Risk factors and timing of postoperative hematomas following microvascular breast reconstruction: A prospective cohort study

Abstract

Background Microvascular free tissue transfer has become the gold standard for breast reconstruction. While safe and reliable, there are operative complications, with hematomas developing under the free flap among the more common. These can compromise flap viability, lead to hemodynamic instability and infection. This study aims to identify predictors of hematomas following free‐flap breast reconstruction. Methods A prospective study was undertaken of patients undergoing autologous free‐flap breast reconstruction over a 4‐year period. Precise times to hematoma formation, age, arterial and venous anastomosis time, and anastomosis length were recorded and analyzed for association with time to hematoma formation. Results One thousand two hundred twelve flaps were undertaken in 1,070 patients during the period of review. Seventy‐one (5.8%) flaps were taken back to theater for hematomas. Immediate reconstruction had a significantly higher hematoma rate compared to delayed reconstruction 7.4% versus 5.2% (p < .001). It is noted that there were two main peaks for time to develop hematomas—less than 4 hr postsurgery and between 12 and 15 hr postsurgery. Conclusion Hematomas are a complication, which must be managed with prompt return to theater to ensure flap salvage and patient stabilization. Predictors for hematoma are presented, with hematomas most likely encountered within the first 12 hr of surgery.

Long-Term Outcomes Following Hybrid Breast Reconstruction

“…We encountered 2 hematomas (2.6%), which required a return to the operating room, consistent with rates cited in the literature for both autologous and implant-based breast reconstruction. 25–27 This finding demonstrates that, with appropriate care taken to drape the flap pedicle loosely over the implant and the use of mesh to stabilize the implant against the pectoralis and chest wall, there is little to no increased risk of pedicle compromise because of the presence of an implant within the breast pocket.…”

Optimal Timing of Delayed Microvascular Breast Reconstruction after Radiation Therapy

“…[14][15][16][17] However, exposing a newly constructed autologous breast to radiation is associated with unpredictable flap necrosis, discoloration, contracture, displacement, volume loss, and other complications often requiring additional revision procedures and/or hospitalizations. 13,14,16,18,19 A recently published meta-analysis by Heiman et al compared outcomes following immediate and delayed autologous breast reconstruction. Seven hundred twenty-nine patients underwent immediate reconstruction and 868 underwent delayed reconstruction after PMRT.…”

The feasibility of ultrasound-guided vacuum-assisted evacuation of large breast hematomas

“…2 Immediate reoperation is usually indicated in expanding hematomas, hemodynamic instability, and jeopardized flap viability. 3 Less commonly, a hematoma appears days or weeks after surgery and may be associated with minor injury or trauma to the breast, with the majority identified within the first 14 days. Late hematomas can also occur and are thought to be related to direct trauma, clotting disorders, overactivity, and use of intraoperative corticosteroids.…”