Postoperative Abdominal Bulge and Hernia Rates in Patients Undergoing Abdominally Based Autologous Breast...

Area of Science:

• Plastic Surgery
• Surgical Outcomes
• Abdominal Wall Reconstruction

Background:

• Abdominal bulge and hernia are potential complications following abdominally based breast reconstruction.
• The choice of flap and donor site closure technique influences these postoperative outcomes.

Purpose of the Study:

• To evaluate the impact of different flap types (TRAM, MS-2 TRAM, DIEP) and closure methods (mesh vs. no mesh) on abdominal bulge and hernia rates.
• To synthesize existing literature to provide evidence-based estimates of complication risks.

Main Methods:

• Systematic review of 28 studies.
• Meta-analysis of 9 comparative studies.
• Analysis stratified by unilateral and bilateral breast reconstructions.

Main Results:

• For unilateral reconstructions, MS-2 TRAM (with or without mesh) and DIEP flaps (without mesh) showed significantly lower hernia/bulge rates than TRAM flaps (with or without mesh).
• For bilateral reconstructions, MS-2 TRAM (with mesh) and DIEP flaps (without mesh) demonstrated significantly lower hernia/bulge rates compared to TRAM flaps (with or without mesh) and MS-2 TRAM flaps (without mesh).
• No statistically significant differences in hernia/bulge rates were found between MS-2 TRAM (without mesh), MS-2 TRAM (with mesh), and DIEP (without mesh) for unilateral reconstructions.

Conclusions:

• Muscle-sparing techniques (MS-2 TRAM) and free flap techniques (DIEP) are associated with reduced abdominal wall morbidity compared to traditional TRAM flaps.
• The use of mesh in donor site closure does not appear to significantly increase or decrease hernia/bulge rates for MS-2 TRAM or DIEP flaps.
• Surgeons should consider flap type and closure method to minimize the risk of abdominal bulge and hernia after breast reconstruction.