Abdominal Flap-based Breast Reconstruction versus Abdominoplasty: The Impact of Surgical Procedure on Scar Location.

[BACKGROUND] Autologous breast reconstruction has been demonstrated to be associated with superior patient-reported outcomes, and hence is regarded as the gold standard reconstructive modality. A common drawback of this procedure, however, is related to a high abdominal scar. Recently, hybrid breast reconstruction (ie, the combination of autologous and implant-based reconstruction) was presented as an approach that would combine the benefits of both reconstructive modalities. In this study, we sought to assess abdominal aesthetic outcomes associated with this approach.

[METHODS] Thirty-two blinded reviewers evaluated standardized pre- and postoperative abdominal images of patients following autologous reconstruction with free abdominal flap (Group 1; N = 10), hybrid reconstruction (Group 2; N = 5), and abdominoplasty (Group 3; N = 10). Aesthetic abdominal appearance, including overall result, scar position, skin redundancy, and lateral abdominal contour, was rated on a 5-point Likert scale and a comparative analysis was performed.

[RESULTS] Hybrid reconstruction was associated with significantly lower abdominal scars compared with Group 1 ( = 0.01), nearing results of patients in Group 3 ( = 0.39). Significantly higher aesthetic ratings were ascribed to Groups 2 and 3 when compared with Group 1 ( < 0.001) with regard to scar positioning ( < 0.001), skin redundancy ( < 0.001), and lateral abdominal contour ( < 0.001). No significant difference in aesthetic ratings was noted between Groups 2 and 3.

[CONCLUSIONS] When applied to the appropriate patient population, hybrid breast reconstruction is a powerful method to achieve reconstructive goals while optimizing abdominal aesthetics. A significantly lower scar position was noted and higher abdominal aesthetic ratings were given following abdominoplasty and hybrid reconstruction compared with conventional abdominal flap-based reconstruction.