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Flap Failure and Wound Complications in Autologous Breast Reconstruction: A National Perspective

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Abstract

Purpose

There are many options for breast reconstruction following a mastectomy, and data on outcomes are greatly needed for both the patient and the care provider. This study aims to identify the prevalence and predictors of adverse outcomes in autologous breast reconstruction in order to better inform patients and surgeons when choosing a surgical technique.

Methods

This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and identified each autologous breast reconstruction performed between 2005 and 2012. Of the 6855 autologous breast reconstructions, there were 2085 latissimus dorsi (LD) flap procedures, 2464 pedicled transverse rectus abdominis myocutaneous (TRAM) flap procedures, and 2306 free flap procedures that met the inclusion criteria. The prevalence of complications in each of the three procedures was calculated and compared using χ 2 analysis for binomial categorical variables. Univariate and multivariate logistic regression analyses identified independent risk factors for adverse outcomes in autologous reconstruction as a whole.

Results

The prevalence of general complications was 10.8 % in LD flaps, 20.6 % in TRAM flaps, and 26.1 % in free flaps for autologous breast reconstruction (p < 0.001). The prevalence of wound complications was 4.3 % in LD flaps, 8.1 % in TRAM flaps, and 6.2 % in free flaps for autologous breast reconstruction (p < 0.001). The prevalence of flap failure was 1.1 % in LD flaps, 2.7 % in TRAM flaps, and 2.4 % in free flaps for autologous breast reconstruction (p < 0.001). Multivariate regression analysis showed that obesity [odds ratio (OR) 1.495, p = 0.024], hypertension (OR 1.633, p = 0.008), recent surgery (OR 3.431, p < 0.001), and prolonged operative times (OR 1.944, p < 0.001) were independently associated with flap failure in autologous breast reconstruction procedures. When controlling for confounding variables, TRAM flaps were twice as likely (OR 2.279, p = 0.001) and free flaps were three times as likely (OR 3.172, p < 0.001) to experience flap failure when compared to LD flaps.

Conclusions

Latissimus dorsi flaps are associated with the fewest short-term general complications and free flaps are associated with the most short-term general complications in autologous breast reconstruction. Free flaps are the most likely to experience flap failure, though there is no significant difference when compared to pedicled TRAM flaps. Free and TRAM flaps remain as the widely acceptable forms of breast reconstruction in the patient without many risk factors for flap failure or wound complications. The identified risk factors will aid in surgical planning and risk adjustment for both the patient and the care provider. Though many other factors will be taken into consideration with surgical planning of autologous breast reconstruction, the presence of these identified risk factors may encourage the use of a surgical technique associated with fewer adverse outcomes, like the LD flap.

Level of Evidence III

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Acknowledgments

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

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Authors and Affiliations

  1. Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA

    Benjamin B. Massenburg & Paymon Sanati-Mehrizy

  2. Division of Plastic and Reconstructive Surgery, Department of Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th Street, 14th Floor, New York, NY, 10029, USA

    Michael J. Ingargiola, Jonatan Hernandez Rosa & Peter J. Taub

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  1. Benjamin B. Massenburg
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  2. Paymon Sanati-Mehrizy
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  3. Michael J. Ingargiola
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  4. Jonatan Hernandez Rosa
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  5. Peter J. Taub
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Corresponding author

Correspondence to Benjamin B. Massenburg.

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Disclaimer

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Presentations

New York Regional Society of Plastic Surgeons Resident’s Night on March 9, 2015, New York, NY, 1st place, best poster award. 20th Annual Mount Sinai Medical Student Research Day on March 12, 2015, New York, NY. 60th Annual Meeting of the Plastic Surgery Research Council on May 14–16, 2015 in Seattle, WA.

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Massenburg, B.B., Sanati-Mehrizy, P., Ingargiola, M.J. et al. Flap Failure and Wound Complications in Autologous Breast Reconstruction: A National Perspective. Aesth Plast Surg 39, 902–909 (2015). https://doi.org/10.1007/s00266-015-0575-8

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  • DOI: https://doi.org/10.1007/s00266-015-0575-8

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