Risk Factor Analysis for Flap and Donor Site Related Complications in 1274 DIEP Flaps - Retrospective Single Center Study

Fertsch, Sonia; Munder, B; Andree, Christoph; Witzel, Christian; Stambera, Peter; Schulz, Tino; Hagouan, M; Grüter, Lukas; Aufmesser, Birgit; Staemmler, K; Kornetka, Julia; Aldeeri, Mohammed; Seidenstücker, K; Abu-Ghazaleh, Alina; Wolter, A

doi:10.21614/chirurgia.116.2suppl.s5

Cited by 8 publications

(6 citation statements)

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“…Obesity is well known to correlate with increased complication rates after breast reconstruction. 2,4 Panayi et al demonstrated in a recent meta-analysis that for both implant-based and autologous reconstruction, surgical complications were more common in obese patients. 25 In autologous reconstruction specifically, obesity is associated with both donor-site and flap complications, including flap loss, seroma, and infection, at rates of 5.3% to 42% compared with 2.4% to 20% in patients with normal BMI.…”

Section: Discussionmentioning

confidence: 99%

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“Compound Effect of Hypoalbuminemia and Obesity on Complications after Autologous Breast Reconstruction”

Chiang

Finnan²,

Skolnick³

et al. 2023

Plastic &Amp; Reconstructive Surgery

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besity has been consistently associated with postoperative complications in autologous breast reconstruction, as in many other surgical fields, because of impaired wound healing and heavier flaps that may make procedures more complex and lengthy. [1][2][3][4][5] With the rising prevalence of obesity in the United States, there has been a growing interest in the association between increased body mass index (BMI) and poor nutrition. 6 Obesity is often associated with decreased muscle mass, protein malnutrition, and other micronutrient deficiencies, a condition termed sarcopenic obesity. 1,7,8 Background: Obesity is among the risk factors identified that impair postoperative wound healing. Recently, malnutrition and sarcopenia have also been found to correlate with poor surgical outcomes; however, the effect of malnutrition in the setting of obesity is understudied, particularly in reconstructive surgery. The authors examine the American College of Surgeons National Surgery Quality Improvement Program database to determine the impact of obesity plus hypoalbuminemia on complications after autologous breast reconstruction. Methods: Autologous breast reconstruction procedures (pedicled and free flaps) were collected from the 2009 to 2019 National Surgery Quality Improvement Program databases by CPT codes (n = 23,690). Patients without height, weight, or preoperative serum albumin data (n = 12,825) were excluded. Demographics and postoperative outcomes were compared in patients with obesity (body mass index >30 kg/m 2 ) and malnutrition (albumin <3.5 g/dL). Propensity scorematched cohorts with and without malnutrition were also compared. Results: A total of 10,865 procedures were included in analysis; 4565 involved patients with obesity (42%). Obesity was associated with increased length of stay, reoperations, wound complications, and medical complications (all P < 0.001). Among patients with obesity, 198 had malnutrition (4.3%). The combination of obesity and malnutrition was associated with a higher rate of wound complications (16%) over obesity alone (9.2%) or malnutrition alone (9.2%, both P < 0.05). This difference is recapitulated in propensity score-matched analysis. Conclusion: Hypoalbuminemia, a marker of malnutrition, is underappreciated in obese patients and is associated with worse surgical outcomes after autologous breast reconstruction compared with obesity alone.

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Section: Discussionmentioning

confidence: 99%

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mentioning

confidence: 99%

“Compound Effect of Hypoalbuminemia and Obesity on Complications after Autologous Breast Reconstruction”

Chiang

Finnan²,

Skolnick³

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…Осложнения, возникшие при восстановление молочной железы лоскутами, отличаются своей спецификой, могут быть связаны как с донорской областью, откуда берется материал для восстановления, так и с реципиентной зоной, куда лоскут помещается, а любая неудача в этом процессе сопряжена с более тяжелым периодом восстановления и снижением психоэмоционального фона пациентки [5]. В некоторых случаях мы можем с этими осложнениями успешно справиться и достичь окончательного стабильного эстетического результата, а иногда даже их предотвратить, выбрав оптимальный вариант реконструкции для конкретной пациентки.…”

Section: в в е д е н и еunclassified

“…В то время как вмешательства с использованием аутологичных тканей требуют реопераций либо при полной потере лоскута, либо при частичной потере лоскута >20%. При этом частота полной потери лоскута составляет от 1 до 5% [5]. В нашем исследовании случилась одна потеря лоскута, что составило 5%, при достаточно маленькой выборке (n=20), и потребовалась всего одна реоперация для достижения приемлемого косметического результата.…”

Section: о б с у ж д е н и е р е з ул ьтато вunclassified

Breast reconstruction with a DIEP flap for breast cancer: a current trend or a necessary component

Topuzov,

Skvortsov,

Gor

et al. 2024

jour

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Background. Breast reconstruction for breast cancer (BC) is often associated with the development of complications, which can even lead to unsuccessful consequences in the form of loss of an implant or flap. Despite the rapid development of reconstructive surgery for breast cancer, the percentage of complications continues to remain at a high level and can reach 50%. Undoubtedly, complications during reconstruction with implants and flaps are different and have their own specifics. Sometimes we can successfully manage or prevent these complications by choosing the best reconstruction option for that particular patient. Breast reconstruction using a DIEP flap in patients with risk factors minimizes the rate of complications that occur with implant reconstruction, thereby leading to a good aesthetic result.Purpose of the study: to evaluate the effectiveness and aesthetic acceptability of the DIEP flap in patients with a history of complications after breast reconstruction with implants/expanders and high-risk factors for complications.Materials and methods. The study performed 20 breast reconstructions using the DIEP flap in patients with risk factors who had previously experienced complications and had failed implant reconstruction.Results. The total complication rate was 35%. The dominant complication was long-term seroma in the donor area — 3 cases (15%), all of them had obesity of 1.2 degrees. Loss of the flap occurred in 1 (5%) case with a complicated medical history (grade 3 obesity, radiation therapy). Partial necrosis was detected in 1 (5%) of the subjects. Early postoperative hematoma was detected in 1 (5%) case, which required emergency surgical intervention, without loss or partial necrosis of the flap. Postoperative ventral hernia formed in 1 (5%) woman after previous abdominal surgery. It was also noted that patients with a BMI of 30.0 to 35 kg/m2 and 35 kg/m2 or higher were at significantly greater risk of complications compared to patients with a normal BMI (from 18.5 to 25 kg/m2) p-value 0.05. A history of radiation therapy increased the risk of complications. The difference is statistically significant p-value 0.02. There was no effect of chemotherapy on the number of complications encountered. The Breast Q questionnaire showed a good aesthetic result of 72 points.Conclusions. The use of the DIEP-flap in patients with a history of complications after breast reconstruction with implants/expanders and high-risk factors for complications is an effective and safe method of breast reconstruction with a good cosmetic result.

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“…The popularization of free tissue transfer and the continuous development of microsurgical techniques have made breast microsurgical reconstruction an extremely safe procedure with minimal failure rates when an experienced microsurgical team is present [5]. Indeed, when assessing breast reconstruction outcomes, the final aesthetic result and near-perfect simulation of the contralateral native breast have become the new surgical goals.…”

Section: Introductionmentioning

confidence: 99%

Abdominal-Based Microsurgical Breast Reconstruction: How to Inset the Flap to Maximize the Aesthetic Result—A Systematic Review

Sapino,

Tay,

Maruccia

et al. 2023

JCM

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Nowadays, the ultimate goal of microsurgical breast reconstruction is not merely the effective transfer of vascularized tissue but the achievement of a natural, symmetric appearance. The aim of this present study was to systematically summarize the published evidence on abdominal-based free flap inset for breast reconstruction in order to provide principles and classification that could guide the surgeon in choosing the most appropriate inset technique based on patient and flap characteristics. A comprehensive review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, looking for articles on the insetting technique for free flap breast reconstruction. After screening 306 publications, 24 papers (published from 1994 to 2020) were included in the study. We identified four main breast anatomical features on which the papers reviewed focused when describing their insetting technique: breast width, breast ptosis, breast projection, and upper pole fullness. Patient body type, type of mastectomy, and reported complications are also discussed. Flap shaping and inset during breast reconstruction are fundamental steps in any reconstructive procedure. Despite the low evidence in the current literature, this systematic review provides a framework to guide the surgeon’s decision-making and optimize the aesthetic outcomes of abdominal-based free flap breast reconstruction.

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Risk Factor Analysis for Flap and Donor Site Related Complications in 1274 DIEP Flaps - Retrospective Single Center Study

Cited by 8 publications

References 0 publications

“Compound Effect of Hypoalbuminemia and Obesity on Complications after Autologous Breast Reconstruction”

“Compound Effect of Hypoalbuminemia and Obesity on Complications after Autologous Breast Reconstruction”

Breast reconstruction with a DIEP flap for breast cancer: a current trend or a necessary component

Abdominal-Based Microsurgical Breast Reconstruction: How to Inset the Flap to Maximize the Aesthetic Result—A Systematic Review

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