Risk Factors and Complications of Abdominally Based Breast Reconstruction: A Comparative Analysis of 13,587 Patients

Abstract

INTRODUCTION: Autologous breast reconstruction is most commonly abdominally based. Deep inferior epigastric perforator (DIEP), pedicled transverse rectus abdominis musculocutaneous (pTRAM), and free transverse rectus abdominus musculocutaneous (fTRAM) flaps subject a patient to significant abdominal wall morbidity. A comparative analysis of DIEP, pTRAM, and fTRAM flaps for breast reconstructions is necessary to understand major risk factors for adverse outcomes. The purpose of this study is to determine the safety and advantages of a DIEP vs pedicled TRAM vs fTRAM flap for breast reconstruction. METHODS: Admitted patients with a DIEP or pTRAM or fTRAM breast flap were analyzed using the National Inpatient Sample database, 2005–2014. Demographics, clinical data, and outcomes were collected. The relationship between mortality and predictors was assessed using a stratified analysis and multivariable logistic regression model. RESULTS: A total of 13,587 patients with DIEP, fTRAM, or pTRAM breast flap reconstruction were analyzed. Patients with a fTRAM were the most likely to experience a complication, followed by DIEP and then pTRAM. The most common complication for all groups was hemorrhage, most common in DIEP flaps. However, DIEP flap reconstructions were performed with shorter hospital stays. This group also exhibited the highest rates of thrombosis compared with pTRAM and fTRAM flaps. Conversely, the DIEP group had the lowest rates of postoperative infections, dehiscence, and pulmonary embolism. There were no significant differences in flap type used in the breast reconstruction between survived and deceased patients. CONCLUSION: These data support the DIEP flap as the chosen flap for autologous breast reconstruction in postmastectomy patients.