Bilateral Breast Reconstruction with Abdominal Free Flaps: A Single Centre, Single Surgeon Retrospective Review of 55 Consecutive Patients

Abstract

Breast reconstruction using free tissue transfer is an increasingly utilised oncoplastic procedure. The aim was to review all bilateral breast reconstructions using abdominal free flaps by a single surgeon over an 11-year period (2003–2014). A retrospective review was performed on all patients who underwent bilateral breast reconstruction using abdominal free flaps between 2003 and 2014 by the senior author (DAM). Data analysed included patient demographics, indication for reconstruction, surgical details, and complications. Fifty-five female patients (mean 48.6 years [24–71 years]) had bilateral breast reconstruction. The majority (41, 74.5%) underwent immediate reconstruction and DIEP flaps were utilised on 41 (74.5%) occasions. Major surgical complications occurred in 6 (10.9%) patients, all of which were postoperative vascular compromise of the flap. Failure to salvage the reconstruction occurred on 3 (5.5%) occasions resulting in a total flap failure rate of 2.7%. Obesity (>30 kg/m2) and age > 60 years were shown to have a statistically increased risk of developing postoperative complications (P < 0.05). Our experience demonstrates that abdominal free flaps for bilateral breast reconstruction fares well, with a flap failure rate of 2.7%. Increased body mass index and patient age (>60 years) were associated with higher complication rates.

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

“…This fairly high complication rate is comparable to those reported in other large studies of DIEP flap breast reconstruction. [31][32][33][34][35][36] Comparing our data to national datasets reveals comparable rates of postoperative hematoma and suggests similar rates of any immediate postoperative complications. 35,36 Fat necrosis is the most common complication in our cohort, affecting 13.6% of patients with prior abdominal surgery and 11.7% of patients with no prior abdominal surgery.…”

Interdisciplinary Treatment of Breast Cancer After Mastectomy With Autologous Breast Reconstruction Using Abdominal Free Flaps in a University Teaching Hospital—A Standardized and Safe Procedure

“…Although other risk factors, such as radiotherapy or obesity, are discussed in the literature, we could not prove an influence of previous radiation therapy or a BMI of >30 kg/m 2 on vesselassociated complications (32)(33)(34)(35). Furthermore, flap failure was not associated with venous thrombosis underlining the superiority of venous coupler systems compared to handsewn anastomoses (23,30,36).…”

Risk factors and timing of postoperative hematomas following microvascular breast reconstruction: A prospective cohort study

“…Microsurgical free tissue transfer is currently the gold standard after mastectomy for breast reconstruction. While risk factors, such as smoking and complications of free-flap operations including seroma formation, necrosis of tissue, and flap failure, have been documented and studied (Drazan et al, 2008;Duraes et al, 2015;Guerra et al, 2004;Hofer et al, 2007;McAllister et al, 2016;Rao, Parikh, Goldstein, & Nahabedian, 2010;Schaverien et al, 2011;Scheer et al, 2006), there is a lack of clinical data in the medical literature present analyzing factors that contribute to hematoma formation. The incidence of postoperative hematomas has been reported up to 9.4% (Scheer et al, 2006).…”

“…However, there are known complications associated with such surgery, including skin and fat necrosis, seroma formation, vascular complications, and flap failure. These have been extensively explored in the literature, with complication rates ranging from 0% to 37.5% reported (McAllister, Teo, Chin, Makubate, & Alexander Munnoch, ). Hematoma developing under the free flap is a specific risk to this surgery, given the nature of the mastectomy defect in immediate reconstructions, the donor and recipient site dissection needed for flap harvest and inset, and the nature of vascular dissection, with the incidence of hematoma formation reported in the range of 1.8–9.4% (Drazan et al, ; Hofer, Damen, Mureau, Rakhorst, & Roche, ; McAllister et al, ; Scheer, Novak, Neligan, & Lipa, ).…”

“…These have been extensively explored in the literature, with complication rates ranging from 0% to 37.5% reported (McAllister, Teo, Chin, Makubate, & Alexander Munnoch, ). Hematoma developing under the free flap is a specific risk to this surgery, given the nature of the mastectomy defect in immediate reconstructions, the donor and recipient site dissection needed for flap harvest and inset, and the nature of vascular dissection, with the incidence of hematoma formation reported in the range of 1.8–9.4% (Drazan et al, ; Hofer, Damen, Mureau, Rakhorst, & Roche, ; McAllister et al, ; Scheer, Novak, Neligan, & Lipa, ). Complications arising from flap hematoma formation can be significant, including requirement for blood transfusion (Ting, Rozen, Le Roux, Ashton, & Garcia‐Tutor, ), return to theater for hematoma evacuation complicating up to 7% of all free flaps (Ahmad, Gerecci, Gonzalez, Peck, & Wax, ; Drazan et al, ; Glass & Nanchahal, ), vascular compromise from compression of the pedicle, flap thrombosis, reduced flap perfusion, and flap compromise, with an incidence of up to 23% reported (Ahmad et al, ; Glass & Nanchahal, ).…”