Patient-Reported Abdominal Morbidity Following Abdomen-Based Breast Reconstruction.

BACKGROUND: Abdominal wall morbidity occurs with increased frequency following flap harvest in the obese abdomen. Its impact on patient-reported outcomes in breast reconstruction has been poorly characterized.

METHODS: A retrospective review of obese patients undergoing abdominal-based free autologous breast reconstruction (ABFABR) was conducted over fifteen years. Patient and operative characteristics were recorded and outcomes analyzed. Patient-reported outcomes (PRO) were assessed using the BREAST-Q™ abdominal survey.

RESULTS: 75 women (108 flaps) with mean body mass index (BMI) of 33.2 were included. Flaps included deep inferior epigastric artery perforator (DIEP; 24%), muscle-sparing (MS-TRAM; 43%) and free transverse rectus abdominis myocutaneous flaps (f-TRAM; 33%). World Health Organization (WHO) obesity class, BMI, and flap type did not affect flap failure (1%) or complication rates. Hernia developed in seven percent; all necessitated repair. Eight percent developed abdominal bulge; one was repaired. Hernia formation was associated with increased patient age (p<0.05). Bulge formation occurred more often in f-TRAM donor sites (p=0.005). BMI, WHO class, flap type, and mesh use were not related to hernia or bulge occurrence in either univariate or multivariate analysis. Survey response rate was 63%. Abdominal Physical Well-Being (proxy for abdominal wall function) and Satisfaction with Abdomen (patient-perceived cosmesis) were similar across flap types, age, and WHO classification groups. Patients with post-op bulge reported higher abdominal physical well-being scores, regardless of flap type (p<0.01). Bulge was correlated with lower satisfaction (p<0.05).

CONCLUSION: The incidence of abdominal wall morbidity following abdominal free-tissue transfer for breast reconstruction was acceptably low in our population of obese patients. Hernia was a clinically significant complication, warranting surgical repair. Bulge was a primarily cosmetic concern and did not detract from patient-reported abdominal wall function. Age may represent an independent risk factor for hernia formation in this population.