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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction

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Microsurgical breast reconstruction and primary hypercoagulable disorders.

Rakel M Zarb¹, Charles Lamberton¹, Aishwarya Ramamurthi¹

¹Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA.

|February 12, 2024

Summary

Microsurgical breast reconstruction is feasible for patients with primary hypercoagulability disorders. Extended low-molecular-weight heparin (LMWH) prophylaxis is safe, though flap salvage is challenging.

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Area of Science:

Microsurgery
Plastic Surgery
Hematology

Background:

Primary hypercoagulable disorders present challenges in microsurgery, traditionally contraindicating free tissue transfer.
Free flaps offer advantages in breast reconstruction, necessitating expanded criteria for patient selection.
This study evaluates a chemoprophylaxis regimen for hypercoagulable patients undergoing breast reconstruction.

Observation:

A retrospective review included 15 patients (25 flaps) with primary hypercoagulability and 785 controls (1268 flaps).
Hypercoagulable conditions included Factor V Leiden mutation, Protein S deficiency, prothrombin mutation, and antiphospholipid syndrome.
Patients received extended low-molecular-weight heparin (LMWH) postoperatively.

Findings:

No significant difference in postoperative venous thromboembolism (VTE), mortality, hematoma, or transfusion rates compared to controls.
Flap loss rate was 4% in the hypercoagulable group versus 0.92% in controls (p=0.15).
Salvage rates for arterial or venous compromise were significantly lower in the hypercoagulable group (0% vs. 52%).

Implications:

Microsurgical breast reconstruction is feasible in hypercoagulable patients with acceptable flap loss rates.
Extended LMWH prophylaxis appears safe for this population.
Poor salvage potential highlights the need for careful patient selection and surgical technique.