Secondary operations of the anterior abdominal wall following microvascular breast reconstruction with the TRAM and DIEP flaps

BACKGROUND: Secondary operations of the anterior abdominal wall following breast reconstruction with abdominal flaps are sometimes performed to improve outcome. The purpose of this study was to review a single surgeon's experience with secondary abdominal wall operations following breast reconstruction with the deep inferior epigastric perforator (DIEP) and free transverse rectus abdominis musculocutaneous (TRAM) flaps. METHODS: Over a 7-year period, 330 women had microvascular breast reconstruction using abdominal flaps. Indications for secondary abdominal operations that were considered necessary included bulge, abdominal skin necrosis (wound), hematoma, neuroma, and seroma. Indications that were considered elective included lateral dog-ear scars and lipodystrophy. Mean follow-up time was 40 months (range, 3 to 84 months). RESULTS: Secondary abdominal operations were performed in 59 women (17.9 percent). The cumulative number of indications was 64. The indications were considered necessary in 33 women (10 percent) and elective in 31 women (9.4 percent). Lower abdominal bulge was the most common necessary indication and was repaired in 9.3 percent of free TRAM flaps and 4.7 percent of DIEP flaps. Dog-ear scars were the most common elective indication and were revised in 29 women (8.8 percent). Neuromas of the anterior abdominal wall were diagnosed in three women (0.9 percent). Secondary procedures for indications with a low frequency included skin necrosis (n = 3), hematoma (n = 3), seroma (n = 1), and lipodystrophy (n = 2). CONCLUSIONS: The incidence of secondary procedures of the abdominal wall following microvascular breast reconstruction using abdominal flaps approximates 20 percent, with an equal distribution between necessary and elective procedures. Women considering breast reconstruction using a free TRAM or DIEP flap should be advised of these statistics.