The Hidden Morbidity Of The Abdominal Donor Site After Autologous Breast Reconstruction
Arturo J. Rios-Diaz, MD, Jessica R. Cunning, BS, MBA, Cutler Whitely, BS, Harrison Davis, BS, Omar Elfanagely, MD, Robyn B. Broach, PhD, Joseph M. Serletti, MD, John P. Fischer, MD, MPH.
University of Pennsylvania, Philadelphia, PA, USA.
Purpose: Long-term follow-up is required to capture abdominal donor-site morbidities after autologous breast free flap (ABFF) reconstruction. We sought to explore long-term donor-site morbidity using a prospective longitudinal ABFF registry.
Methods: Patients who underwent TRAM, DIEP, or SIEA flaps for ABFF reconstruction were identified in an institutional ABFF registry between 2006-2017. Outcomes included hernia/bulge (primary), surgical site infection (SSI), and small bowel obstruction (SBO). Descriptive statistics and backward-stepwise logistic regression determined factors associated with donor-site complications.
Results: Overall, 2,296 patients underwent abdominal-based ABFF reconstruction, comprising 96.9% of registry patients. Abdominal-based ABFFs were mainly TRAMs (73.6%), followed by DIEPs (23.0%) then SIEAs (3.4%). Patients were 52 years-old (IQR 45-58), 73.1% Caucasian, 39% obese, and 19.3% multimorbid; 65.9% received mesh. The median time to last encounter was 936 days (IQR 510-2619). The rates of hernia/bulge, SSI, and SBO were 8.1%, 3.2%, and 0.4%, respectively. Median time to hernia/bulge was 346 days (IQR 138-816), 44.6% of hernias were surgically repaired, and 10.8% recurred. Rates of hernia/bulge did not differ by mesh use (p=0.131). Selected factors associated with these complications are shown in the Table.
Conclusion: Hernias/bulges are prevalent after abdominal-based ABFF reconstruction and seem to be driven by delayed healing and mesh infections. Morbidity continues long after surgery with SBO and hernia recurrence. New strategies are necessary to tackle this complex complication as mesh has not proven successful. 
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