Comparing outcomes between stacked/conjoined and non-stacked/conjoined abdominal microvascular unilateral breast reconstruction
Ara A. Salibian MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorJonathan M. Bekisz MD, MSc
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorJordan D. Frey MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorIan T. Nolan BM
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorChristodoulos Kaoutzanis MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorJason W. Yu MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorJamie P. Levine MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorNolan S. Karp MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorMihye Choi MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorCorresponding Author
Vishal D. Thanik MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Correspondence
Vishal D. Thanik, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, 6th floor, New York, NY 10017.
Email: [email protected]
Search for more papers by this authorAra A. Salibian MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorJonathan M. Bekisz MD, MSc
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorJordan D. Frey MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorIan T. Nolan BM
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorChristodoulos Kaoutzanis MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorJason W. Yu MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorJamie P. Levine MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorNolan S. Karp MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorMihye Choi MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Search for more papers by this authorCorresponding Author
Vishal D. Thanik MD
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
Correspondence
Vishal D. Thanik, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, 6th floor, New York, NY 10017.
Email: [email protected]
Search for more papers by this authorThis article was presented at the Annual Meeting of the American Society for Reconstructive Microsurgery 2020, Ft. Lauderdale, FL.
Abstract
Background
Stacked and conjoined free flaps are increasingly utilized in autologous breast reconstruction to augment tissue transfer volume. However, there is a paucity of comparative data on abdominally-based stacked/conjoined versus non-stacked/conjoined flaps. The purpose of this study was to compare ability to match native breast size, complications, recovery, and symmetrizing procedures between these two cohorts in unilateral breast reconstruction.
Methods
A retrospective review of all stacked (two separate hemiabdominal)/conjoined (bipedicled full abdominal) flaps and non-stacked/conjoined (unipedicled hemiabdominal) flaps in unilateral abdominally-based autologous breast reconstructions was performed from 2011 to 2018. Variables including demographics, operative characteristics, complications, and revisions were compared in 36 stacked/conjoined patients versus 146 non-stacked/conjoined patients.
Results
The stacked/conjoined cohort had more DIEP flaps (91.7 vs. 65.1%) and the non-stacked/conjoined group more MS-TRAMs (34.2 vs. 6.9%, p = .000). Additionally, non-stacked/conjoined flaps had greater utilization of combined medial and lateral row perforators (p = .000). Mean flap weight was significantly higher than mastectomy weight in stacked/conjoined flaps (+110.7 g) when compared to non-stacked/conjoined flaps (−40.2) (p = .023).
Average follow-up was 54.7 ± 27.5 and 54.6 ± 29.3 months, respectively. Stacked/conjoined flaps had lower fat necrosis rates (8.3 vs. 25.4%, p = .039) and had a decreased risk of fat necrosis on multivariable regression analysis (OR 0.278, p = 0.045). There were otherwise no differences in flap, breast, or donor-site complications. Stacked/conjoined flaps also had a lower rate of contralateral breast reduction (p = .041).
Conclusion
Stacked/conjoined flaps were associated with a lower risk of fat necrosis compared with non-stacked/conjoined flaps and had a lower rate of contralateral symmetrizing reductions in patients undergoing unilateral abdominally-based breast reconstruction.
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