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Comparative Study
. 2015 Feb;135(2):356-367.
doi: 10.1097/PRS.0000000000000989.

Comparison of postoperative pain control in autologous abdominal free flap versus implant-based breast reconstructions

Andrew A Gassman  1 , Alfred P Yoon, Justin B Maxhimer, Ivan Sanchez, Harleen Sethi, Kevin W Cheng, Charles Y Tseng, Jaco H Festekjian, Andrew L Da Lio, Chris A Crisera
Affiliations
Comparative Study

Comparison of postoperative pain control in autologous abdominal free flap versus implant-based breast reconstructions

Andrew A Gassman et al. Plast Reconstr Surg. 2015 Feb.

Abstract

Background: Women who undergo mastectomy and breast reconstruction are shown to express more pain than those who undergo mastectomy alone. The authors evaluated postoperative pain outcomes following breast reconstruction.

Methods: Patients undergoing primary implant-based (n = 1038) or flap-based (n = 837) reconstructions from 2004 to 2012 at the University of California, Los Angeles, were evaluated. Postoperative pain was measured using the visual analogue scale, total narcotic use, and number of patient-controlled analgesia attempts. Narcotic dosage was standardized to morphine equivalents per kilogram. The authors modeled postoperative narcotic use, patient-controlled analgesia attempts, and visual analogue scale scores over time using spline graphs for comparison between the two reconstruction methods.

Results: Both total narcotic use and patient-controlled analgesia attempts were higher in the implant-based group throughout the immediate postoperative period. Implant-based reconstruction patients had significantly higher visual analogue scale scores (p < 0.0001) and total narcotic use (p < 0.0001) through postoperative day 3 compared with autologous tissue-based reconstruction patients. When controlling for reconstruction method, bilateral procedures were more painful (visual analogue scale score and patient-controlled analgesia attempts, both p < 0.001). When controlling for laterality, unilateral implant-based and autologous reconstructions had comparable visual analogue scale scores (p = 0.38) and patient-controlled analgesia attempts. However, unilateral implant-based procedures required more narcotic use than unilateral autologous tissue-based procedures (p = 0.0012).

Conclusion: Although commonly perceived as a less distressing operation, implant-based breast reconstruction may be more painful during the immediate postoperative hospitalization than abdominally based free tissue transfer.

Clinical question/level of evidence: Therapeutic, III.

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References

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