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Articles

Divulge the bulge: an international survey of abdominal donor site morbidity in free autologous breast reconstruction

ORCID Icon, ORCID Icon, &
Pages 265-270 | Received 14 Dec 2018, Accepted 12 Mar 2019, Published online: 23 Apr 2019
 

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.

Disclosure statement

The authors report no commercial associations or financial interests which may pose or create a conflict of interest regarding anything in this article.

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