Anaesthesia for free flap breast reconstruction

Abstract

### Key points In the UK, all patients undergoing mastectomy should be offered breast reconstruction surgery either at the time of the mastectomy or as a delayed procedure.1 There are several options for breast reconstruction, which can be broadly divided into implant-based or autologous flap reconstruction using the patient's own tissue. Implant-based reconstruction often involves the use of saline tissue expanders initially which usually require replacement with a definitive silicone implant. Autologous flap surgery uses a combination of skin, fat, and sometimes part of the underlying muscle. The flap is moved from areas such as the abdomen, upper back, inner thigh, upper hip, or buttocks to the chest where it is shaped into a new breast. For implant-based reconstruction, 34% of patients suffer complications such as capsular contracture or a foreign body scarring reaction, that requires them to have further surgery within 5 yr.2 Although autologous flap reconstruction involves a longer duration of initial surgery, when compared with implant-based reconstruction, it may be associated with a reduced number of operations, lower complication rates, and it is often easier to achieve a more natural aesthetic appearance. Autologous flaps can be pedicled or free. The most common example of the former is the latissimus dorsi flap, where donor tissue remains connected to the …