Secondary operations of the anterior abdominal wall following breast reconstruction with abdominal flaps are sometimes performed to improve outcome. These may be considered necessary to correct a complication or elective to improve on the cosmetic result. The purpose of this study was to review a single surgeon's experience with secondary abdominal operations following breast reconstruction with the DIEP and free TRAM flap.
Over a 7-year period, 330 women had microvascular breast reconstruction using abdominal flaps. This included 162 women who had a free TRAM flap [123 unilateral (UFT) and 39 bilateral (BFT)] and 168 women who had a DIEP flap [120 unilateral (UD) and 48 bilateral (BD)] totaling 419 flaps. Indications for secondary abdominal operations that were considered necessary included bulge, abdominal skin necrosis (wound), hematoma, neuroma, and seroma. Indications that were considered elective included lateral dog-ear scars and lipodystrophy. Mean follow-up was 40 months (range: 3–84 months).
Secondary abdominal operations were performed in 59 women (17.9%) for 64 indications (19.3%). The indications were considered necessary in 33 (10%) and elective in 31 (9.4%). The number of indications was 33 (10%) for the free TRAM group and 31 (9.4%) for the DIEP group. Lower abdominal bulge was the most common necessary indication and repaired in 9.3% of free TRAM flaps and 4.7% of DIEP flaps. The relative rate of occurrence was 6.5% (UFT), 17.9% (BFT), 4.2% (UD) and 10.4% (BD). All bulges were confirmed by the patient and surgeon and all, except one (true hernia following UFT), were secondary to attenuation of the anterior rectus sheath. Dog-ear scars were the most common elective indication and revised in 29 women (8.8%). The relative frequency was 7.3% (UFT), 10.3% (BFT), 9.2% (UD), and 10.4% (BD). A neuroma of the ilioinguinal nerve was diagnosed in 3 women (0.9%) and appropriately treated. Secondary procedures for abdominal skin necrosis (n = 3), hematoma (n = 3), seroma (n = 1), and lipodystrophy (n = 2) were rare in this series.
The incidence of secondary procedures of the abdominal wall following microvascular breast reconstruction using abdominal flaps approximates 20%, with an equal distribution between necessary and elective procedures. Lower abdominal bulge was the most significant indication, but dog-ear scars were the most common. Women considering breast reconstruction using a free TRAM or DIEP flap should be advised of these statistics.
