title: Comprehensive analysis of donor-site morbidity in abdominally based free flap breast reconstruction.
abstract: BACKGROUND
  This study aimed to provide a comprehensive analysis of factors that might contribute to abdominal donor-site morbidity after abdominally based free flap breast reconstruction.
  
  
  METHODS
  The authors performed a retrospective analysis of all abdominally based free flap breast reconstructions performed from January of 2000 through December of 2010 at their institution.
  
  
  RESULTS
  Overall, 89 of 1507 patients developed an abdominal bulge/hernia (unilateral: 57 of 1044; bilateral: 32 of 463). A unilateral transverse rectus abdominis musculocutaneous (TRAM) flap was significantly more likely to develop an abdominal bulge/hernia than was a muscle-sparing TRAM flap or a deep inferior epigastric perforator (DIEP) flap (9.9 percent versus 3.7 percent versus 5.9 percent; p = 0.004). However, there was no difference in the risk of developing an abdominal bulge/hernia between a muscle-sparing TRAM and a DIEP flap (p = 0.36). Patients who underwent bilateral reconstructions were 1.35 times more likely to develop an abdominal bulge/hernia than patients who underwent unilateral reconstruction, but the difference was not significant. Harvesting more fascia as occurs when both medial and lateral rows are used was significantly associated with need for mesh (p < 0.0001). Overall, placement of mesh for fascia closure reduced the odds of occurrence of bulge/hernia by 70 percent compared with primary fascia closure.
  
  
  CONCLUSIONS
  There was no significant difference in the risk of developing abdominal bulge/hernia between bilateral versus unilateral breast reconstruction. For abdominally based free flap breast reconstruction, the extent of the fascia harvested, how it is repaired, and the amount of muscle preserved might play an important role in donor-site morbidity.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Houston, Texas From the Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Edward I
authors.initials: EI
authors.lastname: Chang
authors.forename: Eric I
authors.initials: EI
authors.lastname: Chang
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Soto-Miranda
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
authors.forename: Naveed
authors.initials: N
authors.lastname: Nosrati
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Robb
authors.forename: David W
authors.initials: DW
authors.lastname: Chang
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects; D000328:Adult; D001940:Breast / Q000601:surgery; D000071938:Fasciotomy; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects*; D046449:Hernia, Abdominal / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods*; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods