American Association of Plastic Surgeons
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Breast Reconstruction Free Flap Failure: Does Platelet Count Matter?
Christopher L. Kalmar, MD MBA, Brian C. Drolet, MD MBA, Salam Kassis, MD MBA, Kent K. Higdon, MD, Galen Perdikis, MD.
Vanderbilt University Medical Center, Nashville, TN, USA.

PURPOSE: The purpose of this investigation was to perform a multicenter study to assess the risk of microvascular free tissue transfer (MFTT) failure based on preoperative platelet counts in the context of preexisting comorbidities.
METHODS: Retrospective cohort study was conducted of female patients undergoing breast reconstruction with MFTT performed in North America between 2015 and 2019 using the NSQIP database. Breast reconstruction with MFTT was defined as CPT 19364. The primary outcome was flap failure.
RESULTS: During the study interval, 7522 patients underwent MFTT breast reconstruction, and 87.1% (n=6552) patients had preoperative labs available.
Average age at reconstruction was 50.99.5 years, and patients had an average BMI of 29.15.8 kg/m2. Patients with MFTT failure had significantly higher platelet counts than those with successful reconstruction (p=.001, 27266K/mcL vs 25461K/mcL).
In multivariate regression analysis, MFTT failure was significantly higher in patients smoking cigarettes within the past year (p=.030, AOR=1.7) and dyspnea on moderate exertion or at rest (p=.025; AOR= 2.6). Each 50K/mcL elevation in platelet count was independently associated with an increased odds of flap failure (p<.001; AOR=1.2). Patients experienced significantly higher rates of flap failure with platelets above 250K/mcL (p=.004, 3.2% vs 2.0%), which remained significant through progressively increasing thresholds.
CONCLUSION: Preoperative optimization of thrombocytosis may decrease MFTT failure, especially in patients with a history of tobacco use and hypertension undergoing autologous breast reconstruction.


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