Strategies for prevention and management of partial flap loss or fat necrosis in microvascular autologous breast reconstruction

Abstract

Partial flap loss (skin involved) or fat necrosis following autologous breast reconstruction remains a dreaded postoperative complication despite significant advances in microsurgical techniques. Several strategies have been proposed in the preoperative and intraoperative period to prevent this complication ranging from preoperative imaging, intra-operative tissue perfusion assessment, appropriate perforator selection (location and number), maximizing inflow and outflow with additional anastomoses and/or pedicles, and minimizing ischemia time. Postoperative management of partial flap loss (when there is skin involvement) and fat necrosis remains a challenge, with very little published data focusing on classification, timing, and techniques. Early intervention versus close observation may depend on multiple patient factors and the degree or volume of necrosis. Secondary intervention options include hyperbaric oxygen therapy, fat aeration with a needle, liposuction, fat grafting, addition of another flap or implant, depending on the nature of the defect. This review summarizes the current evidence for each of these strategies to help the current surgeon understand their options in preventing and managing patients suffering from partial flap loss.