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Comprehensive Analysis of Donor-Site Morbidity in Abdominally Based Free Flap Breast Reconstruction

Chang, Edward I. M.D.; Chang, Eric I. M.D.; Soto-Miranda, Miguel A. M.D.; Zhang, Hong Ph.D.; Nosrati, Naveed M.D.; Robb, Geoffrey L. M.D.; Chang, David W. M.D.

doi: 10.1097/PRS.0b013e3182a805a3
Breast: Original Article

Background: This study aimed to provide a comprehensive analysis of factors that might contribute to abdominal donor-site morbidity after abdominally based free flap breast reconstruction.

Methods: The authors performed a retrospective analysis of all abdominally based free flap breast reconstructions performed from January of 2000 through December of 2010 at their institution.

Results: Overall, 89 of 1507 patients developed an abdominal bulge/hernia (unilateral: 57 of 1044; bilateral: 32 of 463). A unilateral transverse rectus abdominis musculocutaneous (TRAM) flap was significantly more likely to develop an abdominal bulge/hernia than was a muscle-sparing TRAM flap or a deep inferior epigastric perforator (DIEP) flap (9.9 percent versus 3.7 percent versus 5.9 percent; p = 0.004). However, there was no difference in the risk of developing an abdominal bulge/hernia between a muscle-sparing TRAM and a DIEP flap (p = 0.36). Patients who underwent bilateral reconstructions were 1.35 times more likely to develop an abdominal bulge/hernia than patients who underwent unilateral reconstruction, but the difference was not significant. Harvesting more fascia as occurs when both medial and lateral rows are used was significantly associated with need for mesh (p < 0.0001). Overall, placement of mesh for fascia closure reduced the odds of occurrence of bulge/hernia by 70 percent compared with primary fascia closure.

Conclusions: There was no significant difference in the risk of developing abdominal bulge/hernia between bilateral versus unilateral breast reconstruction. For abdominally based free flap breast reconstruction, the extent of the fascia harvested, how it is repaired, and the amount of muscle preserved might play an important role in donor-site morbidity.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Houston, Texas

From the Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center.

Received for publication May 1, 2013; accepted July 2, 2013.

Presented at the 92nd Annual Meeting of American Association of Plastic Surgeons, April 20 through 23, 2013, in New Orleans, Louisiana.

Disclosure: The authors have no financial disclosures related to the data presented in this study.

Edward I. Chang, M.D., Department of Plastic and Reconstructive Surgery, University of Texas M. D. Anderson Cancer Center, 1400 Pressler Street, FCT 19.5000, Houston, Texas 77030, eichang@mdanderson.org

©2013American Society of Plastic Surgeons