Bilateral Free Flap Breast Reconstruction Outcomes: Do Abdominal Scars Affect Bilateral Flaps?

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oncology

Background:

• Bilateral mastectomies and subsequent breast reconstructions are increasingly common.
• Many patients have pre-existing abdominal scars from various surgical procedures.
• Evaluating the influence of these scars on reconstruction outcomes is crucial.

Purpose of the Study:

• To assess the impact of prior abdominal scars on complication rates in patients undergoing bilateral free flap breast reconstruction.
• To identify specific scar types that may influence surgical outcomes.

Main Methods:

• A prospective study included all patients undergoing abdominally based free flap breast reconstruction from 2007-2014.
• Demographic and clinical data were collected, and complications/reoperations were prospectively recorded.
• Analysis focused on bilateral reconstructions and the presence/type of abdominal scars.

Main Results:

• Of 243 bilateral reconstructions, 73 had Pfannenstiel scars and 69 had laparoscopic scars.
• Four flap failures occurred, all in patients with prior scars (3 Pfannenstiel, 1 laparoscopic).
• Pfannenstiel scars were linked to a significantly higher risk of recipient site hematoma (13.7% vs. 2.2%).

Conclusions:

• Bilateral free flap breast reconstruction outcomes are largely comparable in patients with and without abdominal scars.
• Pfannenstiel scars present a specific risk for hematoma.
• Intraoperative imaging, such as fluorescence angiography, may be beneficial for patients with abdominal scars.