Stacked Abdominal Flap for Unilateral Breast Reconstruction

Murray, Alexandra; Wasiak, Jason; Rozen, Warren M.; Ferris, Scott; Grinsell, Damien

doi:10.1055/s-0034-1390165

Cited by 13 publications

(13 citation statements)

References 26 publications

(49 reference statements)

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“…The safety of this reconstructive modality is well described, but its impact on additional revision surgery still remains unclear. 36–43 While others found no difference or a decreased incidence of revision when comparing patients undergoing bipedicle versus unipedicle reconstruction, the present study demonstrates an association between bipedicle reconstruction and more revision procedures. 43–45 Salibian et al demonstrated that the revision rate was higher in unipedicle reconstruction patients secondary to an increased rate of contralateral reduction.…”

Section: Discussioncontrasting

confidence: 47%

Analysis of Breast Aesthetic Revision Procedures after Unilateral Abdominal-based Free-flap Breast Reconstruction: A Single-center Experience with 1251 Patients

Smith

Boukovalas

Chang

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Breast INTRODUCTIONAlthough patient satisfaction can be achieved in breast reconstruction using either a device-based approach or the patient's own tissue, studies have demonstrated that using autologous techniques results in superior long-term outcomes, particularly in the setting of radiation therapy. [1][2][3] Unilateral autologous free-flap breast reconstruction aims to create a durable, aesthetic breast mound that mirrors the size, shape, and contour of the contralateral native breast. However, symmetry can be difficult to achieve, and breast asymmetry has been shown to have a significant negative impact on patient body image and patient satisfaction. 4,5 As such, additional surgical procedures on the reconstructed breast, the contralateral breast, or both may be necessary to restore maximum balance and symmetry. [6][7][8][9][10] Data are lacking on the variables that influence the number, type, and timing of enhancement procedures Original articleBackground: Although autologous free-flap breast reconstruction is the most durable means of reconstruction, it is unclear how many additional operations are needed to optimize the aesthetic outcome of the reconstructed breast. The present study aimed to determine the average number of elective breast revision procedures performed for aesthetic reasons in patients undergoing unilateral autologous breast reconstruction and to analyze variables associated with undergoing additional procedures. Methods: A retrospective review of all unilateral abdominal-based free-flap breast reconstructions performed from 2000 to 2014 was undertaken at a tertiary academic center. Results: Overall, 1251 patients were included in the analysis. The average number of breast revision procedures was 1.1 ± 0.9, and 903 patients (72.2%) underwent at least one revision procedure. Multiple logistic regression analysis demonstrated that younger age, higher body mass index, and prior oncologic surgery on the reconstructed breast were factors associated with increased likelihood of undergoing a revision procedure. The probability of undergoing at least one revision increased by 4% with every 1-unit (kg/m 2 ) increase in a patient's body mass index. Multiple Poisson regression modeling demonstrated that younger age, prior oncologic surgery on the reconstructed breast, and bipedicle flap reconstruction were significant factors associated with undergoing a greater number of revision procedures. Conclusions: Most patients who undergo unilateral autologous breast reconstruction require at least one additional operation to optimize their breast aesthetic results. Young age and obesity increase the likelihood of undergoing additional operations. These findings can aid reconstructive microsurgeons in counseling patients and establishing patient expectations prior to their undergoing microvascular breast reconstruction.

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Section: Discussioncontrasting

confidence: 47%

Analysis of Breast Aesthetic Revision Procedures after Unilateral Abdominal-based Free-flap Breast Reconstruction: A Single-center Experience with 1251 Patients

Smith

Boukovalas

Chang

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…16 If the superficial vein is present in the flap but there is no second adequate recipient vein, it is suggested that an "intraflap" anastomosis connecting the superficial vein to the deep pedicle of the flap itself be created, thus allowing both to drain into a common recipient vein. [17][18][19] In the present study, the incidence of fat necrosis in the flap was lower in the dual venous drainage system group than in the single venous drainage system group when evaluated both in the physical exam alone (9.37% vs. 1.36%) and in the imaging exams (29.6% vs. 23.94%).…”

Section: Discussioncontrasting

confidence: 41%

The Influence of the Superficial Venous System on DIEP Flap Drainage in Breast Reconstruction

Choi,

Ribeiro,

Montag

et al. 2023

J Reconstr Microsurg

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Background: Autologous tissue has become the gold standard in breast reconstruction. The use of a DIEP flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared to the transverse rectus abdominis myocutaneous (TRAM) flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival. Methods: This was a retrospective cohort study collected from a prospective database mantained by our institution. Data was obtained from the medical records of female patients who underwent mastectomy and breast reconstruction with a DIEP flap between March 2010 and March 2017. We evaluated 137 DIEP patients with unilateral breast reconstructions. In 64 (46.7%) the deep venous system was chosen and 73 (53.3%) had an additional superficial vein anastomosed. Results: Out of the 137 patients evaluated, there were 16 (11.67%) cases of revision, 14 (10.21%) were due to venous thrombosis. 12 cases (8.75%) of flap loss were reported. Reoperation rate was lower in the dual venous drainage group when compared to the single venous drainage group (p = 0.005), as was the rate of flap loss (p = 0.006) and reoperation due to venous thrombosis (p = 0.002). Out of the 125 DIEP flaps, fat necrosis was clinically identified in 7 (5.1%) cases, and the rate was lower in the dual venous drainage system group (p = 0.01). Conclusion: Dual venous drainage of a DIEP flap appears to reduce the rates of venous thrombosis, reoperation, total flap loss and fat necrosis.

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“…Therefore, in many cases, it was necessary to do only one flap at a time. When both complementary flaps are able to be performed during the same operative procedure, the second flap can be anastomosed to the first one in series, in the same manner as described for stacked flaps in mammary reconstruction 13–15 …”

Section: Discussionmentioning

confidence: 99%

Anterior Neck Resurfacing Using Multiple Free Flaps in Patients With Burn Sequelae of the Anterior Neck and Chest

et al. 2022

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Background: It has been established that patients with burn sequelae of the anterior neck and chest have a significant degree of flap descent and deficit in neck extension when resurfaced with a single free flap. A protocol was developed to avoid flap descent in these patients by resurfacing the neck with multiple free flaps. The purpose of this article is to present our protocol for treatment and long-term results of this technique. Methods: Twenty-five 25 patients with burn sequelae of the anterior neck and anterior thorax were retrospectively identified. Ten patients were treated with a single free flap (group 1), and 15 patients were treated with multiple free flaps (group 2). Patients were followed up for an average of 7 years after their definitive reconstructive procedure at which time measurements including flap descent from sternal notch, deficit of neck extension, and subjective reports of discomfort were obtained. Results: Patients in group 1 demonstrated 8 cm (interquartile range [IQR], 1.75 cm) of flap descent, whereas patients in group 2 demonstrated 0.5 cm (IQR, 0 cm) of flap descent. Patients in group 1 demonstrated 12.5 degrees (IQR, 10 degrees) of deficit in neck extension, whereas patients in group 2 demonstrated 0 degrees (IQR, 0 degrees) of deficit in neck extension. Analysis demonstrated significantly greater descent and deficit in neck extension in group 1 compared with group 2. Conclusions: Patients with burn sequelae of the neck and anterior chest experience less flap descent and deficits in neck extension when resurfaced with multiple free flaps.

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Stacked Abdominal Flap for Unilateral Breast Reconstruction

Cited by 13 publications

References 26 publications

Analysis of Breast Aesthetic Revision Procedures after Unilateral Abdominal-based Free-flap Breast Reconstruction: A Single-center Experience with 1251 Patients

Analysis of Breast Aesthetic Revision Procedures after Unilateral Abdominal-based Free-flap Breast Reconstruction: A Single-center Experience with 1251 Patients

The Influence of the Superficial Venous System on DIEP Flap Drainage in Breast Reconstruction

Anterior Neck Resurfacing Using Multiple Free Flaps in Patients With Burn Sequelae of the Anterior Neck and Chest

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