title: The impact of complications on function, health, and satisfaction following abdominally based autologous breast reconstruction: a prospective evaluation.
abstract: BACKGROUND
  The impact of surgical complications following autologous reconstruction on abdominal strength, health, and satisfaction is not completely understood. We prospectively examined the effect of complications on these aspects in patients undergoing abdominally-based autologous reconstruction.
  
  
  METHODS
  A prospective study of patients who underwent autologous breast reconstruction between 2005 and 2010 was performed at a single teaching hospital. Patients enrolled in the study completed an abdominal strength functional assessment, the Short Form 36 (SF-36), and a satisfaction survey. Data were obtained at preoperative, early (<90 d), intermediate (90-365 d), and late (>365 d) follow-up visits. Patients who experienced surgical complications were compared with patients who did not. A subgroup analysis examined the specific impact of abdominal complications.
  
  
  RESULTS
  Overall, 97 enrolled patients had preoperative, early and intermediate follow up. Forty of these patients had late follow-up. Fifty-six (58%) experienced surgical complications. After reconstruction, the complications group had decreased upper abdominal strength and function scores through early (p = 0.009, p = 0.01) and intermediate (p = 0.01, p = 0.06) follow-up. SF-36 physical health (p = 0.053) trended towards being lower in the early follow-up period. The complications group was less satisfied with the overall cosmetic result (p = 0.01) and shape of breasts (p = 0.02) through intermediate follow-up. At late follow-up, both cohorts recovered to baseline values in all study aspects. Patients with abdominal complications alone followed similar trends, with decreased upper abdominal strength and FIM scores through intermediate follow up.
  
  
  CONCLUSIONS
  Having a major postoperative complication can significantly impact early physical health, mental health, abdominal strength, and patient satisfaction. Beyond one year, recovery towards baseline may occur in the majority of patients.
  
  
  METHODS
  Prognostic/Risk Study, Level II.
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Lu
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: Jonas.nelson@uphs.upenn.edu.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Fosnot
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Goldstein
authors.affiliation: Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Selber
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
mesh_terms: D034861:Abdominal Wall / Q000503:physiopathology* / Q000601:surgery; D000328:Adult; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects*; D006304:Health Status; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000523:psychology; D008875:Middle Aged; D053580:Muscle Strength; D018908:Muscle Weakness / Q000209:etiology; D064827:Myocutaneous Flap / Q000009:adverse effects*; D017060:Patient Satisfaction; D011446:Prospective Studies
keywords: Abdominal function; Abdominal strength; Breast reconstruction; Complications; DIEP; Free flap; Prospective; Short Form 36