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J Reconstr Microsurg 2021; 37(07): 566-579
DOI: 10.1055/s-0041-1723816
Original Article

The Impact of Prior Abdominal Surgery on Complications of Abdominally Based Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis

Evalina S. Bond
1   Department of Surgery, Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
,
Carol E. Soteropulos 
1   Department of Surgery, Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
,
Qiuyu Yang
1   Department of Surgery, Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
,
Samuel O. Poore    ∗
1   Department of Surgery, Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Abstract

Background Approximately half of all patients presenting for autologous breast reconstruction have abdominal scars from prior surgery, the presence of which is considered by some a relative contraindication for abdominally based reconstruction. This meta-analysis examines the impact of prior abdominal surgery on the complication profile of breast reconstruction with abdominally based free tissue transfer.

Methods Literature search was conducted using PubMed, Scopus, and Web of Science. Included studies examined patients with a history of prior abdominal surgery who then underwent abdominally based free flap breast reconstruction. Prior liposuction patients and those with atypical flap designs were excluded. The Newcastle-Ottawa Scale was used to assess study quality. Flap complications included total and partial flap loss, fat necrosis, infection, and reoperation. Donor-site complications included delayed wound healing, infection, seroma, hematoma, and abdominal wall morbidity (hernia, bulge, laxity). Relative risk and 95% confidence intervals (CIs) between groups were calculated. Forest plots, I 2 statistic heterogeneity assessments, and publication bias funnel plots were produced. Publication bias was corrected with a trim-and-fill protocol. Overall effects were assessed by fixed-effects and random-effects models.

Results After inclusion and exclusion criteria were applied, 16 articles were included for final review. These included 14 cohort and 2 case–control studies, with 1,656 (46.3%) patients and 2,236 (48.5%) flaps having undergone prior surgery. Meta-analysis showed patients with prior abdominal surgery were significantly more likely to experience donor-site delayed wound healing with a risk ratio of 1.27 (random 95% CI [1.00; 1.61]; I 2= 4) after adjustment for publication bias. No other complications were statistically different between groups.

Conclusion In patients with a history of prior abdominal surgery, abdominally based free tissue transfer is a safe and reliable option. Abdominal scars may slightly increase the risk of delayed donor-site wound healing, which can aid the surgeon in preoperative counseling.

Keywords

autologous breast reconstruction - DIEP flap - abdominal scar - prior abdominal surgery - cesarean section

Authors' Contributions

E.S.B. and C.E.S. conceptualized, designed, and drafted the manuscript. E.S.B. collected and analyzed the data. C.E.S. and S.O.P. revised the manuscript and analyzed the data. Q.Y. analyzed the data analysis and drafted the manuscript.


∗ Twitter handle: @drsamuelpoore


Supplementary Material



Publication History

Received: 16 July 2020

Accepted: 15 December 2020

Article published online:
01 March 2021

© 2021. Thieme. All rights reserved.

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