A 35-Year Evolution of Free Flap-Based Breast Reconstruction at a Large Urban Academic Center.

Background  This study aims to characterize the evolution and trends in free flap breast reconstruction at our institution. Methods  The authors reviewed and analyzed a registry of free flap breast reconstructions performed at a large urban academic center. Results  Between 1979 and mid-2014, a total of 920 patients underwent breast reconstruction with 1,254 flaps. The mean age was 47.7 years (range, 16–79 years). Over the past 10 years, patients were older than all patients seen in the prior decade (average age 48.9 vs. 46.1 years, p  = 0.002). Overall, 82% of flaps were performed at our university hospital, 17% at a major urban county hospital, and  p  = 0.0008). There has been a steady increase in bilateral reconstructions since the first one was performed in 1987 ( p  = 0.002). Conclusions  Over the past 35 years, our institution has seen a significant evolution in free flap-based breast reconstruction. Besides a massive increase in flap numbers we have seen a significant trend toward bilateral reconstructions and perforator-based flaps.