Abstract
Microsurgical abdominally-based reconstruction is considered the gold standard in autologous breast reconstruction. Despite refined surgical procedures, donor-site complications still occur, reducing patient satisfaction and quality of life. Recent work has outlined the potential of morphometric measurements in risk assessment for postoperative hernia development. With rising demand for personalised treatment, the goal of this study was to investigate their potential in risk assessment for any donor site complication. In this retrospective cohort study, 90 patients were included who each received microsurgical breast reconstruction at the hands of one surgeon between January 2015 and May 2017. Donor-site complications formed the primary outcome and were classified according to Clavien–Dindo. Morphometric measurements were taken on a routinely performed computed tomographic angiogram. Complications occurred in 13 of the 90 (14.4%) cases studied. All patients who developed any type of postoperative donor site complication had a history of abdominal surgery. The risk of postoperative complications increased by 3% with every square centimetre of omental fat tissue (OR 1.03, 95% CI 1.00–1.06, and p-value = 0.022). Morphometric measurements provide valuable information in risk assessment for donor-site complications in abdominally-based breast reconstruction. They may help identify personalised reconstructive options for maximal postoperative patient satisfaction and quality of life.
Highlights
Breast cancer is the most common form of cancer in women worldwide [1]
When using a muscle-sparing transverse rectus abdominis myocutaneus flap, care was taken during flap elevation to ensure that the medial and lateral muscle sections were preserved to the maximum
As the validity of previously established risk factors has been put into question, there is an increasing need for additional objective, preoperative risk assessment tools for donor-site complications after abdominally-based breast reconstruction
Summary
Breast cancer is the most common form of cancer in women worldwide [1]. Approximately one third of women diagnosed with breast cancer are still advised to undergo uni- or bilateral mastectomy [2].Nowadays, more women than ever are surviving breast cancer, and various studies have proven that post-mastectomy breast reconstruction brings quality of life benefits to many of the cancer survivors [3,4,5,6].A general advantage of reconstruction with autologous tissue is the natural cosmetic result with respect to texture, consistency, and adaptation to body weight fluctuations—even over longer periods of time. More women than ever are surviving breast cancer, and various studies have proven that post-mastectomy breast reconstruction brings quality of life benefits to many of the cancer survivors [3,4,5,6]. Refinements in surgical techniques over the last decades have led to the development of perforator flaps with as little muscle and/or fascial sacrifice as the individual patient’s anatomy allows. This has reduced donor site morbidity, and complications have become rarer [11]. Donor-site complications like hernias, abdominal bulging, seromas, delayed wound healing, and infections can still occur, with corresponding implications for patient satisfaction and quality of life
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