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J Reconstr Microsurg 2020; 36(09): 694-702
DOI: 10.1055/s-0040-1714426
Original Article

Impact of Smoking Status in Free Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: A Multicenter Study

Lukas Prantl‡   *
1   Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
,
Nicholas Moellhoff‡   *
2   Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
,
Uwe V. Fritschen
3   Department of Plastic and Esthetic Surgery, Hand Surgery, Helios Hospital Emil von Behring, Berlin, Germany
,
Guenter Germann
4   Department of Plastic, Reconstructive, Esthetic and Handsurgery, ETHIANUM Klinik Heidelberg, Heidelberg, Germany
,
Riccardo E. Giunta
2   Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
,
Florian Zeman
5   Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
,
Andreas Kehrer 
1   Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
,
Daniel Lonic
1   Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
,
P. Niclas Broer
6   Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
,
Denis Ehrl
2   Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
,
Paul I. Heidekrueger
1   Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
› Author Affiliations Funding None.
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Abstract

Background Several patient-related factors have been identified with regard to the safety and efficacy of breast reconstructions. Using the largest database available in Europe, the presented study investigated the impact of cigarette smoking on deep inferior epigastric artery perforator (DIEP) free-flap breast reconstructions.

Methods In total, 3,926 female patients underwent 4,577 free DIEP-flap breast reconstructions after malignancies in 22 different German breast cancer centers. The cases were divided into two groups: nonsmokers (NS) and smokers (S). Impact of smoking on surgical complications, controlled for covariates, and cluster effects within the cancer centers were analyzed by using generalized linear mixed models.

Results Overall, there was no significant difference between the groups of patients regarding the rate of total flap loss. However, the rate of partial flap loss (0.9 vs. 3.2%, p < 0.001) and wound-healing disturbances requiring revision surgery (donor site: 1.5 vs. 4.0; recipient site: 1.3 vs. 3.6%, both p < 0.001) was significantly higher in smokers. Multivariable analysis identified smoking to be an independent risk factor for revision surgery (p = 0.001) and partial flap loss (p < 0.0001).

Conclusion Our findings suggest that successful free tissue transfer can be achieved in smokers despite higher rates of partial flap losses and wound-healing disturbances. However, patients with a history of smoking requiring DIEP flap reconstruction should be critically evaluated preoperatively, informed in detail about the higher risk of complications and encouraged to quit smoking prior to surgery.

Keywords

DIEP flap - smoking status - breast reconstruction

* These authors have contributed equally to the preparation of the manuscript.




Publication History

Received: 30 March 2020

Accepted: 16 June 2020

Article published online:
29 July 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

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