Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in Women With Previous Abdominal Incisions

Doval, Andres F.; Lamelas, Andreas M.; Daly, Lauren; Tobias, Adam M.; Lin, Samuel J.; Singhal, Dhruv; Dowlatshahi, Arriyan S.; Lee, Bernard T.

doi:10.1097/sap.0000000000001567

Cited by 13 publications

(14 citation statements)

References 20 publications

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“…In logistic regression analysis, we found that only diabetes mellitus was associated with donor-site complication with a statistical significance (P=0.030). In terms of risk factor analysis, Doval et al reported that smoking history and flap weight were independent risk factors for donor-site complications, especially for wound dehiscence (20). Laporta et al also stated that smoking history and obesity (BMI >25.1 kg/m 2 ) were significantly related to donor-site complications (21).…”

Section: Discussionmentioning

confidence: 99%

The effect of previous scar on breast reconstruction using abdominal flap: a retrospective analysis of 122 consecutive cases and a strategy to reduce complication rates

Chung¹,

Yeo²,

Jung³

et al. 2021

Gland Surg

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Background: Free abdominal tissue transfer is considered the gold standard for autologous breast reconstruction. However, many plastic surgeons are concerned about the theoretical risk of flap-related or donor-site complications associated with previous abdominal surgery. Also, studies have reported conflicting results in the literature due to difference in surgical strategies used in each study. This study analyzes the effect of prior incision on the complications and risk factors in our institution.Methods: In this retrospective cohort study, we analyzed a total of 122 patients who had undergone reconstructive surgery between March 2012 and February 2019. To assess the effect of prior incision, we divided all patients into a scar group (n=59) and a control group (n=63). Based on our operative approach, patient demographics and postoperative complications were analyzed.Results: No significant differences were found between patients in the scar group and the control group in flap-related (13.3% vs. 16.4%, P=0.62) and donor-site complications (31.7% vs. 31.4%, P=0.67). In binary logistic regression modeling, only diabetes mellitus was significantly related with donor-site complications (P=0.030).Conclusions: This result suggested that previous abdominal scars are no longer a reluctant factor for breast reconstruction using an abdominal flap, when an appropriate flap design was used and the surgical techniques were tailored to each scar. In patients with vertical midline or subcostal scar, it requires careful preoperative planning with CT angiography and attentive follow-up are needed.

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Section: Discussionmentioning

confidence: 99%

The effect of previous scar on breast reconstruction using abdominal flap: a retrospective analysis of 122 consecutive cases and a strategy to reduce complication rates

Chung¹,

Yeo²,

Jung³

et al. 2021

Gland Surg

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“…Overall, the mean age for patients included in this analysis was 49.6 (range of means is 42 to 57.2) from 11 articles, excluding two which covered redundant patient databases 22,41 and one article that presented data by flap numbers rather than by patient (►Table 2). 29 In three of these articles, the average age of the patients with abdominal scarring was significantly higher than the control group: Roostaeian et al (51.2 vs. 48.6), 36 Wes et al (50.9 vs. 49.5), 15 and Henry et al (51 vs. 44).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…36,38,42,43 A majority of articles (14/16) reported donor site complications. 4,7,15,22,31,34,36,[41][42][43][44][45][46] The data presented in these articles yielded 3,574 patients for meta-analysis of delayed wound healing, and 2,708 patients for meta-analysis of abdominal wall morbidity including hernia, bulge, or laxity. A minority of articles reported donor site complications of seroma, 4,34,36,[42][43][44][45] hematoma, 34,36,42,43,45 and infection.…”

Section: Complicationsmentioning

confidence: 99%

“…A minority of articles reported donor site complications of seroma, 4,34,36,[42][43][44][45] hematoma, 34,36,42,43,45 and infection. 4,22,36,41,43 Within the scope of this review, no study reported donor site reoperation rates. Complication rates from individual articles are reported in ►Table 4, and aggregate complications rates after meta-analysis in ►Table 5.…”

Section: Complicationsmentioning

confidence: 99%

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The Impact of Prior Abdominal Surgery on Complications of Abdominally Based Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis

Bond

Soteropulos

Yang

et al. 2021

J Reconstr Microsurg

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Background Approximately half of all patients presenting for autologous breast reconstruction have abdominal scars from prior surgery, the presence of which is considered by some a relative contraindication for abdominally based reconstruction. This meta-analysis examines the impact of prior abdominal surgery on the complication profile of breast reconstruction with abdominally based free tissue transfer. Methods Literature search was conducted using PubMed, Scopus, and Web of Science. Included studies examined patients with a history of prior abdominal surgery who then underwent abdominally based free flap breast reconstruction. Prior liposuction patients and those with atypical flap designs were excluded. The Newcastle-Ottawa Scale was used to assess study quality. Flap complications included total and partial flap loss, fat necrosis, infection, and reoperation. Donor-site complications included delayed wound healing, infection, seroma, hematoma, and abdominal wall morbidity (hernia, bulge, laxity). Relative risk and 95% confidence intervals (CIs) between groups were calculated. Forest plots, I 2 statistic heterogeneity assessments, and publication bias funnel plots were produced. Publication bias was corrected with a trim-and-fill protocol. Overall effects were assessed by fixed-effects and random-effects models. Results After inclusion and exclusion criteria were applied, 16 articles were included for final review. These included 14 cohort and 2 case–control studies, with 1,656 (46.3%) patients and 2,236 (48.5%) flaps having undergone prior surgery. Meta-analysis showed patients with prior abdominal surgery were significantly more likely to experience donor-site delayed wound healing with a risk ratio of 1.27 (random 95% CI [1.00; 1.61]; I 2= 4) after adjustment for publication bias. No other complications were statistically different between groups. Conclusion In patients with a history of prior abdominal surgery, abdominally based free tissue transfer is a safe and reliable option. Abdominal scars may slightly increase the risk of delayed donor-site wound healing, which can aid the surgeon in preoperative counseling.

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“…Prior studies investigating abdominally based breast reconstruction in the setting of prior abdominal surgery have focused on flap perfusion and vascularity in patients without ventral hernias. 5,8,9 However, the subject of outcomes of patients with preexisting ventral hernias undergoing abdominally based breast reconstruction remains relatively unaddressed in the literature. With respect to the flap, the presence of an underlying hernia may cause harvest to be more difficult, affect perfusion, or prolong operative time.…”

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confidence: 99%

Concurrent Ventral Hernia Repair Is Effective in Patients Undergoing Abdominally Based Microsurgical Breast Reconstruction

Kraft

Chao

2020

J Reconstr Microsurg

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Background The abdomen remains the most preferable donor site for autologous breast reconstruction. Many patients in this population will have had prior abdominal surgery, which is the chief risk factor for having a ventral hernia. While prior studies have examined the impact of prior abdominal surgery on breast reconstruction, limited data exist on the management of patients with a preexisting ventral hernia. The objective of this study was to investigate outcomes of performing ventral hernia repair concurrent with abdominally based microsurgical breast reconstruction. Methods A 5-year retrospective review of patients undergoing abdominally based microsurgical breast reconstruction was performed. The experimental group consisted of patients with a preexisting ventral hernia that was repaired at the time of breast reconstruction, and was compared with a historical cohort of patients without preexisting hernias. Results There were a total of 18 and 225 patients in the experimental and control groups, respectively. There was a higher incidence of prior abdominal surgery in the experimental group (p = 0.0008), but no other differences. Mean follow-up was 20.5 ± 5.2 months. There were no instances of recurrent hernia or flap loss in the experimental group. No significant differences were observed between the experimental and control groups in the incidence of donor-site complications (27.8 vs. 20.9%, respectively; p = 0.55), recipient site complications (27.8 vs. 24.0%, respectively; p = 0.78), operative time (623 ± 114 vs. 598 ± 100 minutes, respectively; p = 0.80), or length of stay (3.4 ± 0.5 vs. 3.1 ± 0.4 days, respectively; p = 0.98). Conclusion Concurrent ventral hernia repair at the time of abdominally based microsurgical breast reconstruction appears to be safe and effective. Larger studies are needed to further define this relationship.

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Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in Women With Previous Abdominal Incisions

Cited by 13 publications

References 20 publications

The effect of previous scar on breast reconstruction using abdominal flap: a retrospective analysis of 122 consecutive cases and a strategy to reduce complication rates

The effect of previous scar on breast reconstruction using abdominal flap: a retrospective analysis of 122 consecutive cases and a strategy to reduce complication rates

The Impact of Prior Abdominal Surgery on Complications of Abdominally Based Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis

Concurrent Ventral Hernia Repair Is Effective in Patients Undergoing Abdominally Based Microsurgical Breast Reconstruction

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