grover,
R. Vidya,
J. Murphy,
Dorin Dumitru,
Raouef Bichoo,
Nirbhaibir Singh,
Hussein Tuffaha,
Evangelos Mallidis,
Kalliope Valassiadou,
Venla Kantola,
Lydia Prusty,
Anzors Gvaramadze,
Vivienne Blackhall,
James Mansell,
Ahmed Hamad
Affiliations
A. Agrawal
Cambridge University Hospitals, Cambridge, UK; Corresponding author.
L. Romics
New Victoria Hospital, Glasgow, UK
D. Thekkinkattil
Lincoln County Hospital, Lincoln, UK
M. Soliman
Cambridge University Hospitals, Cambridge, UK; Mansoura University, Egypt
M. Kaushik
University Hospitals of Leicester NHS Trust, Leicester, UK
P. Barmpounakis
Department of Statistics, Athens University of Economics and Business, Athens, Greece
C. Mortimer
Ipswich Hospital, Ipswich, UK
C.A. Courtney
Royal Derby Hospital, Derby, UK
A. Goyal
Royal Derby Hospital, Derby, UK
E. Garreffa
Royal Derby Hospital, Derby, UK
A. Carmichael
University Hospital of Derby and Burton, Belvedere Road, Burton on Trent, UK
R.A. Lane
Cambridge University Hospitals, Cambridge, UK
C. Rutherford
Gartnavel General Hospital, Glasgow, UK
B. Kim
St. James's University Hospital, Leeds, UK
R. Achuthan
St. James's University Hospital, Leeds, UK
V. Pitsinis
Ninewells Hospital, Dundee, UK
S. Goh
Peterborough Hospital, Peterborough, UK
B. Ray
Harrogate NHS Trust, Harrogate, UK
K. Grover
Hull Royal Infirmary, Hull, UK
R. Vidya
Royal Wolverhampton NHS Trust, Wolverhampton, UK
J. Murphy
Manchester University Hospital, Manchester, UK
Dorin Dumitru
Dorin Dumitru, Hull Royal Infirmary, Hull
Raouef Bichoo
Raouef Bichoo, Hull Royal Infirmary, Hull
Nirbhaibir Singh
Nirbhaibir Singh, Royal Wolverhampton NHS Trust, Wolverhampton
Hussein Tuffaha
Hussein Tuffaha, Ipswich Hospital, Ipswich
Evangelos Mallidis
Evangelos Mallidis, Ipswich Hospital, Ipswich
Kalliope Valassiadou
Kalliope Valassiadou, University Hospitals of Leicester NHS Trust, Leicester
Venla Kantola
Venla Kantola, St. James’s University Hospital, Leeds
Lydia Prusty
Lydia Prusty, Lincoln County Hospital, Lincoln
Anzors Gvaramadze
Anzors Gvaramadze, Lincoln County Hospital, Lincoln
Vivienne Blackhall
Vivienne Blackhall, Gartnavel General Hospital, Glasgow
Background: Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. Methods: STROBE-compliant protocol ascertained CWPF outcomes between March 2011–March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. Results: Across 15 centres, 507 patients with median age (54 years, IQR; 48–62), body mass index (25.4 kg/m2, IQR; 22.5–29), tumour size (26 mm, IQR; 18–35), and specimen weight (62 g, IQR; 40–92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11–39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). Conclusions: This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.
