Optimizing donor site closure following bilateral breast reconstruction with abdominal-based free flaps

Messina, Noelle M.; Rossi, Kristie; Wetherhold, Lisa M.; Wetherhold, Matthew J.; Litwin, Samuel; Topham, Neal S.; Chang, Eric I.

doi:10.1016/j.bjps.2017.10.022

Cited by 2 publications

(1 citation statement)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, their follow-up time was limited, and they did not evaluate for hernia or bulge formation. 17 Jordan et al compared their experience using polypropylene mesh (58 patients) to absorbable GORE Bio-A mesh (65 patients) in the subfascial plane and reported a bulge rate of 1.7% with the polypropylene group and 20% in the GORE Bio-A group. 18 Boehmler et al compared the use of acellular dermal matrix (ADM) and polypropylene placed as a bridging inlay or underlay with and without primary fascial closure to primary closure alone.…”

Section: Discussionmentioning

confidence: 99%

Polypropylene Mesh Complications in the Sublay Position After Abdominally Based Breast Reconstruction: Les complications des treillis de polypropylène en sous-couche après une reconstruction mammaire par voie abdominale

2020

View full text Add to dashboard Cite

Introduction: Abdominal wall morbidity after microsurgical breast reconstruction is an important consideration for patients and surgeons. Previous studies are limited by multiple mesh locations or types. In this study, we evaluate specifically subfascial polypropylene mesh placement to determine a more definitive complication rate and basis for objective comparison. Methods: A retrospective review was performed for patients undergoing microsurgical breast reconstruction at our institution by 3 surgeons from 2015 to 2018. All patients with sublay placement of polypropylene mesh were included. Patient demographics, medical comorbidities, type of reconstruction, and postoperative abdominal wall complications were recorded. Results: A total of 114 flaps were performed on 81 patients who met the inclusion criteria. Of these, 48 were deep inferior epigastric artery (DIEP) flaps (42%), 43 were MS-2 TRAM flaps (37.8%), 20 were muscle sparing (MS-1) transverse rectus abdominus muscle (TRAM) flaps (17.5%), and 3 were free TRAM flaps (2.6%). Average follow-up was 392 days (range: 29-1191). Average body mass index was 30.7. No patients developed hernias. Two patients (2.5%) complained of post-operative bulges, neither of which required operative treatment. Two patients experienced superficial abdominal wall infection, one of which required admission and intravenous antibiotics. Ten patients (12.3%) had abdominal incision dehiscence, 3 of which required operative intervention. There were no cases of mesh exposure, contamination, or removal. Conclusion: Polypropylene mesh is safe and effective, with subfascial placement resulting in low morbidity and low rates of bulge/hernia formation after microsurgical breast reconstruction. Consideration should be given to using polypropylene mesh for fascial repairs after microsurgical breast reconstruction, particularly in high-risk populations.

show abstract

Section: Discussionmentioning

confidence: 99%

Polypropylene Mesh Complications in the Sublay Position After Abdominally Based Breast Reconstruction: Les complications des treillis de polypropylène en sous-couche après une reconstruction mammaire par voie abdominale

2020

View full text Add to dashboard Cite

show abstract

Comparison of Phasix, polypropylene, and primary closure of the abdominal donor site after bilateral free flap breast reconstruction: Long‐term evaluation of abdominal hernia and bulge formation

Patel

Rossi

et al. 2019

Microsurgery

View full text Add to dashboard Cite

BackgroundAbdominal free flap harvest for breast reconstruction may result in significant morbidity in terms of hernias and bulges. Reinforcement of the donor site with mesh has been recommended to minimize the risk of hernias and bulges, but no studies exist evaluating the optimal type of mesh. Polypropylene has traditionally been used but the development of Phasix restorable mesh may be a reasonable alternative. Here, we compared the use of Phasix to polypropylene and primary closure and hypothesize that the former has lower rates of abdominal morbidity in the long term.Patients and MethodsA retrospective review of all patients undergoing bilateral free flap breast reconstruction from the abdomen was performed while patients with pedicle flaps or alternative donor sites were excluded. Patient demographics, medical/surgical history, cancer treatments, and flap type were analyzed. All patients were monitored for a minimum of 2 years for early donor site complications as well as hernia/bulges.ResultsSixty‐six consecutive patients were included (40 patients with Phasix, 20 patients with polypropylene, and 6 patients with primary closure). Use of Phasix mesh resulted in higher initial operative costs ($2,750 vs. $72 vs. $0). Two patients with polypropylene mesh and one patient undergoing primary closure developed an abdominal bulge in an average follow‐up of 25.2 months (11.5% vs. 0%, p = .04).ConclusionsMesh placement for abdominal wall reinforcement after bilateral free flap breast reconstruction minimizes the risk of hernias and bulges. Although Phasix results in increased initial costs, abdominal morbidity is significantly decreased after follow‐up beyond 2 years.

show abstract

Optimizing donor site closure following bilateral breast reconstruction with abdominal-based free flaps

Cited by 2 publications

References 5 publications

Polypropylene Mesh Complications in the Sublay Position After Abdominally Based Breast Reconstruction: Les complications des treillis de polypropylène en sous-couche après une reconstruction mammaire par voie abdominale

Polypropylene Mesh Complications in the Sublay Position After Abdominally Based Breast Reconstruction: Les complications des treillis de polypropylène en sous-couche après une reconstruction mammaire par voie abdominale

Comparison of Phasix, polypropylene, and primary closure of the abdominal donor site after bilateral free flap breast reconstruction: Long‐term evaluation of abdominal hernia and bulge formation

Contact Info

Product

Resources

About