Background: In contrast to cosmetic abdominoplasty, abdominal flap harvest can result a high degree of morbidity to the abdominal wall. Poor abdominal wall aesthetics that can result following free flap harvest including a high abdominal incision and post-operative hernia or bulge. We report our experience in optimizing cosmesis of the abdominal donor site with the use of a low incision, fascial plication and routine mesh reinforcement. Methods: A retrospective chart review of patients who underwent breast reconstruction with free abdominal tissue transfer from 2013-2017. Pedicled flaps and superior inferior epigastric artery flaps were excluded. Patient demographics, oncologic history, ablative and reconstructive surgery details focusing on abdominal closure techniques, and postoperative complications were evaluated. Results: 135 patients were identified who underwent 223 abdominal free flaps. 59 (26.5%) DIEP flaps were harvested, while 160 (71.7%) msTRAM and 4 (1.8%) fTRAM flaps were harvested (p<0.0001). 160 (71.7%) donor sites closures utilized polypropylene mesh, 9 (4.0%) were closed with biologic mesh and 3 (1.3%) closures used no mesh (p<0.0001). No hernias were observed (0%), while 6 abdominal bulges were identified (2.7%). There were no differences in the rates of abdominal bulge after donor site closure in the DIEP compared with msTRAM and fTRAM groups (3.4% vs 2.4%, p=0.7). No patients required mesh explantation during the study follow up period. Conclusion: To parallel cosmetic abdominoplasty, our authors advocate for a low incision, fascial plication and routine mesh reinforcement of the abdominal wall following free flap harvest.
| Published in | Journal of Surgery (Volume 9, Issue 3) |
| DOI | 10.11648/j.js.20210903.16 |
| Page(s) | 128-133 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2021. Published by Science Publishing Group |
Autologous Breast Reconstruction, Abdominal Wall, Abdominal Bulge, Abdominoplasty
| [1] | Atisha DM, Tessiatore KM, Rushing CN, Dayicioglu D, Pusic A, Hwang S. A National Snapshot of Patient-Reported Outcomes Comparing Types of Abdominal Flaps for Breast Reconstruction: Plast Reconstr Surg. 2019 Mar; 143 (3): 667–77. |
| [2] | Stalder MW, Accardo K, Allen RJ, Sadeghi A. Aesthetic Refinement of the Abdominal Donor Site after Autologous Breast Reconstruction: Plast Reconstr Surg. 2015 Sep; 136 (3): 455–61. |
| [3] | Niddam J, Bosc R, Lange F, Chader H, Hersant B, Bigorie V, et al. DIEP flap for breast reconstruction: Retrospective evaluation of patient satisfaction on abdominal results. J Plast Reconstr Aesthet Surg. 2014 Jun; 67 (6): 789–96. |
| [4] | Erdmann-Sager J, Wilkins EG, Pusic AL, Qi J, Hamill JB, Kim HM, et al. Complications and Patient-Reported Outcomes after Abdominal-Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium (MROC) Study. Plast Reconstr Surg. 2018 Feb; 141 (2): 271–81. |
| [5] | Macadam SA, Zhong T, Weichman K, Papsdorf M, Lennox PA, Hazen A, et al. Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors. Plast Reconstr Surg. 2016 Mar; 137 (3): 758–71. |
| [6] | Lindenblatt N, Gruenherz L, Farhadi J. A systematic review of donor site aesthetic and complications after deep inferior epigastric perforator flap breast reconstruction. Gland Surg. 2019 Aug; 8 (4): 389–98. |
| [7] | Nahabedian MY. Achieving ideal donor site aesthetics with autologous breast reconstruction. Gland Surg. 2015 Apr; 4 (2): 145–53. |
| [8] | Chirappapha P, Trikunagonvong N, Prapruttam D, Rongthong S, Lertsithichai P, Sukarayothin T, et al. Donor-Site Complications and Remnant of Rectus Abdominis Muscle Status after Transverse Rectus Abdominis Myocutaneous Flap Reconstruction. Plast Reconstr Surg Glob Open. 2017 Jun; 5 (6). DOI: 10.1097/GOX.0000000000001387. |
| [9] | Clemens MW, Downey S, Agullo F, Lehfeldt MR, Kind GM, Palladino H, et al. Clinical Application of a Silk Fibroin Protein Biologic Scaffold for Abdominal Wall Fascial Reinforcement. Plast Reconstr Surg Glob Open. 2014 Dec; 2 (11). DOI: 10.1097/GOX.0000000000000217. |
| [10] | Cleveland EC, Fischer JP, Nelson JA, Sieber B, Low DW, Kovach SJ, et al. Optimizing the Fascial Closure: An Analysis of 1261 Abdominally Based Free Flap Reconstructions. Ann Plast Surg. 2013 Sep; 71 (3): 255–60. |
| [11] | Leon DS, Nazerali R, Lee GK. Using Mesh to Reinforce the Abdominal Wall in Abdominal Free Flaps for Breast Reconstruction: Is There a Benefit? What are the Risks? Ann Plast Surg. 2018 Mar; 1. |
| [12] | Karagöz H, ŞahìN C, Sever C, Külahçi Y, Eren F, Cesur C, et al. Three-layer primary closure of the bipedicled TRAM flap donor site for unilateralbreast reconstruction: a 15-year experience with 124 consecutive patients. Turk J Med Sci. 2017; 47: 861–7. |
| [13] | Stone JP, Bello RJ, Siotos C, Meyer ML, Sebai ME, Payne RM, et al. Patient-Related Risk Factors for Worsened Abdominal Well-Being after Autologous Breast Reconstruction: Plast Reconstr Surg. 2020 Mar; 145 (3): 475e–80e. |
| [14] | Panchal H, Matros E. Current Trends in Postmastectomy Breast Reconstruction: Plast Reconstr Surg. 2017 Nov; 140: 7S-13S. |
| [15] | Lee K-T, Park J-W, Mun G-H. Impact of Rectus Muscle Injury during Perforator Dissection on Functional Donor Morbidity after Deep Inferior Epigastric Perforator Flap Breast Reconstruction. Plast Reconstr Surg Glob Open. 2019 Oct; 7 (10). DOI: 10.1097/GOX.0000000000002484. |
| [16] | Ingvaldsen CA, Bosse G, Mynarek GK, Berg T, Tindholdt TT, Tønseth KA. Donor-Site Morbidity After DIEAP Flap Breast Reconstruction—A 2-Year Postoperative Computed Tomography Comparison. Plast Reconstr Surg Glob Open. 2017 Jul; 5 (7). DOI: 10.1097/GOX.0000000000001405. |
| [17] | Uda H, Tomioka YK, Sarukawa S, Sunaga A, Sugawara Y. Comparison of abdominal wall morbidity between medial and lateral row-based deep inferior epigastric perforator flap. J Plast Reconstr Aesthet Surg. 2015 Nov; 68 (11): 1550–5. |
| [18] | Patel KM, Shuck J, Hung R, Hannan L, Nahabedian MY. Reinforcement of the Abdominal Wall following Breast Reconstruction with Abdominal Flaps: A Comparison of Synthetic and Biological Mesh. Plast Reconstr Surg. 2014 Mar; 133 (3): 700–7. |
| [19] | Espinosa-de-los-Monteros A, Avendano-Peza H, Novitsky YW. Abdominal Closure after TRAM Flap Breast Reconstruction with Transversus Abdominis Muscle Release and Mesh. Plast Reconstr Surg Glob Open. 2016 Sep; 4 (9). DOI: 10.1097/GOX.0000000000001014. |
| [20] | Chatterjee A, Ramkumar DB, Dawli TB, Nigriny JF, Stotland MA, Ridgway EB. The Use of Mesh versus Primary Fascial Closure of the Abdominal Donor Site When Using a Transverse Rectus Abdominis Myocutaneous Flap for Breast Reconstruction: A Cost-Utility Analysis. Plast Reconstr Surg. 2015 Mar; 135 (3): 682–9. |
| [21] | Jordan SW, Schulz SA, Carraher AM, Cabiling DS. Comparison of Polypropylene and Bioabsorbable Mesh for Abdominal Wall Reinforcement following Microsurgical Breast Reconstruction. J Reconstr Microsurg. 2019 Jun; 35 (05): 335–40. |
| [22] | Iwabu J, Namikawa T, Kitagawa H, Fujisawa K, Oki T, Ogawa M, et al. Spontaneous rupture of abdominal wall after breast reconstruction using deep inferior epigastric perforator flap following mastectomy for breast cancer. Surg Case Rep. 2018 Jul; 4. DOI: 10.1186/s40792-018-0491-7. |
| [23] | Köckerling F, Alam NN, Antoniou SA, Daniels IR, Famiglietti F, Fortelny RH, et al. What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia. 2018; 22 (2): 249–69. |
APA Style
Peter Deptula, Dung Nguyen. (2021). Abdominal Wall Closure in Autologous Breast Reconstruction: Optimizing Aesthetics. Journal of Surgery, 9(3), 128-133. https://doi.org/10.11648/j.js.20210903.16
ACS Style
Peter Deptula; Dung Nguyen. Abdominal Wall Closure in Autologous Breast Reconstruction: Optimizing Aesthetics. J. Surg. 2021, 9(3), 128-133. doi: 10.11648/j.js.20210903.16
AMA Style
Peter Deptula, Dung Nguyen. Abdominal Wall Closure in Autologous Breast Reconstruction: Optimizing Aesthetics. J Surg. 2021;9(3):128-133. doi: 10.11648/j.js.20210903.16
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Download@article{10.11648/j.js.20210903.16,
author = {Peter Deptula and Dung Nguyen},
title = {Abdominal Wall Closure in Autologous Breast Reconstruction: Optimizing Aesthetics},
journal = {Journal of Surgery},
volume = {9},
number = {3},
pages = {128-133},
doi = {10.11648/j.js.20210903.16},
url = {https://doi.org/10.11648/j.js.20210903.16},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210903.16},
abstract = {Background: In contrast to cosmetic abdominoplasty, abdominal flap harvest can result a high degree of morbidity to the abdominal wall. Poor abdominal wall aesthetics that can result following free flap harvest including a high abdominal incision and post-operative hernia or bulge. We report our experience in optimizing cosmesis of the abdominal donor site with the use of a low incision, fascial plication and routine mesh reinforcement. Methods: A retrospective chart review of patients who underwent breast reconstruction with free abdominal tissue transfer from 2013-2017. Pedicled flaps and superior inferior epigastric artery flaps were excluded. Patient demographics, oncologic history, ablative and reconstructive surgery details focusing on abdominal closure techniques, and postoperative complications were evaluated. Results: 135 patients were identified who underwent 223 abdominal free flaps. 59 (26.5%) DIEP flaps were harvested, while 160 (71.7%) msTRAM and 4 (1.8%) fTRAM flaps were harvested (p<0.0001). 160 (71.7%) donor sites closures utilized polypropylene mesh, 9 (4.0%) were closed with biologic mesh and 3 (1.3%) closures used no mesh (p<0.0001). No hernias were observed (0%), while 6 abdominal bulges were identified (2.7%). There were no differences in the rates of abdominal bulge after donor site closure in the DIEP compared with msTRAM and fTRAM groups (3.4% vs 2.4%, p=0.7). No patients required mesh explantation during the study follow up period. Conclusion: To parallel cosmetic abdominoplasty, our authors advocate for a low incision, fascial plication and routine mesh reinforcement of the abdominal wall following free flap harvest.},
year = {2021}
}
TY - JOUR T1 - Abdominal Wall Closure in Autologous Breast Reconstruction: Optimizing Aesthetics AU - Peter Deptula AU - Dung Nguyen Y1 - 2021/05/27 PY - 2021 N1 - https://doi.org/10.11648/j.js.20210903.16 DO - 10.11648/j.js.20210903.16 T2 - Journal of Surgery JF - Journal of Surgery JO - Journal of Surgery SP - 128 EP - 133 PB - Science Publishing Group SN - 2330-0930 UR - https://doi.org/10.11648/j.js.20210903.16 AB - Background: In contrast to cosmetic abdominoplasty, abdominal flap harvest can result a high degree of morbidity to the abdominal wall. Poor abdominal wall aesthetics that can result following free flap harvest including a high abdominal incision and post-operative hernia or bulge. We report our experience in optimizing cosmesis of the abdominal donor site with the use of a low incision, fascial plication and routine mesh reinforcement. Methods: A retrospective chart review of patients who underwent breast reconstruction with free abdominal tissue transfer from 2013-2017. Pedicled flaps and superior inferior epigastric artery flaps were excluded. Patient demographics, oncologic history, ablative and reconstructive surgery details focusing on abdominal closure techniques, and postoperative complications were evaluated. Results: 135 patients were identified who underwent 223 abdominal free flaps. 59 (26.5%) DIEP flaps were harvested, while 160 (71.7%) msTRAM and 4 (1.8%) fTRAM flaps were harvested (p<0.0001). 160 (71.7%) donor sites closures utilized polypropylene mesh, 9 (4.0%) were closed with biologic mesh and 3 (1.3%) closures used no mesh (p<0.0001). No hernias were observed (0%), while 6 abdominal bulges were identified (2.7%). There were no differences in the rates of abdominal bulge after donor site closure in the DIEP compared with msTRAM and fTRAM groups (3.4% vs 2.4%, p=0.7). No patients required mesh explantation during the study follow up period. Conclusion: To parallel cosmetic abdominoplasty, our authors advocate for a low incision, fascial plication and routine mesh reinforcement of the abdominal wall following free flap harvest. VL - 9 IS - 3 ER -
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