Risk factors for delayed autologous breast reconstruction using pedicled TRAM and latissimus dorsi flaps

The purpose of this study was to compare outcomes between patients submitted to pedicled transverse rectus abdominis musculocutaneous (pTRAM) and latissimus dorsi musculocutaneous (LD) flaps for breast reconstructions and to investigate potential risk factors for complications in autologous reconstruction. A retrospective review of delayed autologous breast reconstructions by five surgeons in a single centre was performed. Between 2014 and 2018, 215 women underwent unilateral breast reconstruction with pTRAM or LD flaps. Patient demographics were analyzed including age, body mass index (BMI), smoking, diabetes mellitus, hypertension, radiotherapy and chemotherapy. Patient medical records were reviewed for the length of hospital stay (LOS), volume and duration of breast drainage, volume and duration of donor area drainage, major immediate complications, early and late complications, reinterventions, readmittances and reinterventions for late complications. LD reconstruction was associated with longer length of stay, duration of breast and donor area drainage and a higher prevalence of seroma in the donor area (37.8% vs 6.5%). pTRAM breast reconstruction had higher rates of pulmonary embolism and late complications. Age over 60 was a risk factor for immediate major complications. Smoking was associated with increased early complications. Late complications increased when the BMI was above 30. Autologous breast reconstruction with pTRAM and LD flaps is safe and offers a long-standing pleasant aesthetic shape. The results of this study show that age over 60, BMI > 30 and smoking increase the complications rate. These patients should be informed about their higher profile risks before proceeding with the reconstruction. Level III, risk/prognostic study.