Abstract
BackgroundFree tissue transfer breast reconstruction is an option for breast cancer patients that is precluded by a number of factors. The authors’ objective was to assess the use of pedicled myocutaneous breast reconstruction in the community hospital setting, with more limited resources, as a viable option with comparable rates of complications, cost, and outcomes.MethodsThe authors performed a retrospective cohort review of pedicled myocutaneous breast reconstructions of a single surgeon at a community-based institution from 2015 to 2019. Rates of complications, including partial and total flap failure, infection, seroma/hematoma, and reoperation were evaluated, as well as initial hospital cost, readmission cost, and subjective patient satisfaction. Statistical analysis was performed on the data and compared to published data on free flap breast reconstruction with regards to similar data points.ResultsThere were ten patients included in the analysis. This data demonstrated an immediate reoperation rate of 0%, with no incidence of partial or total flap loss, infection, seroma, hematoma, or medical complication. Delayed complications included delayed wound healing of the donor site (10%), abdominal wall bulge (10%), and umbilical partial necrosis (10%). The average length of initial stay was 5.7 days and the average initial hospital costs were $94,717.ConclusionsAs demonstrated at St. Barnabas Hospital, this type of breast reconstruction does not require the presence of a microsurgery fellowship program, high volumes, significant ancillary staff training, or other costly resources to monitor the patient, yet yields comparable or favorable rates of complications when compared to free tissue reconstruction. This allows more reconstructive options to be available to patients who may not have access to large tertiary centers for free flap reconstruction.
Highlights
Breast cancer is the most frequently diagnosed life-threatening cancer and the leading cause of cancer deaths in women in the world [1]
Statistical analysis was performed on the data and compared to published data on free flap breast reconstruction with regards to similar data points
Barnabas Hospital, this type of breast reconstruction does not require the presence of a microsurgery fellowship program, high volumes, significant ancillary staff training, or other costly resources to monitor the patient, yet yields comparable or favorable rates of complications when compared to free tissue reconstruction
Summary
Breast cancer is the most frequently diagnosed life-threatening cancer and the leading cause of cancer deaths in women in the world [1]. Pedicled myocutaneous flaps have been used in breast reconstruction since the 1980’s when Hartrampf, Scheflan, and Black introduced it in 1982 [3] They are often cited as a more reliable option than free tissue transfer for breast reconstruction due to their reliable vascular source that is left in continuity. It can be performed by many plastic surgeons that have had exposure to pedicled flap breast reconstruction in training. Due to the nature of free tissue transfer, they are associated with higher cost, more required hospital resources, and higher rates of complications [4]. The authors’ objective was to assess the use of pedicled myocutaneous breast reconstruction in the community hospital setting, with more limited resources, as a viable option with comparable rates of complications, cost, and outcomes
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