Skin Color Match in Autologous Breast Reconstruction: Which Donor Site Gives the Best Result?

Background: Color match of a reconstructed breast with the surrounding area is of importance for the overall aesthetic result. The objective of the authors' study was to quantify the degree of color match achieved with different autologous breast reconstructions and to analyze the changes in color over time by analyzing digital photographs.

Methods: A total of 193 patients who underwent a delayed autologous breast reconstruction (deep inferior epigastric perforator [DIEP], profunda artery perforator [PAP], lumbar artery perforator [LAP], latissimus dorsi [LD]) were included. Standardized photographs from 242 flaps at 3 months and 9 to 12 months postoperatively were analyzed, and the L*a*b* values and delta E2000 (dE) values were determined to qualify the color match. The Kruskal-Wallis and Wilcoxon rank sum tests were used for statistical analysis.

Results: Initially, DIEP flaps had a significant lower dE value compared with LD ( P = 0.012) and PAP flaps ( P < 0.001), when compared with the natural breast. PAP flaps showed a significant decrease after 9 to 12 months ( P = 0.003). Perception of color match was comparable in all flaps. Compared with the cleavage, at late follow-up, DIEP flaps had a significant higher dE value compared with LD ( P = 0.017) and PAP flaps ( P < 0.001). PAP flaps presented a significant decrease of dE after 9 to 12 months ( P = 0.031). Abdominal skin presented no better skin color match in patients with PAP, LD, and LAP flaps.

Conclusions: All analyzed flaps had a comparable color match with the surrounding tissue and with the contralateral breast approximately 1 year after surgery. The color of PAP flaps changes more, which leads to an improvement at a later follow-up.

Clinical Question/level Of Evidence: Therapeutic, III.