Study Compares Procedures for Postmastectomy Reconstruction
Latissimus flaps have significantly fewer complications than other autologous methods
WEDNESDAY, March 6 (HealthDay News) -- For patients undergoing autologous postmastectomy breast reconstruction, the rates of complications vary with different procedures, according to research published in the February issue of the Journal of the American College of Surgeons.
Michael S. Gart, M.D., of the Northwestern Memorial Hospital in Chicago, and colleagues conducted a large-scale, retrospective review of data from 3,296 patients undergoing autologous breast reconstruction from the National Surgical Quality Improvement Program. Complication rates and risk factors for complications and outcomes of interest were compared for free flaps, pedicled transverse rectus abdominis myocutaneous (TRAM) flaps, latissimus, and all flaps in aggregate.
The researchers found that significant predictors of increased complications in autologous reconstruction included American Society of Anesthesiologists classification ≥3, body mass index >30 kg/m², recent surgery, delayed reconstruction, and prolonged operative times. The complication rate, need for reoperation, and rate of flap failure were highest for patients who underwent free tissue transfer. The rate of complications was significantly lower with latissimus flaps compared with other autologous methods. Venous thromboembolic disease and surgical site infections were highest in patients undergoing pedicled TRAM procedures.
"The nationwide use of pedicled flap autologous breast reconstruction remains high, at 81.5 percent. Our multivariate regression analysis showed that the 30-day complication outcomes of pedicled flaps, particularly the latissimus flap, are correspondingly lower than those for free flaps," the authors write. "Integrating this information into the patient-physician dialogue before breast reconstruction will help broaden patient education and guide informed decision-making."