title: Analysis of Flap Weight and Postoperative Complications Based on Flap Weight in Patients Undergoing Microsurgical Breast Reconstruction.
abstract: BackgroundHigher body mass index (BMI) has been shown to increase postoperative complications in autologous breast reconstruction. However, the correlation with flap weight is unknown. Here, we explore the relationship of flap weights and complication rates in patients undergoing microvascular breast reconstruction.MethodsRetrospective chart review identified all patients undergoing microvascular breast reconstruction with abdominally based flaps at a single institution between November 2007 and April 2013. Breasts with documented flap weight and 1-year follow-up were included. Patients undergoing stacked deep inferior epigastric perforator flaps were excluded. Breasts were divided into quartiles based on flap weight and examined by demographics, surgical characteristics, complications, and revisions.ResultsA total of 130 patients undergoing 225 flaps were identified. Patients had a mean age of 50.4 years, mean BMI of 27.1 kg/m2, and mean flap weight of 638.4 g (range: 70-1640 g). Flap weight and BMI were directly correlated. Flaps were divided into weight-based quartiles: first (70-396 g), second (397-615 g), third (616-870 g), and fourth (871-1640 g). There were no associations between flap weight and incidences of venous thrombosis, arterial thrombosis, hematoma, flap loss, fat necrosis, or donor site hernia. However, increased flap weight was associated with increased rate of donor site wound healing problems in both univariate and multivariate analysis.ConclusionsIncreased flap weight is not associated with added flap complications among patients undergoing microvascular breast reconstruction, however, patients with flaps of 667.5 g or more are more likely to have donor site healing problems. The success and evidence contrary to previous studies may be attributed to surgeon intraoperative flap choice.
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Gretl
authors.initials: G
authors.lastname: Lam
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein School of Medicine, Bronx, New York.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Reavey
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Stelios C
authors.initials: SC
authors.lastname: Wilson
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Levine
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Pierre B
authors.initials: PB
authors.lastname: Saadeh
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Allen
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Mihye
authors.initials: M
authors.lastname: Choi
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Nolan S
authors.initials: NS
authors.lastname: Karp
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Vishal D
authors.initials: VD
authors.lastname: Thanik
mesh_terms: D015992:Body Mass Index; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply / Q000473:pathology*; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology*; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors