Peri-Operative Factors in Autologous Breast Reconstruction: A Comparison of Stacked and Extended Abdominal Flap Procedures
Amanda M. Rizzo, BA, Jeffrey Arendash, BS, Nicolas Greige, BS, Evan S. Garfein, MD, Lawrence Draper, MD, J. Alejandro Conejero, MD, Teresa Benacquista, MD, Katie E. Weichman, MD.
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Purpose: Stacked deep inferior epigastric perforator (DIEP) or extended DIEP/ transverse rectus abdominis (TRAM) flaps are possible options where reconstructed breast volume is predicted to be inadequate with standard unilateral flaps. However, there is a paucity of data comparing the two techniques.
Methods: A retrospective review of patients undergoing unilateral breast reconstruction at a single academic center between January 2009 and June 2017 was conducted. Patients were divided into two groups: stacked DIEP or extended DIEP/TRAM. Patient and procedure characteristics, intraoperative parameters, and postoperative complications were collected and analyzed with appropriate bivariate tests comparing groups after assessing for normality of data distribution.
Results: A total of 38 patients were included for analysis (stacked DIEP n=14 (37%), extended DIEP/TRAM n=24 (63%)). Patients were similar in median age and body mass index. Median flap weights were not different between groups (stacked 735.5 [IQR 662-927] grams, extended 694 [IQR 597-835.5] grams; p=0.31). Operative time was significantly different between groups (mean±SD: stacked 505 ± 104 minutes, extended 416 ± 86 minutes; p<0.01), as was length of stay (median [IQR]: stacked 3.5 [3-4] days, extended 5 [4-5] days; p<0.01). When comparing overall complication rates, there was no significant difference between the two groups (stacked 21%, extended 38%; p=0.30). However, when looking at fat necrosis patients undergoing extended flaps trended towards higher incidence at 21% (n=5) as compared to 7.7% (n=1) in stacked group (p=0.39).
Conclusions: Both stacked and extended flaps are acceptable methods of unilateral breast reconstruction; however, patients undergoing reconstruction with stacked flaps may have decreased incidence of fat necrosis while having longer operative times.
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