Patients with breast cancer who undergo a mastectomy followed by breast reconstruction using a transplanted flap of their own tissue have a low rate of early postoperative complications. However, a new study found that their risk varies by the type of flap procedure they undergo. The large-scale, multicenter study indicates that a flap technique known as free flap appears to have a higher rate of 30-day postoperative complications compared with pedicle flap techniques.

Although tissue expansion with an implant is the most common type of breast reconstruction performed, many women prefer the more natural results of using their own, or “autologous,” tissue. However, it has been unclear which of the many autologous reconstructive techniques renders the best result and fewest postoperative complications according to study authors.

“This study is one of the largest to report short-term outcomes of autologous breast reconstruction,” said principal investigator John Kim, MD, FACS, of Northwestern University Feinberg School of Medicine in Chicago, Illinois. “Now we can inform women of some risk factors for complications, calculated using nationwide data from multiple independent sources. The good news is that serious complications are rare and these procedures are generally safe.”

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Kim and colleagues used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for this study so they could analyze surgical outcomes data from nearly 3,300 women who had autologous breast reconstruction. Next, they used the data to track complications within the first month after reconstructive procedures performed at more than 240 medical centers across the United States from 2006 to 2010.

The investigators included women in the study who had one of three common flap procedures: pedicle TRAM flap (which stands for the transverse rectus abdominis myocutaneous muscle), latissimus dorsi flap, or free flap.

Kim and colleagues found that only 12.5% of autologous breast reconstructive procedures result in short-term complications despite the fact that flap breast reconstruction is a complex surgical technique. “There are minor and treatable flap complications that can occur, such as wound infection, but serious complications, such as heart attack, were rare,” Kim said. “Our study dispels the notion that autologous breast reconstruction has major medical complications.”

According to the researchers, the flap techniques have different risk profiles for 30-day postoperative complications. Latissimus flaps showed significantly lower complication rates than the other methods did: 7.1% compared with 13.4% for pedicle TRAM flaps and 19.4% for free flaps. This study was published in the Journal of the American College of Surgeons (2013;216[2]:229-238).