Abstract
Background Higher 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.
Methods Retrospective 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.
Results A 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.
Conclusions Increased 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.
Keywords
microsurgical breast reconstruction - flap weight - postoperative complications
