Complications after microvascular breast reconstruction: experience with 1195 flaps.
BACKGROUND
Reconstruction is an important adjunct to breast cancer management. This study evaluated the frequency of major and minor complications in the largest reported series of consecutive mastectomy patients treated with free tissue transfer for breast reconstruction.


METHODS
All patients treated with microvascular breast reconstruction at the University of California, Los Angeles, Medical Center over an 11-year period were identified using a retrospective analysis. Frequency of complications was assessed.


RESULTS
A total of 1195 breast reconstructions were performed in 952 patients. Transverse rectus abdominis musculocutaneous flaps were used in most cases (81.8 percent), whereas the superior gluteal musculocutaneous flap (10.1 percent) and other free flaps were used in the remaining patients. The overall complication rate was 27.9 percent and consisted primarily of minor complications (21.7 percent). Major complications were noted in 7.7 percent, including six total flap losses (0.5 percent). Obesity was a major predictor of complications. Smoking was not associated with increased rates of overall or microsurgical complications. Neoadjuvant chemotherapy was also an independent predictor of complications and was associated with wound-healing problems and fat necrosis. Prior abdominal surgery in transverse rectus abdominis musculocutaneous flap patients increased the risk of partial flap loss, fat necrosis, and donor-site complications.


CONCLUSIONS
Microsurgical breast reconstruction is a safe and highly effective technique. Complications tend to be minor and do not affect postreconstruction adjuvant therapy. Obesity is a major predictor of flap and donor-site complications, and these patients should be appropriately counseled. Similarly, neoadjuvant preoperative chemotherapy and prior abdominal surgery increase the rates of minor complications.
Mehrara
Babak J
BJ
Los Angeles, Calif.; and New York, N.Y. From the Division of Plastic and Reconstructive Surgery and Department of Surgery, University of California, Los Angeles, Medical Center.
Santoro
Timothy D
TD
Arcilla
Eric
E
Watson
James P
JP
Shaw
William W
WW
Da Lio
Andrew L
AL
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001249:Asthma / Q000453:epidemiology; D001943:Breast Neoplasms / Q000601:surgery; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003131:Combined Modality Therapy; D003920:Diabetes Mellitus / Q000453:epidemiology; D005218:Fat Necrosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006547:Hernia / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D016462:Mammaplasty / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000706:statistics & numerical data; D008833:Microcirculation; D008866:Microsurgery / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009765:Obesity / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D013524:Surgical Flaps / Q000098:blood supply* / Q000706:statistics & numerical data; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D014945:Wound Healing
D000970:Antineoplastic Agents