Assessment of local tissue water in breasts following breast reconstruction with an expander prosthesis or DIEP flap

Figures & data

Table 1. Patient characteristics, treatment factors and times to follow-up listed for all patients (n = 68) and by breast reconstruction method (EP n = 27 and DIEP flap n = 41).

	All patients	EP	DIEP flap	p Value^a
Mean ± SD (range)
Age (years)	54 ± 9.4	56 ± 9.0	53 ± 9.5	0.26
BMI (kg/m^2)	26 ± 3.8	25 ± 2.9	26 ± 2.7	0.37
Volume breast (ml)
RB	474 ± 180	414 ± 139	514 ± 195	0.02
CB	489 ± 186	448 ± 163	517 ± 196	0.14
Arm lymphoedema	7 (10.3%)	1 (3.7%)	6 (14.6%)	0.23^c
Treatment factors
Chemotherapy	39 (57.4%)	13 (48.1%)	26 (63.4%)	0.21^b
Endocrine therapy	47 (69.1%)	19 (70.4%)	28 (68.3%)	0.86^b
Immune therapy	11(16.2%)	4 (14.8%)	7 (17.1%)	0.81^b
Axillary operation
ALND	16 (23.5%)	3 (11.1%)	13 (31.7%)	0.06^a
SLNB	51 (75%)	23 (85.2%)	28 (68.3%)
No	1 (1.5%)	1 (3.7%)	0
Time to follow-up (months)
Breast reconstruction to follow-up	25 ± 9.5	25 ± 10	25 ± 9.3	0.95
	(11–56)	(12–56)	(11–50)
Contralateral surgery to follow-up	18 ± 8.1	15 ± 5.0	21 ± 9.5	0.06
	(2–36)	(4–25)	(2–36)
Breast reconstruction to completed BREAST-Q	25 ± 10	26 ± 11	24 ± 9.3	0.42
	(8–55)	(11–55)	(8–50)

^aStudent’s t-test.

^bChi²-test.

^cFisher’s exact test.

SD: Standard deviation; BMI: Body mass index; EP: Expander prosthesis; DIEP: Deep inferior epigastric perforator; RB: Reconstructed breast; CB: Contralateral breast; ALND: Axillary lymph node dissection; SLNB: Sentinel lymph node biopsy.

p Values < 0.05 were considered significant and is in bold.

Table 2. Comparisons of absolute TDC values and ratios in breasts reconstructed with EP or DIEP flaps, among all patients and in groups by prevalence of contralateral surgery.

	Absolute values			Ratios (reconstructed/contralateral breast)
	EP	DIEP flap	p Value^a	EP	DIEP flap	p Value^a
TDC Median (1q, 3q)
All reconstructed breasts n = 68	27	41		27	41
Mean value quadrants	29.3 (25.5, 31.3)	28.6 (26.0, 31.4)	0.78	1.13 (1.06, 1.19)	1.09 (1.03, 1.15)	0.26
Patients with non-operated contralateral breasts n = 37	12	25		12	25
Mean value quadrants	29.5 (27.4, 32.9)	28.7 (27.4, 30.7)	0.43	1.16 (1.04, 1.27)	1.07 (1.07, 1.16)	0.19
Patients with contralateral surgery n = 31  (reduction/mastopexy)	15 (9/6^b)	16 (15/1)		15 (9/6^b)	16 (15/1)
Mean value quadrants	27.4 (23.7, 31.2)	27.8 (25.6, 43.2)	0.24	1.09 (1.09, 1.17)	1.11 (1.11, 1.14)	0.87

^aMann–Whitney U-test.

^bOne patient had a breast augmentation two years after mastopexy in the contralateral breast.

TDC: Tissue dialectic constant; 1q: Lower quartile; 3q: Upper quartile; EP: Expander prosthesis; DIEP: Deep inferior epigastric perforator.

Table 3. Comparisons of absolute TDC values in reconstructed breasts and non-operated contralateral breasts.

	Reconstructed breast	Non-operated contralateral breast	p Value^a
TDC Median (1q, 3q)
EP and DIEP flap, n			37
Mean value quadrants	28.9 (27.5, 30.8)	26.5 (25.1, 28.4)	<0.01
EP, n			12
Mean value quadrants	29.5 (27.4, 32.9)	26.4 (25.1, 28.9)	<0.01
DIEP flap, n			25
Mean value quadrants	28.7 (27.4, 30.7)	26.5 (25.1, 28.2)	<0.01

^aWilcoxon signed-rank test.

TDC: Tissue dialectic constant; 1q: Lower quartile; 3q: Upper quartile; EP: Expander prosthesis; DIEP: Deep inferior epigastric perforator.

p-values < 0.05 were considered significant and are in bold.

Table 4. Comparisons of absolute TDC values in reconstructed breasts and operated contralateral breasts.

	Reconstructed breast	Operated contralateral breast	p Value^a
TDC Median (1q, 3q)
EP and DIEP flap, n			31
Mean value quadrants	27.4 (24.8, 31.9)	25.9 (23.4, 29.3)	<0.01
EP, n			15^b
Mean value quadrants	27.4 (23.7, 31.2)	25.6 (23.4, 27.7)	0.06
DIEP flap, n			16
Mean value quadrants	27.8 (25.6, 34.2)	26.7 (22.9, 29.6)	<0.01

^aWilcoxon signed-rank test.

^bOne patient had a breast augmentation two years after mastopexy in the contralateral breast.

Abbreviations: TDC: Tissue dialectic constant; 1q: Lower quartile; 3q: Upper quartile; EP: Expander prosthesis; DIEP: Deep inferior epigastric perforator.

p-values <0.05 were considered significant and are in bold.

Table 5. Comparisons of absolute TDC values in reconstructed breasts and contralateral breasts after reduction mammaplasty or mastopexy.

	Reconstructed breast	Reduction mammaplasty	p Value^a	Reconstructed breast	Mastopexy	p Value^a
TDC Median (1q, 3q)
EP and DIEP flap, n			24			7
Mean value quadrants	27.8 (25.6, 33.0)	26.1 (23.4, 29.2)	<0.01	24.8 (20.4, 31.5)	25.5 (18.3, 30.0)	0.24
EP, n			9			6^b
Mean value quadrants	27.4 (24.6, 30.6)	25.9 (23.7, 27.1)	0.14	27.3 (20.0, 32.3)	25.6 (19.9, 30.8)	0.25
DIEP flap, n			15			1
Mean value quadrants	28.2 (25.7, 34.3)	27.5 (22.7, 29.6)	<0.01	24.8 (24.8, 24.8)	24.8 (24.8, 24.8)

^aWilcoxon signed-rank test.

^bOne patient had a breast augmentation two years after mastopexy in the contralateral breast.

Abbreviations: TDC: Tissue dialectic constant; 1q: Lower quartile; 3q: Upper quartile; EP: Expander prosthesis; DIEP: Deep inferior epigastric perforator.

p-values <0.05 were considered significant and are bolded.

Table 6. Comparison of pre- and postoperative BREAST-Q responses regarding questions comprising breast oedema-related symptoms for all patients (n = 68) and by breast reconstruction method (EP n = 27 and DIEP flap n = 41).

Median (1q, 3q)	All patients			EP			DIEP flap
	Preop	Postop	p Value^a	Preop	Postop	p Value^a	Preop	Postop	p Value^a
Question 3/6.i “Tightness in your breast area?”	1 (1, 2)	2 (1, 2)	0.83	2 (1, 3)	2 (1, 2)	0.81	1 (1, 2)	1 (1, 2)	0.45
Question 3/6.j “Pulling in your breast area?”	2 (1, 2)	1 (1, 2)	0.12	2 (1, 3)	2 (1, 2)	0.08	2 (1, 2)	1 (1, 2)	0.46
Question 3/6.k “Nagging feeling in your breast area?”	1 (1, 1)	1 (1, 2)	0.04	1 (1, 2)	1 (1, 2)	0.74	1 (1, 1)	1 (1, 2)	0.01
Question 3/6.l “Tenderness in your breast area?”	1 (1, 2)	1 (1, 2)	0.56	1 (1, 2)	1 (1, 2)	0.87	1 (1, 2)	1 (1, 2)	0.21
Question 3/6.m “Sharp pains in your breast area?”	1 (1, 1)	1 (1, 1)	0.25	1 (1, 1)	1 (1, 1)	0.91	1 (1, 1)	1 (1, 1)	0.10
Question 3/6.o “Aching feeling in your breast area?”	1 (1, 1)	1 (1, 1)	0.93	1 (1, 2)	1 (1, 1)	0.36	1 (1, 1)	1 (1, 1)	0.10
Question 3/6.p “Throbbing feeling in your breast area?”	1 (1, 1)	1 (1, 1)	0.21	1 (1, 1)	1 (1, 1)	0.23	1 (1, 1)	1 (1, 1)	0.52

The questions belong to the BREAST-Q Reconstruction Preoperative (question 3) and Postoperative (question 6) Module Version 1.0 and are preceded by ‘In the past two weeks, how often have you experienced:’ The response options range from 1–5 where 1 corresponds to ‘None of the time’ and 5 to ‘All of the time’.

^aWilcoxon signed-rank test.

1q: Lower quartile; 3q: Upper quartile; EP: Expander prosthesis; DIEP: Deep inferior epigastric perforator.

p-values <0.05 were considered significant and are bolded.