Plastic Surgery Research Council
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Presenter: Edward I Chang, MD
Co-Authors: Chang EI; Soto-Miranda MA; Zhang T; Nasrati N; Kronowitz SJ; Butler CE; Chang DW
MD Anderson Cancer Center

Abstract Introduction: A number of factors contribute to abdominal donor site morbidity following free flap breast reconstruction. Our study aims to provide a comprehensive analysis and propose an algorithm for management.

Methods: Retrospective analysis of all free flap breast reconstructions from January 2000-December 2010 at our institution.

Results: Overall 87 of 1507 patients developed an abdominal bulge/hernia (unilateral: 59/1000 vs. bilateral: 28/507). Patients undergoing bilateral free flap reconstruction were 42% more likely to develop an abdominal complication. Placement of mesh reduced bulge/hernia rates by nearly 85% (p=0.001), and primary closure was 3.34 times more likely to result in a hernia/bulge (p=0.004). Patients undergoing bilateral free flaps were significantly more likely to have mesh placed (p=0.0002), and were more likely to require a reoperation for a bulge/hernia (p=0.009). Subgroup analysis of flap type and perforator distribution also had a significant impact on abdominal complications. Bilateral TRAMs had the highest incidence of abdominal complications requiring reoperation; however, bilateral flaps harvested on both rows of perforators also had a significant risk of developing a bulge/hernia compared to unilateral single row flaps (p=0.02) or unilateral both rows (0=0.007). When compared to other bilateral flaps, single row bilateral flaps were significantly less likely to have a bulge (0=0.05); however, if one flap incorporated both rows, the difference was no longer significant.

Conclusion: Patients undergoing bilateral breast reconstruction should have both flaps harvested on a single row of perforators; however, if both rows are necessary, there should be a low threshold for placement of mesh.

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