A single center prospective study of bilateral breast reconstruction with free abdominal flaps: A critical analyses of 144 patients

Abstract

BackgroundBilateral breast reconstruction utilising autologous free tissue transfer is a complex procedure with multiple options for donor tissue available. Autogenous breast reconstruction techniques have evolved over the last three decades to meet this goal. The aim of this study was to determine the outcomes of patients undergoing bilateral breast reconstruction with DIEAP, TRAM or SIEA flaps.Material/MethodsA prospective study was performed in our Interdisciplinary Breast Centre from July 2004 until December 2011 in 144 patients. Demographic information, diabetes mellitus type I status, tobacco use, tumor stage, primary/secondary reconstruction, operative technique, adjuvant therapy received, length of follow-up, and complications were evaluated. Complications were divided into donor site and recipient site. To investigate which risk factors were independently related to flap loss (complete or partial), multiple linear regression analysis was performed.ResultsThe study identified 144 patients who had bilateral breast reconstruction with DIEAP, TRAM or SIEA flaps. For all flaps (n=248), outcome included 98.4% survival and 0.7% vein microanastomosis revision. Recipient site complications included 1.6% complete flap loss, 0.8% fat necrosis, 2.9% partial skin loss/dehiscence flap necrosis and 2.0% haematoma rate. Donor site complications included 3.7% partial skin loss/dehiscence. There was evidence of abdominal bulges in TRAM patients (1.1%) but no hernias in any patients. BMI is a major determinant of flap loss (complete or partial) in these patients.ConclusionsThe primary goal of bilateral breast reconstruction is to provide a treatment option that can create a natural, symmetric breast mounds with minimal donor-site morbidity following bilateral mastectomies. These results support weight loss therapy prior to bilateral breast reconstruction.

A comparative study for the rate of adverse outcomes in unilateral and bilateral abdominal flap breast reconstruction

“…[ 43 , 44 ] The increase in demand for bilateral breast reconstruction has been facilitated by improved genetic testing, as well as surgical and reconstruction techniques and outcomes. [ 45 – 49 ] However, the studies evaluating the risk of postoperative complications after unilateral vs bilateral breast reconstruction are controversial, especially in terms of complication percentage. The present meta-analysis further evaluated the risk of adverse outcomes after unilateral vs bilateral breast reconstruction.…”

Fibrin glue as a protective tool for microanastomoses in limb reconstructive surgery

“…In breast reconstruction, fibrin glue is routinely used. It helped to reduce flap losses to less than 1% at one center with over 1,500 DIEP flaps [ 1 ], [ 2 ]. This excellent result is associated with stabilization of the pedicle during the shaping of the breast and its intermittent motion into and out of the breast’s pocket.…”

“…The Breast Center in Duesseldorf, Germany, pioneered the use of fibrin glue in supporting microvascular anastomoses. To date, the Duesseldorf team has sealed microvascular anastomoses in over 1,500 free DIEP flaps [ 1 ], [ 2 ], [ 3 ], [ 4 ]. The fibrin glue plug is one major factor contributing to a very low complication rate and flap losses of less than 1% [ 4 ].…”

Low-intensity pulsed ultrasound stimulation in different regions in the viability of myocutaneous flaps

“…Silicone implants, deep inferior epigastric perforator, and transverse rectus abdominis myocutaneous flaps are used for reconstruction of the breast tissue. Silicone-gel prosthesis is a popular option which is naturally associated with shorter surgery time and shorter hospital stays as the use of autologous tissues allows more natural and apoptotic breast cells to grow, with the breast tissue becoming less edematous and smoother as the patient ages [ 1 , 2 ].…”