Concurrent Ventral Hernia Repair Is Effective in Patients Undergoing Abdominally Based Microsurgical Breast ReconstructionFunding None.
Background The abdomen remains the most preferable donor site for autologous breast reconstruction. Many patients in this population will have had prior abdominal surgery, which is the chief risk factor for having a ventral hernia. While prior studies have examined the impact of prior abdominal surgery on breast reconstruction, limited data exist on the management of patients with a preexisting ventral hernia. The objective of this study was to investigate outcomes of performing ventral hernia repair concurrent with abdominally based microsurgical breast reconstruction.
Methods A 5-year retrospective review of patients undergoing abdominally based microsurgical breast reconstruction was performed. The experimental group consisted of patients with a preexisting ventral hernia that was repaired at the time of breast reconstruction, and was compared with a historical cohort of patients without preexisting hernias.
Results There were a total of 18 and 225 patients in the experimental and control groups, respectively. There was a higher incidence of prior abdominal surgery in the experimental group (p = 0.0008), but no other differences. Mean follow-up was 20.5 ± 5.2 months. There were no instances of recurrent hernia or flap loss in the experimental group. No significant differences were observed between the experimental and control groups in the incidence of donor-site complications (27.8 vs. 20.9%, respectively; p = 0.55), recipient site complications (27.8 vs. 24.0%, respectively; p = 0.78), operative time (623 ± 114 vs. 598 ± 100 minutes, respectively; p = 0.80), or length of stay (3.4 ± 0.5 vs. 3.1 ± 0.4 days, respectively; p = 0.98).
Conclusion Concurrent ventral hernia repair at the time of abdominally based microsurgical breast reconstruction appears to be safe and effective. Larger studies are needed to further define this relationship.
Received: 12 January 2020
Accepted: 20 April 2020
15 June 2020 (online)
Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.
- 1 Granzow JW, Levine JL, Chiu ES, Allen RJ. Breast reconstruction with the deep inferior epigastric perforator flap: history and an update on current technique. J Plast Reconstr Aesthet Surg 2006; 59 (06) 571-579
- 2 Holoyda KA, Simpson AM, Ye X, Agarwal JP, Kwok AC. Immediate bilateral breast reconstruction using abdominally based flaps: an analysis of the nationwide inpatient sample database. J Reconstr Microsurg 2019; 35 (08) 594-601
- 3 Kwok AC, Simpson AM, Ye X, Tatro E, Agarwal JP. Immediate unilateral breast reconstruction using abdominally based flaps: analysis of 3,310 cases. J Reconstr Microsurg 2019; 35 (01) 74-82
- 4 Center for Disease Control United States Cancer Statistics Data Visualizations. Available at: https://gis.cdc.gov/grasp/USCS/DataViz.html . Accessed December 8, 2019
- 5 Roostaeian J, Yoon AP, Sanchez IS. , et al. The effect of prior abdominal surgery on abdominally based free flaps in breast reconstruction. Plast Reconstr Surg 2014; 133 (03) 247e-255e
- 6 Vyas RM, Dickinson BP, Fastekjian JH, Watson JP, Dalio AL, Crisera CA. Risk factors for abdominal donor-site morbidity in free flap breast reconstruction. Plast Reconstr Surg 2008; 121 (05) 1519-1526
- 7 Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL. Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg 2006; 118 (05) 1100-1109 , discussion 1110–1111
- 8 Laporta R, Longo B, Sorotos M, Santanelli di Pompeo F. Tips and tricks for DIEP flap breast reconstruction in patients with previous abdominal scar. Microsurgery 2017; 37 (04) 282-292
- 9 Doval AF, Lamelas AM, Daly LT. , et al. Deep inferior epigastric artery perforator flap breast reconstruction in women with previous abdominal incisions: a comparison of complication rates. Ann Plast Surg 2018; 81 (05) 560-564
- 10 Manrique OJ, Bustos SS, Mohan AT. , et al. Robotic-assisted DIEP flap harvest for autologous breast reconstruction: a comparative feasibility study on a cadaveric model. J Reconstr Microsurg 2020
- 11 Di Candia M, Asfoor AA, Jessop ZM, Kumiponjera D, Hsieh F, Malata CM. Previous multiple abdominal surgeries: a valid contraindication to abdominal free flap breast reconstruction?. Eplasty 2012; 12: e31
- 12 Hsieh F, Kumiponjera D, Malata CM. An algorithmic approach to abdominal flap breast reconstruction in patients with pre-existing scars--results from a single surgeon's experience. J Plast Reconstr Aesthet Surg 2009; 62 (12) 1650-1660
- 13 Dayhim F, Wilkins EG. The impact of Pfannenstiel scars on TRAM flap complications. Ann Plast Surg 2004; 53 (05) 432-435
- 14 Parrett BM, Caterson SA, Tobias AM, Lee BT. DIEP flaps in women with abdominal scars: are complication rates affected?. Plast Reconstr Surg 2008; 121 (05) 1527-1531
- 15 Takeishi M, Shaw WW, Ahn CY, Borud LJ. TRAM flaps in patients with abdominal scars. Plast Reconstr Surg 1997; 99 (03) 713-722
- 16 Schoeller T, Huemer GM, Kolehmainen M, Otto-Schoeller A, Wechselberger G. Management of subcostal scars during DIEP-flap raising. Br J Plast Surg 2004; 57 (06) 511-514
- 17 Hughes KC, Weider L, Fischer J. , et al. Ventral hernia repair with simultaneous panniculectomy. Am Surg 1996; 62 (08) 678-681
- 18 Saxe A, Schwartz S, Gallardo L, Yassa E, Alghanem A. Simultaneous panniculectomy and ventral hernia repair following weight reduction after gastric bypass surgery: is it safe?. Obes Surg 2008; 18 (02) 192-195 , discussion 196
- 19 Fischer JP, Tuggle CT, Wes AM, Kovach SJ. Concurrent panniculectomy with open ventral hernia repair has added risk versus ventral hernia repair: an analysis of the ACS-NSQIP database. J Plast Reconstr Aesthet Surg 2014; 67 (05) 693-701
- 20 Fischer JP, Basta MN, Wink JD, Wes AM, Kovach SJ. Optimizing patient selection in ventral hernia repair with concurrent panniculectomy: an analysis of 1974 patients from the ACS-NSQIP datasets. J Plast Reconstr Aesthet Surg 2014; 67 (11) 1532-1540
- 21 Warren JA, Epps M, Debrux C. , et al. Surgical site occurrences of simultaneous panniculectomy and incisional hernia repair. Am Surg 2015; 81 (08) 764-769