Venous Coupler Size in Autologous Breast Reconstruction – Does it Matter?

Background:

Autologous microvascular breast reconstruction has become an increasingly common reconstructive procedure. The venous anastomoses are commonly completed with a coupler device. While its efficacy has been shown using 3.0 mm size and greater, little is known about the consequences of using coupler sizes less than 2.5 mm.

Methods:

A retrospective chart review of all patients undergoing autologous breast reconstruction was conducted at New York University Medical Center (2007 – 2011). Flaps were divided based on coupler size used: 1.5 mm, 2.0 mm, 2.5 mm, 3.0 mm, and 3.5 mm. Outcomes were measured by incidence of arterial or venous insufficiency, hematoma, fat necrosis, partial flap loss, full flap loss, and need for future fat grafting.

Results:

197 patients (392 flaps) were evaluated. Patients were similar in age, type of flap, smoking status, and radiation history. Coupler size less than or equal to 2.0 mm was found to be a significant risk factor for venous insufficiency (p =.038); risk reduction with coupler size greater than or equal to 2.5 mm 87%) as well as for development of fat necrosis (p =.041; 73% risk reduction) and need future need for fat grafting (45% reduction).

Conclusions:

Postoperative complications are significantly increased in patients requiring the use of 2.0 mm venous coupler. Vessel modification including beveling or fish-mouthing, as well as more aggressive vessel exposure through rib harvest should be considered. Additionally, the use of thoracodorsal vessels or hand-sewn anastomosis should be considered in cases of IMV caliber of 2.0 mm or less.