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Bleeding in fresh concrete occurs when water from the mix rises to the surface. This happens because the mix's solid components fail to retain all the water as they settle, leading to separation where water collects at the top. The severity of bleeding can be measured by assessing the total settlement or by noting the decrease in height per unit height of concrete.
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Bleeding After Free Flap-Based Breast Reconstruction: A NSQIP Analysis.

Jonah Parker Orr1, Ronnie Labib Shammas1, Analise B Thomas1

  • 1Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, North Carolina.

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Immediate bilateral breast reconstruction after mastectomy increases the risk of bleeding complications and return to the operating room. Patients should be counseled on the higher morbidity associated with bilateral procedures.

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Area of Science:

  • Plastic Surgery
  • Oncologic Surgery
  • Breast Reconstruction

Background:

  • Contralateral prophylactic mastectomy (CPM) rates are rising, despite limited oncologic benefit for low-risk women.
  • Patients undergoing CPM often opt for bilateral and immediate breast reconstruction.
  • The study investigates risks associated with the timing and laterality of free flap breast reconstruction.

Purpose of the Study:

  • To assess the relationship between reconstructive timing and laterality and postoperative bleeding complications.
  • To identify specific reconstructive approaches associated with increased surgical risks.
  • To inform patient counseling regarding bilateral versus unilateral breast reconstruction.

Main Methods:

  • Analysis of the National Surgical Quality Improvement Program (NSQIP) dataset (2010-2015).
  • Inclusion of women undergoing postmastectomy free flap-based breast reconstruction.
  • Categorization by reconstructive laterality (unilateral/bilateral) and timing (immediate/delayed).
  • Modified Poisson regression to evaluate bleeding complication risks.

Main Results:

  • 12% of 4,133 patients experienced postoperative bleeding.
  • Immediate bilateral reconstruction had the highest bleeding incidence (16.6%).
  • Immediate bilateral reconstruction showed a significantly higher risk of bleeding (RR=1.58) and return to OR (RR=1.39) compared to unilateral procedures.

Conclusions:

  • Immediate bilateral free flap breast reconstruction is linked to increased acute postoperative bleeding.
  • A higher rate of return to the operating room is observed with immediate bilateral reconstruction.
  • Patients considering CPM and immediate reconstruction require counseling on the elevated morbidity of bilateral procedures.