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Fat Necrosis in Autologous Abdominal Based Breast Reconstruction: A Systematic Review
Ibrahim Khansa, MD1, Adeyiza O. Momooh, MD2, Priti P. Patel, MD3, John T. Nguyen, MD3, Bernard T. Lee, MD MBA3.
1Wexner Medical Center at The Ohio State University, Columbus, OH, USA, 2University of Michigan Medical Center, Ann Arbor, MI, USA, 3Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA, USA.

Background:
Fat necrosis is a common and potentially exasperating complication of autologous breast reconstruction. The purpose of this study was to perform a systematic review of the English literature on autologous breast reconstruction to determine significant patient and surgical factors that are predictors for postoperative fat necrosis.
Methods:
A PubMed search using the terms “fat necrosis” and “breast reconstruction” was conducted. Articles were screened using pre-determined inclusion and exclusion criteria. Data extracted from the articles included patient characteristics, the reconstructive techniques utilized and the specific postoperative morbidity of interest. The patient cohorts were pooled, and the incidence of fat necrosis was calculated in the presence and absence of each risk factor. Chi-squared analysis was applied, with a p value smaller than 0.05 considered statistically significant.
Results:
The literature search yielded 172 articles, 70 of which met our inclusion criteria. The mean rate of fat necrosis was 11.3%. DIEP flaps had the highest rate of fat necrosis (14.4%), followed by pedicled TRAM (12.3%), SIEA (8.1%) and free TRAM flaps (6.9%). Significant predictors of fat necrosis included obesity (p=0.035), pre-reconstruction radiation (p=0.022), post-reconstruction radiation (p<0.001), active smoking (p<0.001), and abdominal scars (p=0.05). Protective factors included supercharging (p<0.001) and bilateral reconstruction (p=0.01). Surgical delay and choice of recipient vessel did not affect the rate of fat necrosis.
Conclusions:
Although there is little agreement in the literature regarding risk factors for fat necrosis, we were able to demonstrate several significant predictors by systematically analyzing 70 articles. Improved knowledge of the risk factors for fat necrosis can help surgeons provide improved preoperative counseling, and take measures to minimize the risk of this complication.


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