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Higher postoperative pain linked to implant-based vs. flap-based breast reconstruction

Despite common perception that it is less-distressing of an operation, implant-based breast reconstruction may be more painful postoperatively than abdominally based free tissue transfer, according to findings from a 7-year retrospective study.

Out of 1,875 patients who underwent implant-based reconstruction or autologous abdominal free tissue reconstructions, 824 patients had sufficient electronic data available for inclusion in the study. A total of 438 patients underwent autologous abdominal based free flap reconstruction (280 unilateral, 158 bilateral) and 386 patients had implant-based reconstruction (119 unilateral and 267 bilateral).

Researchers analyzed postoperative pain using the visual analogue scale (VAS), number of patient-controlled analgesia attempts and total narcotic use by each group.

Results showed the implant-based group had higher total narcotic usage and patient-controlled analgesia attempts during the immediate postoperative period compared with the abdominal free flap group, according to the researchers. The implant-based group also had significantly higher VAS scores and total narcotic use through postoperative day 3.

Although both groups showed an increase in intravenous morphine equivalents over time during the postoperative period, the implant-based group displayed a greater overall narcotics usage postoperatively. The researchers also found that the number of narcotics consumed after postoperative day 2 by the implant group increased relative to the autologous group.

No statistically significant differences in VAS or patient-controlled analgesia attempts were observed between the reconstructive methods for unilateral reconstruction. However, patients who underwent unilateral implant-based procedures required more narcotic use than patients who underwent unilateral flap-based procedures.

The researchers also reported that bilateral reconstruction appeared to be more painful than unilateral reconstruction for both implant-based and flap-based cases, as patients who underwent bilateral reconstruction in each subgroup had higher VAS scores and patient-controlled analgesia attempts than unilateral patients in either subgroup. – by Abigail Sutton

Disclosures: The researchers report no relevant financial disclosures.