Predicting Donor Site Complications: A Review of 2,316 Abdominal Flaps for Breast Reconstruction

242 Background: Perforator flap breast reconstruction has strong appeal for many women seeking breast reconstruction, but the procedure requires adequate donor site tissue to produce realistic breasts. Thin women requesting perforator flaps are often advised that they lack sufficient donor site tissue for autologous tissue breast reconstruction, and that implants are their only option. We have expanded the reconstructive options for thin women who seek an alternative to implants with innovative new techniques. Methods: A retrospective review was done of 223 patients who underwent 293 consecutive perforator flap breast reconstructions from April 2007-May 2011. Preoperative imaging allowed visualization of the microvascular anatomy and subcutaneous tissue. Donor sites evaluated included the abdomen, medial thigh, buttocks, and back. Complications included flap loss, hematoma, seroma, takeback, and fat necrosis. No patients were turned away for perforator flap breast reconstruction due to insufficient donor site tissue. Results: Out of 293 perforator flap breast reconstructions, 45 perforator flap breast reconstructions (15.4%) were reported in 26 thin women with a BMI < 23 (mean BMI 20.7, range BMI 18.2-22.7). Out of 45 perforator flap breast reconstructions in thin women, donor sites included 35 hemi-abdominal flaps (77.8%), 4 medial thigh flaps (8.9%), 7 buttock flaps (15.6%), and 2 back flaps (4.4%). Of the 35 hemi-abdominal flaps, 8 hemi-abdominal flaps were combined to create 4 stacked DIEP flaps (22.9%) while the remaining 27 hemi-abdominal flaps were regular DIEP flaps (77.1%). There was one seroma (2.2%) and one takeback for postoperative pain (2.2%); there were no flap losses. Conclusions: Even in thin women, perforator flap breast reconstruction is a safe, reliable, and consistent technique for recreating new breasts. While implant-based breast reconstruction may be acceptable to many women, there is a growing subgroup of patients who prefer autologous tissue breast reconstruction. By challenging common conceptions about the amount of donor site tissue required, we have been able to expand reconstructive options in thin women by using perforator flaps to construct natural, aesthetic breasts.

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Validating machine learning approaches for prediction of donor related complication in microsurgical breast reconstruction: a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-85155-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yujin Myung ◽

Sungmi Jeon ◽

Chanyeong Heo ◽

Eun-Kyu Kim ◽

Eunyoung Kang ◽

...

Keyword(s):

Machine Learning ◽

Breast Reconstruction ◽

Risk Group ◽

Donor Site ◽

Autologous Reconstruction ◽

Complication Rates ◽

Learning Approaches ◽

Related Complication ◽

Fascial Defect ◽

Abdominal Flaps

AbstractAutologous reconstruction using abdominal flaps remains the most popular method for breast reconstruction worldwide. We aimed to evaluate a prediction model using machine-learning methods and to determine which factors increase abdominal flap donor site complications with logistic regression. We evaluated the predictive ability of different machine learning packages, reviewing a cohort of breast reconstruction patients who underwent abdominal flaps. We analyzed 13 treatment variables for effects on the abdominal donor site complication rates. To overcome data imbalances, random over sampling example (ROSE) method was used. Data were divided into training and testing sets. Prediction accuracy, sensitivity, specificity, and predictive power (AUC) were measured by applying neuralnet, nnet, and RSNNS machine learning packages. A total of 568 patients were analyzed. The supervised learning package that performed the most effective prediction was neuralnet. Factors that significantly affected donor-related complication was size of the fascial defect, history of diabetes, muscle sparing type, and presence or absence of adjuvant chemotherapy. The risk cutoff value for fascial defect was 37.5 cm2. High-risk group complication rates analyzed by statistical method were significant compared to the low-risk group (26% vs 1.7%). These results may help surgeons to achieve better surgical outcomes and reduce postoperative burden.

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Development of a breast reconstruction satisfaction questionnaire (BRECON): Dimensionality and clinical importance of breast symptoms, donor site issues, patient expectations, and relationships

Journal of Surgical Oncology ◽

10.1002/jso.21477 ◽

2010 ◽

pp. n/a-n/a

Author(s):

Claire L.F. Temple ◽

E. Francis Cook ◽

Douglas C. Ross ◽

Margo Bettger-Hahn ◽

Joy MacDermid

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Clinical Importance ◽

Patient Expectations ◽

Satisfaction Questionnaire

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How Do We Raise the Bar in Autologous Breast Reconstruction? The Use of Progressive Tension Sutures for Donor Site Closure

Plastic & Reconstructive Surgery Global Open ◽

10.1097/01.gox.0000584316.54908.08 ◽

2019 ◽

Vol 7 ◽

pp. 22-23

Author(s):

Kristy L. Hamilton ◽

Andres F. Doval ◽

Kieran S. Boochoon ◽

Aldona J. Spiegel

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Autologous Breast Reconstruction ◽

Progressive Tension Sutures

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Breast Reconstruction After Resection of Bilateral Giant Phyllodes Tumors: Two Separate Deep Inferior Epigastric Perforator Flaps From One Donor Site

Clinical Breast Cancer ◽

10.1016/j.clbc.2019.11.007 ◽

2020 ◽

Vol 20 (2) ◽

pp. e188-e191

Author(s):

Chin-Wen Tu ◽

Chien-Liang Fang ◽

Chong-Bin Tsai ◽

Chin-Hao Hsu ◽

Chih-Hsuan Changchien ◽

...

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Perforator Flaps ◽

Phyllodes Tumors ◽

Deep Inferior Epigastric Perforator

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Safety of a Modified Lipoabdominoplasty Technique for Donor-Site Closure in Abdominal-Based Free Flap Breast Reconstruction

Aesthetic Plastic Surgery ◽

10.1007/s00266-020-02117-y ◽

2021 ◽

Cited By ~ 1

Author(s):

Dimitra Kotsougiani-Fischer ◽

Laura Sieber ◽

Sebastian Fischer ◽

Christoph Hirche ◽

Spyridoula Maraka ◽

...

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Donor Site

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Risk factors of mastectomy skin flap necrosis in immediate breast reconstruction using low abdominal flaps

Journal of Plastic Surgery and Hand Surgery ◽

10.3109/2000656x.2016.1170026 ◽

2016 ◽

Vol 50 (5) ◽

pp. 302-306 ◽

Cited By ~ 8

Author(s):

Taik Jong Lee ◽

Tae Suk Oh ◽

Eun Key Kim ◽

Hyunsuk Suh ◽

Sei Hyun Ahn ◽

...

Keyword(s):

Risk Factors ◽

Breast Reconstruction ◽

Skin Flap ◽

Immediate Breast Reconstruction ◽

Flap Necrosis ◽

Skin Flap Necrosis ◽

Abdominal Flaps

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Autologous Unilateral Breast Reconstruction with Venous Supercharged IMAP-Flaps: A Step by Step Guide of the Split Breast Technique

Journal of Clinical Medicine ◽

10.3390/jcm9093030 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3030

Author(s):

Kathrin Bachleitner ◽

Laurenz Weitgasser ◽

Amro Amr ◽

Thomas Schoeller

Keyword(s):

Breast Cancer ◽

Surgical Technique ◽

Breast Reconstruction ◽

Donor Site ◽

Operating Time ◽

Cancer Recurrence ◽

Free Tissue Transfer ◽

Donor Site Morbidity ◽

Aesthetic Result ◽

Secondary Operations

Various techniques for breast reconstruction ranging from reconstruction with implants to free tissue transfer, with the disadvantage of either carrying a foreign body or dealing with donor site morbidity, have been described. In patients who had a unilateral mastectomy and offer a contralateral mamma hypertrophy a breast reconstruction can be performed with the excess tissue from the hypertrophic side using the split breast technique. Here a local internal mammary artery perforator (IMAP) flap of the hypertrophic breast can be used for reconstruction avoiding the downsides of implants or a microsurgical reconstruction and simultaneously reducing the enlarged donor breast in order to achieve symmetry. Methods: Between April 2010 and February 2019 the split breast technique was performed in five patients after mastectomy due to breast cancer. Operating time, length of stay, complications and the need for secondary operations were analyzed and the surgical technique including flap supercharging were described in detail. Results: All five IMAP-flaps survived and an aesthetically pleasant result could be achieved using the split breast technique. An average of two secondary corrections to achieve better symmetry were necessary after each breast reconstruction. Complications included venous flap congestion, partial flap necrosis and asymmetry. No breast cancer recurrence was recorded. An overall approval of the surgical technique among patients was observed. Conclusions: The use of the contralateral breast for unilateral total breast reconstruction represents an additional highly useful technique for selected patients, is safe and reliable results can be achieved. Although this technique is carried out as a single-stage procedure, including breast reduction and reconstruction at the same time, secondary operations may be necessary to achieve superior symmetry and a satisfying aesthetic result. Survival of the IMAP-flaps can be improved by venous supercharging of the flaps onto the thoracoepigastric vein.

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