Incidence of Complications in Delayed Abdominal-Based Flap Breast Reconstruction Utilizing a Drainless Recipient Site: A Case Series
Elizabeth G. Zolper, BS1, Kenneth L. Fan, MD1, Jenna C. Bekeny, BA2, Gabriel Del Corral, MD3.
1MedStar Georgetown University Hospital, Washington, DC, USA, 2Georgetown University School of Medicine, Washington, DC, USA, 3MedStar Franklin Square Medical Center, Baltimore, MD, USA.
Seroma and hematoma are common complications after breast surgery such as mastectomy. However, there is a lack of evidence for the utility of drains in the recipient site in delayed autologous breast reconstruction. We reviewed our experience with delayed abdominal-based flap breast reconstruction with a drainless recipient site.
A single surgeon retrospective case review was performed for delayed abdominal-based flap breast reconstruction utilizing drainless recipient sites from May 2018 to June 2019. Primary outcomes were recipient-site complications.
Twenty-one delayed abdominal-based flap breast reconstructions that did not utilize drains in the recipient site were identified in 16 patients. Mean age was 54 years (SD 9.5). Mean BMI was 32.4 kg/m2 (SD 5.0). Common comorbidities were: obesity 50.0%, prior tobacco use 31.2%, diabetes 12.5%. Indication for mastectomy was oncologic in 76.2%; the remainder were prophylactic. There was a history of radiation in 52.4% of cases. Median time to abdominal-based flap reconstruction was 49.4 months (range 1.6-120.6). There were 20 muscle sparing transverse rectus abdominis musculocutaneous (msTRAM) flaps and one deep inferior epigastric artery perforator (DIEP) flap performed. Six patients (37.5%) underwent bilateral reconstruction. Mean operative time was 291.6 minutes (SD 92.4). Flap take back occurred in one case (4.8%). Median length of stay was 4 days (range 3-5). Recipient-site complications were: healing complications 28.6%, seroma 4.8%, hematoma 0%, infection 14.3%, fat necrosis 28.6%. Mean follow up was 4.1 months (SD 2.7).
The low incidence of seroma and hematoma in this case series suggests autologous breast reconstruction is successful with a drainless recipient site when performed in a delayed fashion.
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