AAPS Home AAPS Annual Meeting
Annual Meeting Home
Program & Abstracts
Past & Future Meetings


Back to Annual Meeting Program


Comprehensive Analysis of Donor Site Morbidity in Abdominal Free Flaps for Breast Reconstruction
Edward I. Chang, MD, Eric I. Chang, MD, Miguel A. Soto-Miranda, MD, Hong Zhang, BS, Naveed Nosrati, MD, David W. Chang, MD.
MD Anderson Cancer Center, Houston, TX, USA.

Abstract
Purpose: A number of factors contribute to abdominal donor site morbidity following free flap breast reconstruction. Our study aims to provide a comprehensive analysis and propose an algorithm for management.
Methods: Retrospective analysis of all abdominal based free flap breast reconstructions from January 2000-December 2010 at a single academic institution.
Results: A total of 1575 patients underwent abdominal based free flaps for breast reconstruction. Unilateral SIEA flaps were excluded from analysis. Overall 87 of 1507 patients developed an abdominal bulge/hernia (unilateral: 59/1000 vs. bilateral: 28/507). Patients undergoing bilateral free flap reconstruction were 42% more likely to develop an abdominal complication. Primary closure was 3.34 times more likely to result in a hernia/bulge (p=0.004), and placement of mesh reduced bulge/hernia rates by nearly 85% (p=0.001). Patients undergoing bilateral free flaps were significantly more likely to have mesh placed (p=0.0002), and to require a reoperation for a bulge/hernia (p=0.009). Subgroup analysis of flap type demonstrated unilateral TRAM flaps had significantly higher abdominal hernia/bulge rates than unilateral DIEP or muscle-sparing TRAM flaps (p=0.004). However, while bilateral TRAM flaps did have higher abdominal wall complications than bilateral MSTRAM or DIEP, the difference was not statistically significant (8.2% vs. 6.3% vs. 4.3% respectively). Further subgroup analysis of perforator distribution demonstrated bilateral flaps utilizing both rows of perforators had a significant risk of developing a bulge/hernia compared to
bilateral flaps based on a single row (p=0.05). However, if one flap was based on a single row, and the other incorporated both rows, the difference was no longer significant. Average follow-up was 53.2 months; however, bilateral patients had significantly longer follow-up than unilateral patients (52.5 years vs. 64.7 year; p=0.01). The odds of developing a hernia increased 1% for every 1-month increment increase in follow-up (p=0.01).
Conclusion: Donor site closure, flap type and perforator distribution have a significant impact on donor site morbidity. Patients undergoing unilateral free TRAM flaps should have the donor site reinforced with mesh. Patients undergoing bilateral breast reconstruction should have both flaps harvested on a single row of perforators if possible; however, if both rows are necessary, there should be a low threshold for placement of mesh.


Back to Annual Meeting Program