A comparison of reconstructive outcomes following rotation flap approach (RoFA) versus standard mastectomy: a randomized controlled trial

• Published in: ANZ journal of surgery 2023-01, Vol.93 (1-2), p.263-269
• Main Authors: Baxter, Claire R., Crittenden, Tamara A., Yip, Jia Miin, Smallman, Andrea, Dean, Nicola R.
• Format: Article
• Language: English
• Subjects: Aesthetics; Breast; Breast Neoplasms - surgery; breast reconstruction; Complications; Female; Humans; Imports; Mammaplasty - methods; Mastectomy; Mastectomy - methods; Necrosis; Patient satisfaction; Postoperative Complications; Prospective Studies; Quality of Life; Rotation; Skin; Statistical analysis; Surgical Flaps; Surgical Wound; Vascular Diseases
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.18167

Background The rotation flap approach (RoFA) mastectomy is a skin‐sparing technique that actively imports skin to the centre of the skin envelope and therefore aids in achieving natural ptosis to the reconstructed breast. The objective of this study was to compare clinical outcomes, aesthetics, patient satisfaction and health‐related quality of life between the ROFA mastectomy and standard mastectomy approach. Methods This study is a prospective randomised controlled trial of participants undergoing mastectomy using either the RoFA technique or standard technique with breast reconstruction. The BREAST‐Q was administered pre‐operatively and at 3‐, 6‐, 9‐ and 12‐months following mastectomy. A panel assessment of clinical photographs was conducted to score aesthetics and outcomes of reconstruction. Results A total of 100 participants were enrolled in the study; of these, 51 underwent RoFA incision, 47 underwent standard incision and 2 were lost to follow up. There were no statistically significant differences in BREAST‐Q scores or panellist assessment between the mastectomy groups following breast reconstruction. The post‐operative incidence of mastectomy skin flap tip necrosis was high in the RoFA incision group, with rates of other complications such as seroma being similar. Conclusion The RoFA skin‐sparing mastectomy incision showed no significant difference in results across patient‐reported outcomes or aesthetics when compared to the standard approach, however, did rate higher for skin flap tip necrosis. A comparison of reconstruction outcomes in patients who have undergone either rotation flap approach or standard approach mastectomy by assessing BREAST‐Q scores, panel assessment of aesthetic outcomes and complication rates. The rotation flap approach demonstrated comparable outcomes to the standard mastectomy approach with higher rates of skin flap necrosis.