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Background:. The incidence of bilateral mastectomies is increasing along with the rates of breast reconstructions. A substantial number of patients will present with abdominal scars after Cesarean section, laparoscopy, laparotomy, and so on. The aim of this study was to evaluate the impact of prior abdominal scars on complication rates in abdominal...
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Context 1
... (n = 243) P The scar locations on the abdominal wall were as follows: Pfannenstiel (n = 73; 30.1%), midline (n = 16; 6.6%), lower oblique (n = 17; 7.0%), upper oblique (n = 5; 2.1%), and laparoscopic (n = 69; 28.4%). Some pa- tients also had more than 1 scar each, most often hav- ing a combination of Pfannenstiel and another incision (Table 2; Fig. ...
Context 2
... have addressed the effects of prior abdominal surgery on the autologous breast recon- struction. [7][8][9][10][11] The main limitation of these studies is that their data were analyzed on a per flap basis, where the variables for unilateral and bilateral procedures were col- *Some patients had a combination of scars and more than 1 procedure, see Fig. 1. †Five patient underwent prophylactic bilateral salpingoophorectomy concur- rently with breast ...
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Citations
... In bilateral flap harvest for breast reconstruction, this risk of scarring is particularly important as both hemi-abdomens are required. Although the safety of bilateral abdomen-based free flap reconstruction in patients with certain abdominal scars has been shown [2], abdominal scar remains a relative contraindication in the eyes of the reconstructive surgeon. This case report of a female with a history of two stoma formations and reversals and multiple other laparotomies, who underwent successful bilateral abdominal flap based breast reconstruction, highlights that even the most complex abdominal surgery is not an absolute contraindication to this procedure. ...
... Unilateral and bilateral DIEP flap breast reconstruction in women with certain abdominal scars has been shown to be feasible [1,2,10]. Retrospective studies comparing flap outcomes between patients with and without abdominal scar have shown comparable flap outcomes (flap loss, fat necrosis) with an increased risk of donor site healing complications (delayed healing, hernia formation, seroma) [1,10]. ...
Introduction:
This case reports a female patient with a history of multiple laparotomies including stoma formations and reversals, who underwent successful bilateral abdominal flap based breast reconstruction. It highlights that even complex and repeated abdominal surgery is not an absolute contraindication to this procedure.
Presentation of case:
A 52-year-old female with a history of bilateral mastectomy and implant-based breast reconstruction presented with bilateral capsular contracture, wanting removal and alternative breast reconstruction. Her history of ulcerative colitis and multiple complex and extensive abdominal surgeries initially seemed to preclude bilateral abdominal flap harvest and the patient was referred on for another opinion. CT-angiography after the subsequent opinion identified adequate deep inferior epigastric artery perforators and successful bilateral abdomen-based flap reconstruction was performed.
Discussion:
This is the first case report of successful bilateral abdomen-based flap harvest in a patient with 6 previous laparotomies including stoma formations and reversals.
Conclusion:
Complex and extensive abdominal surgery is not an absolute contraindication to bilateral flap harvest from the abdomen. With accurate CT-angiography to guide pre-operative planning and meticulous surgery, safe flap harvest is possible.
... Unilateral and bilateral DIEP flap breast reconstruction in women with abdominal scars is feasible [2,3,4]. These comparative retrospective studies have shown comparable flap outcomes (flap loss, fat necrosis) with an increased risk of donor site healing complications (delayed healing, hernia formation, seroma) [3,4]. ...
Background:
Patients with limited English proficiency (LEP) have starkly different healthcare experiences compared to their English proficient counterparts. The authors aim to examine the link between LEP and postoperative outcomes in patients undergoing microsurgical breast reconstruction.
Methods:
A retrospective review of all patients who underwent abdominal-based microsurgical breast reconstruction at our institution between 2009 and 2019 was performed. Variables collected include patient demographics, language status, interpreter usage, perioperative complications, follow-up visits, and self-reported outcomes (Breast-Q). Pearson's χ2 test, Student's t-test, odds ratio analysis, and regression modeling was used for analysis.
Results:
A total of 405 patients were included. LEP patients comprised 22.22% of the overall cohort with 80% of LEP patients utilizing interpreter services. LEP patients reported significantly lower satisfaction with abdominal appearance at the 6-month follow-up and lower physical and sexual well-being scores at the 1-year follow-up (p = 0.05, 0.02, 0.01, respectively). Non-LEP patients had significantly longer operative times (539.6 vs 499.3 minutes, p=0.024), were more likely to have post-operative donor site revisions (p=0.05), and more likely to receive pre-operative neuraxial anesthesia (p=0.01). After adjusting for confounders, LEP stats was associated with 0.93 fewer follow-up visits (p=0.02). Interestingly, compared to LEP patients who did not receive interpreter services, LEP patients who did had 1.98 more follow up visits (p=0.02). There were no significant differences in emergency room visits or complications between the cohorts.
Conclusion:
Our findings suggest that language disparities exist within microsurgical breast reconstruction and underscore the importance of effective, language-conscious communication between surgeon and patient.
Background:
Abdominal scars can affect the patency of deep inferior epigastric artery (DIEA) perforators and are a concern when planning free flap breast reconstruction (FFBR). Computed tomography angiography (CTA) is routinely used for preoperative DIEA flap imaging. We investigated CTA utility in predicting the most clinically useful DIEA perforators in scarred abdomens.
Methods:
A single surgeon's CTA FFBR patients were studied. All were imaged by one radiologist. CTA reports, abdominal scars, and flap intraoperative details were analyzed. The operative findings were then correlated with the CTA "predictions."
Results:
A hundred and six patients with preoperative CTAs underwent 132 FFBRs, 44% (58) from scarred and 56% (74) from virgin abdomens. All flap transfers were successful. Concordance between perforators identified by CTA preoperatively and those selected by the surgeon intraoperatively was 95% (scarred 93%; non-scarred 96%, P = 0.470). There was a significant difference in the proportion of single-perforator flaps between the two groups (scarred 46%; non-scarred 28%, P = 0.041). "Scarred" flaps were heavier (789 vs 676 g, P = 0.0244) than those harvested from virgin abdomens.
Conclusions:
CTA accurately predicted perforator choice in flaps from scarred and virgin abdomens. "Scarred" flaps are more likely to be heavier and based on one perforator suggesting that scarring may have an effect on intraflap vascular anatomy. Further investigations are needed to delineate the mechanism by which this occurs.
