Loai Abdullah Alsalmi is associated with King Fahad Medical City, Saudi Arabia. He completed his Hand and Microsurgery Fellowship from the University of Texas Southwestern Medical School and University of Pennsylvania. He has completed his Experimental Surgery Fellowship from Mc Gill University. He has completed his bachelor of medicine and surgery from King Saud University.

Objectives: Reviewing patient satisfaction and quality of life following post-mastectomy breast reconstruction in breast cancer patients of the Middle East.

Methods: Retrospective study of 68 patients of postmastectomy who underwent free flap based breast reconstruction with a mean follow up of 6 months were studied over a period of 5½ years (between July 2012 to December 2017).Patients collected data included age at the time of reconstruction, any comorbid illness, contraindication for surgery, whether or not chests were irradiated post-mastectomy. The specific preoperative investigation included CT angiography of the abdominal wall for proper localization of the skin perforators. All of the breasts were reconstructed by standard methods of microsurgical free flap breast flap reconstruction based on Inferior epigastric artery vascular pedicle (Deep and Superficial). A questionnaire was developed for the postoperative patients in order to assess their satisfaction grades and the scores were calculated at successive followups in the clinics.

Results: A total of 67 patients of post-mastectomy females attended our clinic for breast reconstruction. Most of the patients (97.3%) were in the age group of 29-53 years with the mean age of 45.5 years. Rightsided mastectomy (57%) was more common than left and bilateral cases accounted for 6%. Delayed reconstruction was done in 68% of patients and the rest underwent primary reconstruction at the time of mastectomy. Average BMI at reconstruction in most females was 30.1. CT angio demonstrated two ideal medial perforators in 59% of cases whereas single ideal perforator was noted in 32% of patients. Free deep inferior epigastric artery perforator flap was performed in majority 94% of the patients whereas rest underwent reconstruction by superficial inferior epigastric artery flap. Mean operative time was 4.5 hours. Most of the patients tolerated the procedure well and were usually discharged on 3rd postoperative day. Complications occurred in 6.4% of patients and the most common immediate complication included partial abdominal wound dehiscence (2.3%) and late included fat necrosis seen in 2.8%. Only 2 total flap losses were noted. On follow up examination, the patients reported overall satisfaction rates of 92% on long term examinations. At the time of completion of this study, 30% of patients had completed nipple reconstruction on their reconstructed breasts.

Conclusion: Breast cancer is one of leading cancers in women of the Middle East. Early diagnosis and treatment has improved the cure rates considerably. With the availability of “state of the art” microsurgical breast reconstruction, in properly selected patients, the quality of life and satisfaction rates are high and free flap breast reconstruction has proven to be the standard of care in post mastectomy patient population.