Smoking increases donor site complications in breast reconstruction with DIEP flap

Klasson, Stina; Nyman, Johan; Svensson, Henry; Velander, Patrik

doi:10.1080/2000656x.2016.1175357

Cited by 22 publications

(23 citation statements)

References 31 publications

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“…A comparison of subgroups differentiated according to their respective BMI category showed that being overweight (BMI 25 to ≤ 30 kg/m 2 ) or obese (BMI 30 to ≥ 40 kg/m 2 ) was associated with a higher incidence of flap-specific complications, particularly flap edge and fat necrosis (p < 0.05). Other studies have reported similar results [36,41,42].…”

Section: Discussionsupporting

confidence: 72%

The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

Munder¹,

Andree²,

Witzel³

et al. 2020

Geburtshilfe Frauenheilkd

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Background Breast cancer is the most common cancer affecting women in Germany. Despite breast-conserving therapy (BCT) being carried out in almost 70% of cases, a high number of women still require complete mastectomy. Prophylactic mastectomy is also indicated for women with a BRCA 1/2 gene mutation. In addition to implant-based heterologous breast reconstruction, autologous breast reconstruction using a DIEP flap has been found to be beneficial, particularly for patients who had prior radiotherapy. This study aims to show that DIEP flap reconstruction surgery is the method of choice for autologous breast reconstruction with a low rate of complications. Patients and Methods Autologous breast reconstruction using a DIEP flap was performed in 1124 patients between July 2004 and December 2014. Retrospective study criteria included potential risk factors such as age, BMI, smoking, chemotherapy and/or radiotherapy, and comorbidities as well as outcome parameters such as postoperative complications. Outcomes were evaluated with a mean follow-up of 24 months. Results A total of 1124 patients underwent 1274 free DIEP flap breast reconstructions, of which 150 were bilateral reconstructions. The primary indication was previous mastectomy in 785 cases, followed by prior implant-based reconstruction in 265 cases. The total flap loss rate was 0.6%. Postoperative surgical revision for abdominal wall hernia was required in 0.2% of cases. The group with a higher BMI and the group of smokers had significantly higher complication rates. Elderly patients (> 65 years), patients who had undergone chemo-/radiotherapy and patients with diabetes did not have higher complication rates. Conclusion DIEP flap surgery is an excellent option for autologous breast reconstruction, with a low rate of donor site morbidity and low complication rates. DIEP flap surgery carried out in a specialised interdisciplinary breast centre in a standardised clinical setting after prior careful patient selection to take account of risk factors such as high BMI and smoking is a reliable method with a low complication rate and satisfactory long-term reconstruction results.

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Section: Discussionsupporting

confidence: 72%

The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

Munder¹,

Andree²,

Witzel³

et al. 2020

Geburtshilfe Frauenheilkd

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“…Better still, this particular study even suggests that obesity is negligible as an important risk factor in general surgery [ 51 ]. Studies by Modarressi et al, Chang et al, and Klasson et al achieved similar results: no significant association between obesity and donor-site complications was discovered [ 52 , 53 , 54 ]. In opposition to these findings, the meta-analysis by Schaverien et al determined a significant association between obesity and complications both at donor and recipient sites [ 12 ].…”

Section: Discussionmentioning

confidence: 69%

The Value of Morphometric Measurements in Risk Assessment for Donor-Site Complications after Microsurgical Breast Reconstruction

Meyer

Handschin

Boll

et al. 2020

JCM

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Microsurgical abdominally-based reconstruction is considered the gold standard in autologous breast reconstruction. Despite refined surgical procedures, donor-site complications still occur, reducing patient satisfaction and quality of life. Recent work has outlined the potential of morphometric measurements in risk assessment for postoperative hernia development. With rising demand for personalised treatment, the goal of this study was to investigate their potential in risk assessment for any donor site complication. In this retrospective cohort study, 90 patients were included who each received microsurgical breast reconstruction at the hands of one surgeon between January 2015 and May 2017. Donor-site complications formed the primary outcome and were classified according to Clavien–Dindo. Morphometric measurements were taken on a routinely performed computed tomographic angiogram. Complications occurred in 13 of the 90 (14.4%) cases studied. All patients who developed any type of postoperative donor site complication had a history of abdominal surgery. The risk of postoperative complications increased by 3% with every square centimetre of omental fat tissue (OR 1.03, 95% CI 1.00–1.06, and p-value = 0.022). Morphometric measurements provide valuable information in risk assessment for donor-site complications in abdominally-based breast reconstruction. They may help identify personalised reconstructive options for maximal postoperative patient satisfaction and quality of life.

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“…28 Smoking is associated with complications and unplanned reoperations in flap surgeries, with evidence supporting increased risk with higher doses and longer smoking history. [29][30][31][32][33][34] A large systematic review found a clear association between smoking tobacco and flap necrosis and a clear benefit of cessation for 1 week versus 24 hours preoperatively. 35 Another systematic review and metaanalysis has found that smoking has a negative impact on flap survival, including increased risk of hematoma and overall surgical complications.…”

Section: Perioperative Nicotine Replacement Therapy Detrimentsmentioning

confidence: 99%

Is There a Smoking Gun for Nicotine? A Review of the Role of Nicotine in Dermatologic Surgery

Jin

Campbell

Somani

2022

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BACKGROUND Dermatologic surgeons are faced with a dilemma when counseling actively smoking patients who require dermatologic surgery: recommend total cessation of all nicotine that is associated with extremely high rates of cessation failure or recommend nicotine replacement therapy (NRT). OBJECTIVE To determine the safety of NRT in dermatologic surgery. MATERIALS AND METHODS PubMed was queried: [(nicotine OR electronic cigarettes) AND (flap OR wound healing)]. RESULTS Smoking tobacco is detrimental to wound healing, supported by ample evidence (1A). Perioperative smoking cessation reduces risk (1B). Basic science demonstrates both a benefit and detriment of nicotine depending on the factor studied (2A). Human studies suggest no detrimental effect of nicotine on perioperative complications (1B). Nicotine may be detrimental to flaps, but evidence is limited to basic science (2A). CONCLUSION Dermatologists should consider recommending nicotine replacement for smokers in the perioperative period. Evidence is lacking to determine safety in flaps. It is presumed based on animal studies that nicotine has a negative effect on flaps; however, it is likely less than tobacco. Weighing the risk of cessation failure without nicotine replacement versus nicotine replacement after flap is challenging. Electronic cigarettes should be discouraged as a means of NRT.

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Smoking increases donor site complications in breast reconstruction with DIEP flap

Cited by 22 publications

References 31 publications

The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

The Value of Morphometric Measurements in Risk Assessment for Donor-Site Complications after Microsurgical Breast Reconstruction

Is There a Smoking Gun for Nicotine? A Review of the Role of Nicotine in Dermatologic Surgery

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