Comparing outcomes between stacked/conjoined and non‐stacked/conjoined abdominal microvascular unilateral breast reconstruction. Issue 3 (30th September 2020) - Salibian, Ara A.
Abstract: Background: Stacked and conjoined free flaps are increasingly utilized in autologous breast reconstruction to augment tissue transfer volume. However, there is a paucity of comparative data on abdominally‐based stacked/conjoined versus non‐stacked/conjoined flaps. The purpose of this study was to compare ability to match native breast size, complications, recovery, and symmetrizing procedures between these two cohorts in unilateral breast reconstruction. Methods: A retrospective review of all stacked (two separate hemiabdominal)/conjoined (bipedicled full abdominal) flaps and non‐stacked/conjoined (unipedicled hemiabdominal) flaps in unilateral abdominally‐based autologous breast reconstructions was performed from 2011 to 2018. Variables including demographics, operative characteristics, complications, and revisions were compared in 36 stacked/conjoined patients versus 146 non‐stacked/conjoined patients. Results: The stacked/conjoined cohort had more DIEP flaps (91.7 vs. 65.1%) and the non‐stacked/conjoined group more MS‐TRAMs (34.2 vs. 6.9%, p = .000). Additionally, non‐stacked/conjoined flaps had greater utilization of combined medial and lateral row perforators ( p = .000). Mean flap weight was significantly higher than mastectomy weight in stacked/conjoined flaps (+110.7 g) when compared to non‐stacked/conjoined flaps (−40.2) ( p = .023). Average follow‐up was 54.7 ± 27.5 and 54.6 ± 29.3 months, respectively. Stacked/conjoined flaps had lower fat necrosis rates (8.3 vs. 25.4%, p = .039) and had a decreased risk of fat necrosis on multivariable regression analysis (OR 0.278, p = 0.045). There were otherwise no differences in flap, breast, or donor‐site complications. Stacked/conjoined flaps also had a lower rate of contralateral breast reduction ( p = .041). Conclusion: Stacked/conjoined flaps were associated with a lower risk of fat necrosis compared with non‐stacked/conjoined flaps and had a lower rate of contralateral symmetrizing reductions in patients undergoing unilateral abdominally‐based breast reconstruction.