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Predicting Postoperative Recovery Following Intraoperative Microvascular Complications in Autologous Breast

Kerilyn N Godbe1, Erin E Rauber2, Niaman Nazir3

  • 1Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States.

Journal of Reconstructive Microsurgery
|April 21, 2026
PubMed
Summary

Intraoperative complications during autologous breast reconstruction, like pedicle injury or thrombosis, increase the risk of postoperative issues and prolonged hospital stays. Surgeons should anticipate complex recoveries when these events occur.

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Area of Science:

  • Microsurgery
  • Plastic Surgery
  • Breast Reconstruction

Background:

  • Intraoperative microvascular complications in autologous breast reconstruction can lead to postoperative flap issues, including congestion, thrombosis, and loss.
  • The specific impact of these intraoperative complications on patient outcomes is not well-defined.

Purpose of the Study:

  • To investigate the association between specific intraoperative microvascular complications and postoperative outcomes in autologous breast reconstruction.
  • To identify intraoperative factors that predict adverse patient outcomes.

Main Methods:

  • Retrospective review of 1005 microsurgical breast reconstruction cases performed between 2017 and 2023.
  • Statistical analysis to determine correlations between intraoperative complications and postoperative complications, including flap ischemia, congestion, and length of stay.

Main Results:

  • Intraoperative complications occurred in 15.1% of flaps, with pedicle/perforator injury being most common (5.3%).
  • Difficult flap pedicle dissection predicted the need for blood transfusion (OR 2.4).
  • Intraoperative arterial thrombosis was linked to postoperative flap ischemia (OR 2.8) and prolonged hospital stay (OR 3.7 for >3 days, OR 5.4 for >4 days).
  • Alternate venous outflow complications (OR 34.4) and pedicle/perforator injury (OR 6.0) were associated with postoperative flap congestion.

Conclusions:

  • Specific intraoperative complications significantly increase the likelihood of postoperative complications in autologous breast reconstruction.
  • Awareness of these associations is crucial for anticipating and managing complex postoperative recoveries.