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Abdominal-based autologous breast reconstruction may lead to surgically treated hernia

Surgically repaired abdominal hernias were not uncommon in women who underwent abdominal-based autologous breast reconstruction, according to recent data.

“Breast reconstruction using abdominal-based tissue is a well-established option for patients undergoing mastectomy,” the researchers wrote. “Donor-site hernia is one of the most feared complications following abdominal-based autologous breast reconstruction.”

Researchers identified 8,246 women who underwent pedicled transverse rectus abdominis muscle (TRAM; 29.9%), free TRAM (30%), or deep inferior epigastric perforator (DIEP; 40.8%) flap breast reconstruction from 2008 to 2012 by using inpatient and ambulatory surgery data from California, Florida, Nebraska and New York.

Surgical report of abdominal hernia within 4 years of the procedure was primary outcome.

The pedicled TRAM cohort had the highest frequency of surgically repaired abdominal hernia following breast reconstruction: 7% vs. 5.7% for free TRAM and 1.8% for DIEP. There were also significant health care expenditures for hernia repairs: $39,704 for pedicled TRAM; $48,378 for free TRAM; and $46,481 for DIEP.

There was a higher incidence of surgically repaired abdominal hernia among patients who developed a surgical site infection within 30 days of discharge (IRR = 1.99; 95% CI, 1.44-2.75), according to multivariate analysis.

“Abdominal hernias necessitating repair are not uncommon following abdominal-based autologous breast reconstruction with the amount of rectus muscle harvested correlated to the likelihood of developing an abdominal hernia,” the researchers concluded. “Ongoing studies to refine the technique of abdominal closure across reconstructive modalities are needed to reduce this complication.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.