Suspension of the aging face with barbed sutures offers the promise of a minimally invasive technique with diminished adverse events. The technique is in its infancy, but it has potential to be a useful and effective clinical tool as further innovations are made in the clinic and laboratory.
Patients who underwent delayed abdominal free flap breast reconstruction after 12 months from the completion of postmastectomy radiation therapy developed fewer complications, including microvascular thrombosis and total flap loss, than those who underwent delayed abdominal free flap breast reconstruction within 12 months of completing postmastectomy radiation therapy. Allowing an interval of 12 months between the completion of postmastectomy radiation therapy and delayed abdominal free flap breast reconstruction will likely minimize complications and optimize outcomes in free flap breast reconstruction in patients receiving postmastectomy radiation.
BACKGROUND
We hypothesized that for obese patients, abdominal-based free flap, rather than implant-based, and delayed, rather than immediate, breast reconstruction would result in fewer overall complications and reconstruction losses.
METHODS
We retrospectively analyzed consecutive implant- and abdominal-based free-flap breast reconstructions performed in obese patients between 2005 and 2010 utilizing the World Health Organization obesity classifications: class I (30.0–34.9 kg/m2), class II (35.0–39.9 kg/m2), and class III (≥40 kg/m2). Primary outcome measures included flap failures and overall complications. Logistic regression analysis identified associations between patient, defect, and reconstructive characteristics and surgical outcomes.
RESULTS
The analysis included 990 breast reconstructions (548 flaps vs. 442 implants) in 700 patients. Mean follow-up was 17 months. Age (p<0.01), smoking (p=0.02), medical illness (p=0.01), and BMI>37 (p=0.01) predicted overall complications on regression analysis. Implants demonstrated a higher failure rate (15.8%) than flaps (1.5%; p<0.001). While failure rates were similar for immediate and delayed flap reconstructions overall (1.3% vs. 1.9%; p=0.7) and among obesity classifications, there was a trend toward more implant failures in immediate rather than delayed reconstructions (16.8% vs. 5.3%; p=0.06). Differences between immediate implant versus flap reconstruction failure rates were highest among more obese patients (class II [24.7% vs. 1.3%, respectively; p<0.01] and class III [25.4% vs. 0%, respectively; p<0.01] compared to class I [11.7% vs. 1.4%, respectively; p<0.01]).
CONCLUSIONS
Obese patients, particularly patients with class II and III obesity, experience higher failure rates with implant-based breast reconstruction, particularly immediate reconstruction. Free flap techniques or delayed implant reconstruction may be warranted in this population.
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