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Risk Factors And Overall Outcomes Following Abdominal-based Free Flap Breast Reconstruction After Nipple-sparing Mastectomy.
Paul Durand MD, Eliana Duraes MD, Jordan Gales BS, Andrea Moreira MD, Risal Djohan MD, Steven Bernard MD, Joao Batista de Sousa MD PhD, Graham Schwarz MD.
Cleveland Clinic Foundation
2015-03-15
Presenter: Paul Durand, MD
Affidavit:
I certify that this is the original work of my resident Paul Durand, MD.
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background/Purpose:
The purpose of this study is to determine risk factors impacting surgical outcomes and examine aesthetics following free flap breast reconstruction in patients who undergo NSM.
Methods:
Patients undergoing free tissue transfer after NSM at a single, tertiary-care institution from 2007 to 2014 were reviewed. Patient demographics, anatomic characteristics, oncologic considerations, complications, and reoperations were examined. Descriptive statistical analysis performed included Chi-Square, independent t-test, and regression analysis using SPSS software.
Results:
Total of 45 breasts (23 oncologic, 22 prophylactic) in 28 patients were reconstructed with mean follow-up of 11.5 months. Forty-one DIEP and four free-TRAM flaps were performed. Mean BMI was 28.6. Four breasts previously irradiated (8.8%), two patients active smokers (6%). HTN was associated with higher rates of flap ischemia (p=0.02). BMI, smoking and radiation not associated with increased complications. No evidence of vascular compromise or flap loss was noted. Mean number of reoperations due to complications was 0.66. Mean total number of surgeries per patient was 2.97. Total skin infection rate was 8.8%. Higher rates of NAC necrosis were seen in breasts with smaller preoperative cup sizes (p=0.02). Total NAC necrosis was 11%. Indication for NSM was not associated with an increase in complications/reoperations.
Conclusion:
Free tissue transfer after NSM is shown as a safe reconstructive alternative. HTN was the only risk factor for increased complications. Indication for mastectomy did not affect rates of NAC necrosis. Studies are ongoing to further optimize patient selection in an effort to maximize patient safety and aesthetic outcomes.
