A comparative study for the rate of adverse outcomes in unilateral and bilateral abdominal flap breast reconstruction

Abstract

Background: Adverse outcomes after unilateral vs bilateral breast reconstruction involve an unknown level of risk that warrants thorough investigation. Methods: To address this research need, PubMed, Ovid, Medline, EMBASE, and Scopus databases were searched through systematically from January 1, 1990, to January 1, 2019 to retrieve the relevant studies on the risk of postoperative complications after unilateral vs bilateral abdominal flap breast reconstruction. According to the pre-designed inclusion criteria, available data were extracted from the relevant studies, and then analyzed comparatively in order to identify the relative risk (RR) and 95% confidence intervals (CI) applying either a random or a fixed effects model. Results: Eventually, 20 studies involving 8122 female subjects met the inclusion criteria. It was found that unilateral reconstruction involved a significantly higher risk of flap loss (RR: 1.56, 95% CI: 1.21–2.00; P < .05) and fat necrosis (RR: 1.60, 95% CI: 1.23–2.09; P < .05) compared to bilateral reconstruction, while bilateral reconstruction involved a greater risk of abdominal hernia/bulge (RR: 1.67, 95% CI: 1.25–2.24; P < .05). The risk was found to be higher following bilateral free transverse rectus abdominis myocutaneous (fTRAM) flaps in comparison with deep inferior epigastric perforator (DIEP) flaps (RR: 2.62, 95% CI: 1.33–5.15; P < .05). Conclusion: The risk of postoperative flap complications in unilateral breast reconstruction is significantly higher than that in bilateral reconstruction. Contrarily, the abdominal complications were significantly higher in the bilateral group vs the unilateral group. Meanwhile, the risk of abdominal hernia/bulge complication after bilateral breast reconstruction was significantly higher with fTRAM vs DIEP. Therefore, DIEP flaps are recommended in priority for bilateral breast reconstruction, unless specifically contraindicated.

Updated Trends and Outcomes in Autologous Breast Reconstruction in the United States, 2016–2019

“…42,43 The study by Bennett et al 44 in 2018 showed that patients who received bilateral reconstructions were at a greater risk of complications. Conversely, we found that bilateral reconstruction was associated with lower odds of experiencing complications, similar to a prior analysis by Cao et al 45 As bilateral mastectomy and reconstruction gain popularity, it is necessary to continue to investigate ways in which this surgery can be made safer for patients in the perioperative and postoperative periods.…”

Predictors of complications in autologous breast reconstruction using deep inferior epigastric perforator flaps: Implications for management

“…However, in a meta-analysis of 8122 patients, unilateral reconstruction was associated with a higher risk of flap loss (relative risk, 1.56; P < 0.05). 20 In contrast, Wade et al 18 reported total flap loss was six times greater in bilateral reconstruction (relative risk, 6.4; P = 0.011). Bilateral reconstructions in our cohort were more common in the partial flap loss group (76.5% versus 52.3%; P = 0.081), with a less pronounced difference when comparing total flap loss (66.7% versus 52.7%; P = 0.393).…”

“…Previous studies have been limited by their heterogeneous grouping of reconstruction methods, lack of precise coding of outcomes, and unavailable variables for query. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Informed decisionmaking about breast reconstruction is reportedly low, 23 and more evidence is needed to evaluate the relative risks of comorbidities, body habitus, and cancer-related factors. We performed this institutional analysis to assess risk factors for complications after DIEP breast reconstruction.…”

“…For each additional hour of operative time, the risk of developing a complication increased by 16%. As the variable of operative time was not queried previously, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] this study contributes to the knowledge base for DIEP reconstructions. There may be several explanatory factors for prolonged operative time in certain cases.…”

Long-Term Outcome Analysis and Technical Refinements after Autologous Breast Reconstruction with PAP Flap: What We Have Learnt

“…It is known from a large meta-analysis that bilateral autologous breast reconstruction yields a higher risk for flap loss than unilateral procedures [10], but interestingly a recent meta-analysis on bilateral DIEP-based breast reconstruction found that the unilateral reconstruction yields an overall higher complication risk for flap complications than cases, including both sides [18]. This fact goes against our findings; however, the authors did also find a higher complication rate concerning the donor site in bilateral cases, which is corresponding to our data [18]. Factors that will have an impact here are not only longer operative time, but also the bigger wound area and higher blood loss, aside from patient factors that have to be considered as well [19].…”