Abstract
Background: In contrast to cosmetic abdominoplasty, abdominal flap harvest can result a high degree of morbidity to the abdominal wall. Poor abdominal wall aesthetics that can result following free flap harvest including a high abdominal incision and post-operative hernia or bulge. We report our experience in optimizing cosmesis of the abdominal donor site with the use of a low incision, fascial plication and routine mesh reinforcement. Methods: A retrospective chart review of patients who underwent breast reconstruction with free abdominal tissue transfer from 2013-2017. Pedicled flaps and superior inferior epigastric artery flaps were excluded. Patient demographics, oncologic history, ablative and reconstructive surgery details focusing on abdominal closure techniques, and postoperative complications were evaluated. Results: 135 patients were identified who underwent 223 abdominal free flaps. 59 (26.5%) DIEP flaps were harvested, while 160 (71.7%) msTRAM and 4 (1.8%) fTRAM flaps were harvested (p<0.0001). 160 (71.7%) donor sites closures utilized polypropylene mesh, 9 (4.0%) were closed with biologic mesh and 3 (1.3%) closures used no mesh (p<0.0001). No hernias were observed (0%), while 6 abdominal bulges were identified (2.7%). There were no differences in the rates of abdominal bulge after donor site closure in the DIEP compared with msTRAM and fTRAM groups (3.4% vs 2.4%, p=0.7). No patients required mesh explantation during the study follow up period. Conclusion: To parallel cosmetic abdominoplasty, our authors advocate for a low incision, fascial plication and routine mesh reinforcement of the abdominal wall following free flap harvest.
Highlights
It is well known that patients undergoing autologous breast reconstruction with abdominal free tissue transfer demonstrate greater satisfaction and quality of life. [1] While much attention of patient outcomes has focused on the reconstructed breast, the secondary abdominal donor site has emerged as a significant factor in patient outcomes. [2, 3] Studies evaluating patient reported outcomes have demonstrated superior patient well-being of the abdomen when muscle-preserving abdominally based flaps were utilized. [1, 4, 5]In comparison to cosmetic abdominoplasty, abdominal flap harvest has traditionally prioritized the harvest of large periumbilical perforators
We report our experience in optimizing cosmesis of the abdominal donor site with the use of a low incision, fascial plication and mesh reinforcement
Attention to the secondary abdominal defect following autologous breast reconstruction is gaining deserved attention as it relates to patient satisfaction and quality of life. [2, 3, 13] In an effort to provide an aesthetic outcome in parallel to cosmetic abdominoplasty, the senior author’s preferred technique includes a low-incision, routine fascial plication and mesh reinforcement of the abdomen
Summary
It is well known that patients undergoing autologous breast reconstruction with abdominal free tissue transfer demonstrate greater satisfaction and quality of life. [1] While much attention of patient outcomes has focused on the reconstructed breast, the secondary abdominal donor site has emerged as a significant factor in patient outcomes. [2, 3] Studies evaluating patient reported outcomes have demonstrated superior patient well-being of the abdomen when muscle-preserving abdominally based flaps were utilized. [1, 4, 5]In comparison to cosmetic abdominoplasty, abdominal flap harvest has traditionally prioritized the harvest of large periumbilical perforators. Following harvest of an abdominal free flap, the abdominal wall is weakened, which can result in additional problems of hernia and bulge. We report our experience in optimizing cosmesis of the abdominal donor site with the use of a low incision, fascial plication and mesh reinforcement. Poor abdominal wall aesthetics that can result following free flap harvest including a high abdominal incision and post-operative hernia or bulge. We report our experience in optimizing cosmesis of the abdominal donor site with the use of a low incision, fascial plication and routine mesh reinforcement. There were no differences in the rates of abdominal bulge after donor site closure in the DIEP compared with msTRAM and fTRAM groups (3.4% vs 2.4%, p=0.7). Conclusion: To parallel cosmetic abdominoplasty, our authors advocate for a low incision, fascial plication and routine mesh reinforcement of the abdominal wall following free flap harvest
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