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Advise patient weight loss, smoking cessation in bilateral free flap breast reconstruction
As number of bilateral free flap breast reconstructions increases, there have been higher revision rates to achieve symmetry. While obesity, smoking and radiation therapy were associated with increased complications, successful reconstruction can be achieved with acceptable risk, according to new research from Plastic and Reconstruction Surgery.
In a retrospective review, all bilateral free flap breast reconstructions conducted at a single center from 2000 to 2010 were analyzed.
Edward I. Chang
A total of 488 patients underwent bilateral breast reconstruction (immediate, 283; delayed, 93; immediate/delayed, 112). These numbers more than doubled in the last 5 years of the study, 2006-2010. Contralateral prophylactic mastectomy had a similar increase over the decade.
Surgeons preferred perforator flaps compared with traditional transverse rectus abdominus myocutaneous (TRAM) flaps for the second half of the decade.
Only 70 deep inferior epigastric perforator flaps (25.6%) were performed from 2000-2005 compared with 203 for 2006-2010, a 3-fold increase throughout the decade.
Revision surgery was more common in the bilateral immediate/delayed reconstruction groups, particularly on the immediate reconstructed breast.
Patients with a BMI greater than 30 kg/m2 were twice as likely to experience a complication as those with a normal BMI. BMI was also significantly related to infection, seroma, wound dehiscence and hematoma according to researchers.
Patients undergoing delayed reconstruction were more than four times likely to develop a postoperative flap infection than those undergoing immediate bilateral reconstruction.
Compared to unilateral patients, bilateral patients were significantly younger and had a higher BMI.
Bilateral reconstruction patients had significantly lower flap loss rates than those undergoing unilateral reconstruction.
Bilateral reconstruction patients were more likely to undergo additional revision surgeries compared to unilateral patients.
While bilateral reconstruction is safe and not associated with a higher risk for flap loss or donor-site complications, obese patients and smokers should be counseled about the increased risks.-by Abigail Sutton
Disclosure: The authors reported no relevant financial disclosures.