Reduce Flap Necrosis After Autologous Breast Reconstruction: A Systematic Review

Abstract

Background: Autologous breast reconstruction provides substantial benefits in terms of aesthetics and longevity. However, the risk of flap necrosis poses potential challenges to patients' appearance and psychological well-being, while also escalating health care costs. Consequently, examining the risk factors, assessment techniques, and therapeutic approaches for flap necrosis is critically important.

Method: The authors conducted a comprehensive search for relevant studies from January 2010 to August 2024 using PubMed, Web of Science, and the Cochrane Library. The search terms included "autologous breast reconstruction", "flap necrosis", "risk factor", "assessment", and "treatment". The authors initially screened titles and abstracts, followed by a detailed review by 3 investigators to determine the studies that met the inclusion criteria.

Result: A total of 68 studies were ultimately selected for analysis. Identified risk factors for flap necrosis include smoking, advanced age, obesity, diabetes, large breast volume, previous radiotherapy, and abdominal surgery. Various assessment methods (e.g., preoperative imaging, intraoperative blood flow monitoring, and postoperative evaluations) can enhance flap survival. The review also covered surgical treatment strategies and non-surgical interventions, including local wound care, hyperbaric oxygen therapy, and pharmacological treatments.

Conclusion: This review highlights the critical role of thorough planning and management in minimizing the risk of flap necrosis after autologous breast reconstruction. Effective preoperative assessments, perioperative monitoring, and specific postoperative interventions can significantly lower the incidence of flap necrosis.

Keywords: Autologous breast reconstruction; breast cancer; flap necrosis; mastectomy; postoperative complications.

FIGURE 1

PRISMA flow diagram. PRISMA indicates Preferred Reporting Items for Systematic Reviews.

FIGURE 2

Risk factors for flap necrosis after autologous breast reconstruction.

FIGURE 3

This is a preoperative CTA image of a 50-year-old female patient who underwent a right mastectomy 9 years ago and is scheduled for a second-stage autologous breast reconstruction. CTA is used preoperatively to locate the perforating vessels in the abdominal donor area. CTA indicates computed tomography angiography.

FIGURE 4

How to avoid flap necrosis after autologous breast reconstruction. CDU indicates color Doppler ultrasonography; CTA, computed tomography angiography; DIRT, dynamic infrared thermography; HBOT, hyperbaric oxygen therapy; ICGA, indocyanine green angiography; MRA, magnetic resonance angiography; NIRS, near-infrared spectroscopy.