Background: Nowadays, multimodal cancer therapy results in very high survival rates of early-stage breast cancer and microsurgical flap-based breast reconstruction has become safe and reliable, with gradually increasing demand because of its durable and aesthetically pleasing results. This study aimed to explore the impact of different flap shaping and inset techniques on patient-reported outcome measures (PROMs) with regard to the aesthetic result in abdominal flap-based breast reconstruction. Methods: A systematic review was performed screening Pubmed, Cochrane Library and Web of Science for original articles reporting flap inset strategies, concomitantly providing PROMs on the aesthetic result. Results: Of 319 studies identified, six met the inclusion criteria. The studies described different flap rotation options according to the patient’s morphology, different inset planes, and avoidance of the monitoring skin paddle, and suggested that a higher flap-to-mastectomy mass ratio was associated with better aesthetic results. In two comparative studies, according to the PROMs (BREAST-Q, Likert scale) and independent observer judgement, both higher patient satisfaction and superior aesthetic results were observed with the newly described techniques. Conclusions: Emphasis on the aesthetic outcome in terms of breast shape and symmetry, providing an individualized approach of flap inset, considering the contralateral breast’s shape and volume, results in higher satisfaction scores.

中文翻译：

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基于腹部的游离皮瓣乳房再造术的插入和成形对患者报告的美学结果评分的影响——系统评价

背景：如今，多模式癌症治疗使早期乳腺癌的生存率非常高，基于显微外科皮瓣的乳房再造已变得安全可靠，因其持久且美观的效果而需求逐渐增加。本研究旨在探讨不同皮瓣成形和插入技术对基于腹部皮瓣的乳房重建美学结果的患者报告结果测量（PROM）的影响。方法：对 Pubmed、Cochrane 图书馆和 Web of Science 进行系统评价，筛选报道皮瓣插入策略的原始文章，同时提供有关美学结果的 PROM。结果：在确定的 319 项研究中，有 6 项符合纳入标准。研究根据患者的形态、不同的插入平面以及避免监测皮肤桨描述了不同的皮瓣旋转选项，并表明较高的皮瓣与乳房切除术质量比与更好的美学效果相关。在两项比较研究中，根据 PROM（BREAST-Q、李克特量表）和独立观察者的判断，使用新描述的技术观察到更高的患者满意度和更好的美学效果。结论：强调乳房形状和对称性方面的美学效果，考虑对侧乳房的形状和体积，提供个性化的皮瓣插入方法，可以获得更高的满意度。