Avoiding Chest Wall Morbidity in Outpatient Microvascular Free-Flap Breast Reconstruction

Area of Science:

• Plastic Surgery
• Microsurgery
• Breast Reconstruction

Background:

• Rib and cartilage removal is standard for recipient vessel exposure in free-flap breast reconstruction.
• This practice contributes to both short-term and long-term patient morbidity.
• An alternative approach to avoid rib removal is explored.

Purpose of the Study:

• To describe the experience and outcomes of avoiding rib removal in microvascular breast reconstruction.
• To evaluate the safety and efficacy of this modified surgical technique.

Main Methods:

• Retrospective review of recipient vessel preparation in free-flap breast reconstructions.
• Analysis of 556 patients and 1106 flaps performed by a single surgeon over 5 years.
• Focus on internal mammary artery (IMA) and internal mammary perforator flaps.

Main Results:

• No complete rib resections were performed; only minor rib resection (20%) in two cases.
• Three flaps (one PAP, two DIEP) were lost out of 1106 total flaps.
• The approach preserved anatomy, decreased pain, and allowed for outpatient procedures.

Conclusions:

• Microsurgery techniques in breast reconstruction have advanced significantly.
• Excessive rib removal causes significant short- and long-term complications.
• The described approach of avoiding rib removal is safe, preserves anatomy, reduces pain, and facilitates outpatient surgery.