Evidence map›Paper›PMID 39210299›Full record

Observational studyBMC cancer2024

Strategically shifting paradigms: the new era of DIEP flaps with minimally invasive mastectomy: a retrospective cross-sectional study.

Tzu-En Lin, Allen Wei-Jiat Wong, David Chon-Fok Cheong, Wen-Ling Kuo, Hsiu-Pei Tsai, Jung-Ju Huang

Registry-linked trialAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC cancer, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06321549 (Shifting Strategic Approach in Breast Reconstruction Using Free DIEP Flap Along With The Paradigm Shifting of Mastectomy Technique), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06321549 completednot on this map

Shifting Strategic Approach in Breast Reconstruction Using Free DIEP Flap Along With The Paradigm Shifting of Mastectomy Technique

TypeobservationalSponsorChang Gung Memorial HospitalRan2022 to 2023Enrolled278ConditionsBreast Reconstruction, Mastectomy, LymphedemaArmsThe reference point of minimally invasive mastectomy procedure conducted
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Tzu-En LinDivision of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsing St., Kwei-Shan, Taoyuan, Taiwan.
Allen Wei-Jiat WongDivision of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsing St., Kwei-Shan, Taoyuan, Taiwan.
David Chon-Fok CheongDivision of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsing St., Kwei-Shan, Taoyuan, Taiwan.
Wen-Ling KuoCollege of Medicine, Chang Gung University, Taoyuan, Taiwan.
Hsiu-Pei TsaiCollege of Medicine, Chang Gung University, Taoyuan, Taiwan.
Jung-Ju HuangDivision of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsing St., Kwei-Shan, Taoyuan, Taiwan. jungjuhuang@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe free deep inferior epigastric artery perforator (DIEP) flap is the gold standard in autologous breast reconstruction. Asian patients often present with a smaller body mass index with relatively insufficient tissue. To restore appropriate symmetry, a larger flap inset ratio must be transferred. Supercharging of the second vein or inclusion of bilateral pedicle is commonly required. Current paradigm shifts in mastectomy has also resulted in more minimally invasive surgeries (MIS) espousing smaller lateral incisions, leading to a significant change in available recipient vessels. This study aimed to demonstrate our experience in changing strategies of DIEP flaps following the evolution of mastectomy techniques.

methodsBetween October 2008 and March 2022, retrospective data was gathered for 278 patients who underwent breast reconstruction surgery utilizing DIEP flaps by a single plastic surgeon. These patients were divided into two distinct groups based on their operation dates, with November 2018 marking a pivotal moment when the first MIS, including endoscopic-assisted and robot-assisted mastectomy, was introduced.

resultsA total of 278 patients were included. Bipedicle vessel utilization for flap supercharge saw a significant increase (15.9% vs. 7%, p < 0.001), while the use of the superior inferior epigastric vein (SIEV) decreased (5.1% vs. 17.1%, p = 0.01). Preceding MIS, SIEV was the primary choice for flap supercharge (96.0%, p < 0.001), whereas post-introduction, the contralateral DIEP pedicle gained prominence (75.9%, p < 0.001). There was also an increased utilization of thoracodorsal artery and lateral thoracic artery following MIS.

conclusionThese findings underscore the profound impact of MIS on the strategic choices made in DIEP flap-based breast reconstruction.

trial registrationThis study is retrospectively registered on ClinicalTrials.gov (NCT06321549).

Indexed as

Breast NeoplasmsEpigastric ArteriesMammaplastyMastectomyMinimally Invasive Surgical ProceduresPerforator FlapAdultAgedCross-Sectional StudiesFemaleHumansMiddle AgedRetrospective StudiesYoung AdultBreast cancerBreast reconstructionDIEPMicrosurgeryMinimally invasive mastectomy

Identifiers

PMID39210299
PMCPMC11363413

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.