Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Short-term Adverse Outcome Comparison in Autologous Breast Reconstruction: Latissimus, Free, and TRAM Flaps
Benjamin B. Massenburg, BA, Paymon Sanati-Mehrizy, BA, Michael J. Ingargiola, MD, Jonatan Hernandez Rosa, MD, Peter Taub, MD.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Purpose: There are many options for breast reconstruction following a mastectomy and data on adverse outcomes is greatly needed for both the patient and the care provider. This study aims to identify the incidence and predictors of adverse outcomes in autologous breast reconstruction in order to better inform patients and surgeons when choosing a surgical technique.
Methods: This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and identified each autologous breast reconstruction performed between 2005 and 2012. Of the 8731 autologous breast reconstructions, there were 2083 latissimus dorsi flap procedures, 2339 free flap procedures, and 2494 transverse rectus abdominis myocutaneous flap procedures (TRAM) that met the inclusion criteria. The incidence of complications in each of the three procedures was calculated and compared using chi-squared analysis for binomial categorical variables. Univariate and multivariate logistic regression analyses identified independent risk factors for adverse outcomes in each of the procedures as well as in autologous reconstruction as a whole.
Results: Latissimus flap breast reconstruction had the lowest incidence of total complications (p<0.0001) and free flap breast reconstruction had the highest incidence of total complications (p<0.0001). Free flap procedures also had a significantly higher incidence of superficial surgical site infections, flap failures, bleeding, and unplanned reoperations than either latissimus or TRAM flaps. The incidence of surgical complications in free flaps and TRAM flaps was not significantly different (p=0.1844).
Extended operative time (Odds Ratio[OR]=2.036, p<0.0001), recent surgery (OR=3.506, p<0.0001), obesity (OR=1.586, p=0.0050), smoking (OR=1.795, p=0.0058), and hypertension (OR=1.524, p=0.0130) were independently associated flap failure in all autologous breast reconstruction procedures. Extended operative time (OR=2.097, p<0.0001), obesity (OR=1.546, p<0.0001), ASA class ≥ 3 (OR=1.546, p<0.0001), recent surgery (OR=1.808, p=0.0009), and hypertension (OR=1.201, p=0.0380) were independently associated with total adverse outcomes in all autologous breast reconstruction procedures.
Conclusion: Data acquired from the ACS-NSQIP suggests that latissimus flaps are associated with the least short-term adverse outcomes and free flaps are associated with the most short-term adverse outcomes in autologous breast reconstruction. The identified risk factors will aid in surgical planning and risk adjustment for both the patient and the care provider. Though many other factors will be taken into consideration with surgical planning of autologous breast reconstruction, presence of these identified risk factors may suggest the use of a technique associated with less adverse outcomes, like the latissimus flap.


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