Divulge the bulge: an international survey of abdominal donor site morbidity in free autologous breast reconstruction. Issue 5 (3rd September 2019)

• Record Type: Journal Article
• Authors: Christie, Brian; Shulzhenko, Nikita O.; Poore, Samuel O.; Afifi, Ahmed M.
• Is Part Of: Journal of plastic surgery and hand surgery. Volume 53:Issue 5(2019)
• Page Start: 265
• Page End: 270
• Publication Date: 2019-09-03
• Subjects: Breast reconstruction -- complication -- perforator -- microvascular -- plastic surgery -- survey -- international; Surgery -- Periodicals; Hand -- Surgery -- Periodicals; Orthopedics -- Periodicals; Surgery, Plastic -- Periodicals; 617.95
• DOI: 10.1080/2000656X.2019.1597372
• Languages: English
• ISSNs: 2000-656X

Abstract

Abstract: The frequency of donor-site complications following abdominal free-flap breast reconstruction remains controversial. Consensus on strategies to minimize morbidity is underdeveloped. An online survey was distributed to surgeons practicing free-flap breast reconstruction worldwide. Contact information was obtained via (1) official website listings/directories of US Plastic Surgery residencies/fellowships and (2) first/last authors of PubMed-indexed publications relating to free autologous breast reconstruction over the past decade. Questions related to practice environment, surgical volume/preferences, complications, mesh-use, referrals and perceptions of interventions for decreasing abdominal complications. Statistics were performed using non-parametric Kruskal–Wallis H test. The response rate was 26% (140/537). The majority of respondents came from the United States (100, 71%), and reported an academic practice environment (120, 86%). Fifty-six percent reported bulge rates ≥3% and sixteen percent reported bulge rates ≥10%. Most (93%) reported 0–2% hernia incidence. Those performing fewer surgeries were more likely to use mesh ( p =.034) and report higher bulge incidence ( p =.002). US surgeons performed a lower fraction of deep inferior epigastric perforator (DIEP) flaps ( p <.001) and were more likely to believe that mesh use lowered complication risk ( p <.001). Bulge and hernia incidence were associated with an increased proportion of non-DIEPs performed and mesh use ( p =.004 and p =.024). Most respondents (54%) 'never' or 'rarely' had patients see occupations/physical therapy postoperatively. Bulge and abdominal muscle weakness are under-recognized donor site complications following free-flap breast reconstruction. Low surgical volume, non-DIEP reconstruction and mesh use may be associated with higher complication rates. Current practice patterns to reduce morbidity vary widely both domestically and internationally.