Do Prior Abdominal Surgeries Increase Complications in Abdominally Based Breast Reconstructions?

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oncology

Background:

• Many patients seeking autologous breast reconstruction have prior abdominal surgeries.
• The impact of abdominal wall alterations on free tissue transfer needs characterization.

Purpose of the Study:

• To assess the impact of prior abdominal surgery on perfusion-related complications and donor-site morbidity in free tissue abdominal transfer for breast reconstruction.

Main Methods:

• Retrospective review of 1257 abdominally based free flap breast reconstructions (2005-2011).
• Data collected included types and number of prior abdominal surgeries, and rectus sheath violation.
• Outcomes assessed: thrombotic complications, flap loss, surgical complications, wound healing, and hernia formation.

Main Results:

• 51.4% of patients had prior abdominal surgery (e.g., hysterectomy, C-section).
• No significant differences in major complications or flap loss based on prior surgery.
• Prior rectus sheath violation correlated with delayed donor-site healing (P=0.03).
• Prior hernia repair increased risk of postoperative hernia formation (P=0.04).

Conclusions:

• Prior abdominal surgery is an acceptable risk for free flap breast reconstruction.
• Patients with prior hernia repairs need careful fascial closure to mitigate hernia risk.
• Preoperative counseling should address risks associated with prior abdominal surgeries.