Comparative Analysis of Single versus Stacked Free Flap Breast Reconstruction: A Single-Center Experience

Research output: Contribution to journalArticle

Abstract

BACKGROUND: As breast reconstructive microsurgeons increase their available flap techniques with experience, the need for stacked and multiple flaps may generate an improved aesthetic outcome. The authors present their institutional experience of using single versus stacked free flap breast reconstruction. METHODS: ONE THOUSAND SEVENTY: flaps were performed on 509 patients from 2010 to 2018 by two senior surgeons at a single university hospital. Three hundred eighty-eight flaps were either stacked profunda artery perforator (PAP) flaps, four-flap flaps [bilateral PAP plus bilateral deep inferior epigastric perforator (DIEP) flap], or double-pedicle DIEP/superficial inferior epigastric perforator flaps. Six hundred eighty-two flaps were either unilateral or bilateral DIEP or PAP flap (one flap per breast). Demographics, patient comorbidities, and flap complications were compared between the two groups. RESULTS: Of the 509 patients, 359 underwent single DIEP or PAP flap (one flap per breast) and 150 patients underwent stacked free flaps. The stacked flap group had statistically lower body mass index, higher rates of radiation therapy, longer procedure time, smaller flaps, higher deep venous thrombosis rates, and higher take-back rates compared with the single flap group. There were no statistical differences in the rates of flap loss (2.2 percent in stacked flaps versus 1.1 percent in single flaps), wound complication, hematoma, or pulmonary embolism. CONCLUSIONS: Autologous breast reconstruction is the gold standard for natural and durable breast reconstruction, often giving superior aesthetic outcomes and higher patient satisfaction. However, the true success of autologous breast reconstruction is limited to the amount of tissue available to provide total breast reconstruction. This study shows that stacked flap breast reconstruction is safe and has similar complication rates as single-flap breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Original languageEnglish (US)
Pages (from-to)369e-377e
JournalPlastic and reconstructive surgery
Volume144
Issue number3
DOIs
StatePublished - Sep 1 2019

Fingerprint

Mammaplasty
Free Tissue Flaps
Perforator Flap
Arteries
Breast
Esthetics
Patient Satisfaction
Pulmonary Embolism
Venous Thrombosis
Hematoma
Comorbidity
Body Mass Index
Radiotherapy
Demography
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Comparative Analysis of Single versus Stacked Free Flap Breast Reconstruction : A Single-Center Experience. / Haddock, Nicholas T.; Cho, Min Jeong; Teotia, Sumeet S.

In: Plastic and reconstructive surgery, Vol. 144, No. 3, 01.09.2019, p. 369e-377e.

Research output: Contribution to journalArticle

@article{f37102c39b5b44688f0e1e6abfffad5c,
title = "Comparative Analysis of Single versus Stacked Free Flap Breast Reconstruction: A Single-Center Experience",
abstract = "BACKGROUND: As breast reconstructive microsurgeons increase their available flap techniques with experience, the need for stacked and multiple flaps may generate an improved aesthetic outcome. The authors present their institutional experience of using single versus stacked free flap breast reconstruction. METHODS: ONE THOUSAND SEVENTY: flaps were performed on 509 patients from 2010 to 2018 by two senior surgeons at a single university hospital. Three hundred eighty-eight flaps were either stacked profunda artery perforator (PAP) flaps, four-flap flaps [bilateral PAP plus bilateral deep inferior epigastric perforator (DIEP) flap], or double-pedicle DIEP/superficial inferior epigastric perforator flaps. Six hundred eighty-two flaps were either unilateral or bilateral DIEP or PAP flap (one flap per breast). Demographics, patient comorbidities, and flap complications were compared between the two groups. RESULTS: Of the 509 patients, 359 underwent single DIEP or PAP flap (one flap per breast) and 150 patients underwent stacked free flaps. The stacked flap group had statistically lower body mass index, higher rates of radiation therapy, longer procedure time, smaller flaps, higher deep venous thrombosis rates, and higher take-back rates compared with the single flap group. There were no statistical differences in the rates of flap loss (2.2 percent in stacked flaps versus 1.1 percent in single flaps), wound complication, hematoma, or pulmonary embolism. CONCLUSIONS: Autologous breast reconstruction is the gold standard for natural and durable breast reconstruction, often giving superior aesthetic outcomes and higher patient satisfaction. However, the true success of autologous breast reconstruction is limited to the amount of tissue available to provide total breast reconstruction. This study shows that stacked flap breast reconstruction is safe and has similar complication rates as single-flap breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.",
author = "Haddock, {Nicholas T.} and Cho, {Min Jeong} and Teotia, {Sumeet S.}",
year = "2019",
month = "9",
day = "1",
doi = "10.1097/PRS.0000000000005906",
language = "English (US)",
volume = "144",
pages = "369e--377e",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Comparative Analysis of Single versus Stacked Free Flap Breast Reconstruction

T2 - A Single-Center Experience

AU - Haddock, Nicholas T.

AU - Cho, Min Jeong

AU - Teotia, Sumeet S.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - BACKGROUND: As breast reconstructive microsurgeons increase their available flap techniques with experience, the need for stacked and multiple flaps may generate an improved aesthetic outcome. The authors present their institutional experience of using single versus stacked free flap breast reconstruction. METHODS: ONE THOUSAND SEVENTY: flaps were performed on 509 patients from 2010 to 2018 by two senior surgeons at a single university hospital. Three hundred eighty-eight flaps were either stacked profunda artery perforator (PAP) flaps, four-flap flaps [bilateral PAP plus bilateral deep inferior epigastric perforator (DIEP) flap], or double-pedicle DIEP/superficial inferior epigastric perforator flaps. Six hundred eighty-two flaps were either unilateral or bilateral DIEP or PAP flap (one flap per breast). Demographics, patient comorbidities, and flap complications were compared between the two groups. RESULTS: Of the 509 patients, 359 underwent single DIEP or PAP flap (one flap per breast) and 150 patients underwent stacked free flaps. The stacked flap group had statistically lower body mass index, higher rates of radiation therapy, longer procedure time, smaller flaps, higher deep venous thrombosis rates, and higher take-back rates compared with the single flap group. There were no statistical differences in the rates of flap loss (2.2 percent in stacked flaps versus 1.1 percent in single flaps), wound complication, hematoma, or pulmonary embolism. CONCLUSIONS: Autologous breast reconstruction is the gold standard for natural and durable breast reconstruction, often giving superior aesthetic outcomes and higher patient satisfaction. However, the true success of autologous breast reconstruction is limited to the amount of tissue available to provide total breast reconstruction. This study shows that stacked flap breast reconstruction is safe and has similar complication rates as single-flap breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

AB - BACKGROUND: As breast reconstructive microsurgeons increase their available flap techniques with experience, the need for stacked and multiple flaps may generate an improved aesthetic outcome. The authors present their institutional experience of using single versus stacked free flap breast reconstruction. METHODS: ONE THOUSAND SEVENTY: flaps were performed on 509 patients from 2010 to 2018 by two senior surgeons at a single university hospital. Three hundred eighty-eight flaps were either stacked profunda artery perforator (PAP) flaps, four-flap flaps [bilateral PAP plus bilateral deep inferior epigastric perforator (DIEP) flap], or double-pedicle DIEP/superficial inferior epigastric perforator flaps. Six hundred eighty-two flaps were either unilateral or bilateral DIEP or PAP flap (one flap per breast). Demographics, patient comorbidities, and flap complications were compared between the two groups. RESULTS: Of the 509 patients, 359 underwent single DIEP or PAP flap (one flap per breast) and 150 patients underwent stacked free flaps. The stacked flap group had statistically lower body mass index, higher rates of radiation therapy, longer procedure time, smaller flaps, higher deep venous thrombosis rates, and higher take-back rates compared with the single flap group. There were no statistical differences in the rates of flap loss (2.2 percent in stacked flaps versus 1.1 percent in single flaps), wound complication, hematoma, or pulmonary embolism. CONCLUSIONS: Autologous breast reconstruction is the gold standard for natural and durable breast reconstruction, often giving superior aesthetic outcomes and higher patient satisfaction. However, the true success of autologous breast reconstruction is limited to the amount of tissue available to provide total breast reconstruction. This study shows that stacked flap breast reconstruction is safe and has similar complication rates as single-flap breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

UR - http://www.scopus.com/inward/record.url?scp=85071642756&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071642756&partnerID=8YFLogxK

U2 - 10.1097/PRS.0000000000005906

DO - 10.1097/PRS.0000000000005906

M3 - Article

C2 - 31461004

AN - SCOPUS:85071642756

VL - 144

SP - 369e-377e

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 3

ER -