Reconstruction With Perforator Flaps Ups Fat Necrosis

Wednesday, June 5, 2013 (Last Updated: 06/06/2013)

WEDNESDAY, June 5 (HealthDay News) -- Autologous breast reconstruction with perforator flaps has an increased risk of fat necrosis, according to a study published in the May issue of Plastic and Reconstructive Surgery.

Carolyn L. Mulvey, from Johns Hopkins University in Baltimore, and colleagues retrospectively reviewed data from 123 patients who underwent reconstruction with deep inferior epigastric perforator (DIEP) and/or muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps between 2010 through 2011.

The researchers note that 179 flap reconstructions in total were included (166 DIEP and 13 MS-TRAM). There were 132 (73.7 percent) single perforator flaps, with a mean flap weight of 658 g. Fat necrosis occurred in 13 flaps (7.5 percent). There were significantly increased odds of fat necrosis (odds ratio, 11.58) in African-American patients. Fat necrosis occurred significantly more often with higher flap weight (odds ratio, 1.5 per 100 g increase). Compared to 14.3 percent of large multiple perforator flaps, six single perforator flaps weighing more than 1,000 g (42.9 percent) developed fat necrosis.

"These data suggest that inclusion of more than one perforator may decrease odds of fat necrosis in large flaps," the authors write. "Perforator flap breast reconstruction can be performed safely; however, considerations concerning race, body mass index, staging with tissue expanders, perforator number, and flap weight may optimize outcomes."

One author disclosed financial ties to LifeCell Corporation.

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Specialties Cosmetic Surgery

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