We conducted an anonymous survey among Plastic Surgeons in our country consisting of 11 multiple-choice questions sent by e-mail to each participant. Questionnaire made emphasis on preferred reconstructive timing, technique and work setting(Table 1). A statistical analysis was performed using Student t-test. A p value of <0.05 was set for statistical significance.
From a total of 725 surgeons invited to participate, 222 confirmed to perform BR surgeries on their regular practice and participated in the survey. Most of them performed less than 25 breast reconstructions per year. Seventy one percent of them work in a private non-academic setting(p<0.05), while those who execute between 75-100 or >100 BR surgeries per-year work in an academic either public or private setting.
Most respondents(79.3%) reported performing implant-based reconstructions as the most frequent technique. Autologous reconstruction was performed considerably more often in public hospitals. Pedicled latissimus dorsi flap was reported as the most commonly performed autologous breast reconstruction technique, followed in frequency by pedicled TRAM flap. Just 5.95% of the surgeons reported performing DIEP flap as their preferred autologous reconstruction technique. When asked which was the most common type of flap performed during autologous breast reconstruction, most surgeons responded that they only performed pedicled flaps.
Delayed BR was the most common scenario reported by the participants. Immediate implant-based reconstruction was reported to be the dominant set-up in 26% of the reconstructions while immediate autologous BR was reported in 6.76% of them.
Nearly 90% of the survey respondents use lipofilling as a complement to implant-based BR. Only 11.5% of the surgeons performing prosthetic reconstructions use a mesh during the reconstruction, with polypropylene most commonly used than polyglactin.
In conclusion we can observe a clear predominance of implant-based reconstruction. This tendency seems to have several explanations. First of all there has been a rise in the detection of early stage breast cancer in young women, many of whom don’t have enough adipose tissue deposits to be candidates for an autologous BR. Secondly, many women prefer to avoid long recovery and morbidity of the donor site required for autologous reconstruction, preferring to rapidly return to their daily activities. Moreover, the rise in genetic testing to detect BRCA mutations has raised the implementation of bilateral risk-reducing mastectomies and patients demand on implant based reconstruction. Cultural reasons may also explain this phenomenon; in Argentina many middle-aged women with ptotic breast prefer implant-based reconstruction to achieve a firmer and fuller breast.
The availability of operating rooms is another critical factor in preferring implant-based over autologous BR that usually involves a longer surgery.
The small number of microsurgical reconstructions may be explained by the lack of microsurgery training programs in Argentina and Latin America. On the other hand the need of expensive surgical instruments, like microscopes, hinders the application of these reconstructive resources in our country.