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Updated: Apr 6, 2026
An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
Published on: December 5, 2025
Complications Following Abdominal-Based Free Flap Breast Reconstruction: Is a 30 days Complication Rate
Eliana F R Duraes1, Graham Schwarz, Paul Durand
1Cleveland Clinic, 9500 Euclid Avenue, A6 Building, Cleveland, OH, 44195, USA, duraese@ccf.org.
Purpose:
The purpose of this study was to analyze timing and frequency of complications following free tissue autologous reconstruction in a single tertiary care institution.
Methods:
From August 2012 to December 2013, all patients operated on for abdominal-based free flap breast reconstruction at a single institution were included. Complications were identified and risk factors associated with them were analyzed using SPSS software.
Results:
The total number of patients was 130 with a total of 191 flaps (69 for unilateral and 61 for bilateral reconstructions). Mean surgery time was 570.5 min (±151.24). Fifty-nine of the reconstructed breasts (30.8 %) had early complications. Reoperations due to complications were required in 16 (8.3 %) of the breasts during the first 30 days with seven patients requiring multiple reoperations. Twenty-eight patients required reoperations after 30 days, the most frequent reason being delayed wound healing and abdominal hernia. The most significant complication was a case of disseminated infection with loss of skin coverage of the breasts. Early complications and donor-site complications were higher in active smokers (p = 0.005 and p < 0.001, respectively). Patients with a BMI < 25 had fewer total early complications (p = 0.05), as well as fewer complications on the breast area (p = 0.02). A longer time in the operating room was associated with an increase in late complications (p = 0.018). Bilateral/unilateral operation, immediate/delayed surgery, radiotherapy, age, hypertension, diabetes, and surgery time were not associated with early complications, late complications, or reoperations (p > 0.05).
Conclusions:
Active smoking was found to be a significant risk factor for early complications, reoperations, and donor-site complications. Patients with a normal BMI had fewer early complications, reoperations at 30 days, and complications on the breast area. As a significant number of complications occurred beyond the standard 30-day reporting period, it is important to consider reoperations during an extended period.
Level Of Evidence Iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
