Floor plan - 2013 Annual Meeting - American Association for Hand ...

Functional MRI to Evaluate “Sense of Self” Following Deep Inferior Epigastric Perforator Flap
Breast Reconstruction
Institution where the work was prepared: Beth Israel Deaconess Medical Center, Boston, MA, USA
Stephanie A. Caterson, MD; Sharon Fox, BS; Adam M. Tobias; Bernard T. Lee, MD; Beth Israel Deaconess Medical
Center, Harvard Medical School
INTRODUCTION:
Patient satisfaction following breast reconstruction is an integral component in assessing surgical outcomes. In the past, patient questionnaires
have been the mainstay of satisfaction analysis but are limited by patient bias and subjective answers. In this study, we use
functional MRI (fMRI) to identify changes in patterns of brain activation following deep inferior epigastric perforator flap breast reconstructions.
This method objectively evaluates self-recognition, or “sense of self” in a reconstructed breast compared to a natural breast.
METHODS:
Two patient groups were identified. The first group consisted of four patients scheduled for delayed DIEP flap breast reconstruction,
who had undergone a unilateral mastectomy at least two years prior. The second group included four patients who had undergone a
unilateral immediate DIEP breast reconstruction, at least two years prior. Each patient had one unaffected breast, allowing for an internal
control of self-recognition. In a block-design fMRI experiment, patients were cued to alternately touch their natural breast, operative
site, or silicone gel models. Regions of interest (ROIs) defined in the literature as being associated with self-recognition (as opposed
to "other") were mapped to averaged patient data using normalized spatial coordinates. A general linear model examining activity in
each ROI was applied to average data from each patient group. In addition, analyses of variance between the two patient populations
were performed. A questionnaire was administered to all patients at the time of the fMRI.
RESULTS:
ROIs in the right superior frontal gyrus, inferior parietal, and medial frontal lobes were identified as breast self-recognition areas. In the
pre-operative group, the self-recognition ROIs had minimal activity when the mastectomy site was stimulated. In contrast, the normal
breast showed increased activity in these areas, as compared to the mastectomy site. In the post-operative group, DIEP flap stimulation
was associated with increased activity in the self-recognition ROIs, and was remarkably similar to the natural breast fMRI signals.
Questionnaire results were examined and found to be consistent with favorable patient satisfaction.
CONCLUSIONS:
Two years following unilateral breast reconstruction with DIEP flap, patients demonstrate an association of the reconstructed breast with
self-recognition regions that are also active upon stimulation of the natural breast. These same areas are not active when the pre-operative
mastectomy site was stimulated. This study provides objective evidence that supports an association of DIEP flap breast reconstruction
with "self". Autologous reconstructions can improve patient satisfaction when compared to no reconstruction.
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