Predicting Risk For Flap Loss After Autologous Breast Reconstruction Among 2355 Patients
Marten N. Basta, MD, Arturo J. Rios-Diaz, MD, Jessica R. Cunning, MD, MBA, Cutler B. Whitely, BS, Harrison D. Davis, BS, Robyn B. Broach, PhD, Suhail K. Kanchwala, MD, Stephen J. Kovach, III, MD, Joshua Fosnot, MD, Liza C. Wu, MD, Joseph M. Serletti, MD, FACS.
University of Pennsylvania Health System, Philadelphia, PA, USA.
PURPOSE:
Autologous breast reconstruction (ABR) offers high patient satisfaction with a low risk-profile. Improved outcomes have led to a decreased tolerance for flap loss complications over time. This study provides an individualized risk prediction tool for flap loss after ABR.
METHODS:
IRB-approved, institutional review of patients undergoing ABR between 2010-2019 was conducted. Baseline characteristics, perioperative data, and postoperative flap loss were recorded. Multivariable regression generated a predictive risk model for flap loss.
RESULTS:
2,355 patients received ABR. Patients averaged 51.6 +/- 9.8 years with BMI of 28.9 +/- 6.0 kg/m2. 33% had prior radiation and 45% neoadjuvant chemotherapy. 74% were immediate reconstructions, and 58% were bilateral. Flap choice included msTRAM (69%), DIEP (23%), SIEA (4%), thigh-based/other (4%).
73 flap losses (Complete: 51 (2.2%), Partial: 22 (0.9%)) occurred. Predictors included: age>75 years (OR=3.0, p=0.047), SIEA or non-abdominal-based flaps (OR=2.7-3.0, p<0.05), immediate reconstruction (OR=2.7, p=0.01), smoking history (OR=2.3, p=0.001). msTRAMs were protective against flap loss (OR=0.54, p=0.042). Flap loss was stratified from Low (1.4%) to Extreme Risk (20%) with high accuracy (C-statistic=0.76).
CONCLUSIONS:
This risk-stratification tool quantifies patient-specific flap loss risk after ABR. In addition to managing patient expectations, it may aid in surgical decision-making and postoperative resource allocation. 
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