Plastic and reconstructive surgery. Global open · 2026
Effect of Prior Abdominal Surgery on Abdominal-based Free-flap Breast Reconstruction Outcomes: A Systematic Review and Meta-analysis.
СтатьяНазвание и аннотация: Перевод в очереди
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Allababidi Noor H, AlTamimi Jawahir O, AlAnazi Shahad N, Alghamdi Abdulaziz M, Samandar Abdulaziz F, Bassfr Shahad H, AlZahrani Isra'a Abdulaziz, AlMouaalamy Nora N, AlSaadi Nawaf H, AlKhudeer Abdullah M, Khoshaim Khalid M
Аннотация
BACKGROUND: Autologous tissue reconstruction is a key option for breast reconstruction after mastectomy. Although prior abdominal surgery was traditionally considered a contraindication to abdominal-based flaps, advances in microsurgical techniques and preoperative imaging have expanded patient eligibility. This systematic review and meta-analysis evaluates the impact of prior abdominal scarring on flap viability and complication rates in abdominal-based breast reconstruction.
METHODS: A PRISMA-compliant systematic review identified 12 retrospective comparative studies (11 cohort and 1 case-control) involving 4574 patients who underwent abdominal-based autologous breast reconstruction. Recipient- and donor-site complications were assessed. Meta-analysis was conducted using Review Manager, with subgroup analyses performed according to flap type.
RESULTS: Prior abdominal scarring was not associated with increased recipient-site complications, including hematoma, seroma, infection, venous congestion, partial or complete flap loss, wound-healing delay, reoperation, or revision anastomosis. Flap viability was comparable between groups. However, patients with prior scars had a higher risk of donor-site wound dehiscence (risk ratio [RR] 1.68; P = 0.0001) and abdominal wall laxity (RR 4.19; P = 0.04). The risk of wound dehiscence was greater in deep inferior epigastric perforator-only reconstructions (RR 1.81; P < 0.0001).
CONCLUSIONS: Abdominal-based breast reconstruction remains a safe and effective option for patients with prior abdominal surgery, with preserved flap viability and comparable recipient-site outcomes. However, prior abdominal scarring is associated with an increased risk of donor-site wound dehiscence and abdominal wall laxity, emphasizing the need for careful preoperative planning and optimized donor-site management.
METHODS: A PRISMA-compliant systematic review identified 12 retrospective comparative studies (11 cohort and 1 case-control) involving 4574 patients who underwent abdominal-based autologous breast reconstruction. Recipient- and donor-site complications were assessed. Meta-analysis was conducted using Review Manager, with subgroup analyses performed according to flap type.
RESULTS: Prior abdominal scarring was not associated with increased recipient-site complications, including hematoma, seroma, infection, venous congestion, partial or complete flap loss, wound-healing delay, reoperation, or revision anastomosis. Flap viability was comparable between groups. However, patients with prior scars had a higher risk of donor-site wound dehiscence (risk ratio [RR] 1.68; P = 0.0001) and abdominal wall laxity (RR 4.19; P = 0.04). The risk of wound dehiscence was greater in deep inferior epigastric perforator-only reconstructions (RR 1.81; P < 0.0001).
CONCLUSIONS: Abdominal-based breast reconstruction remains a safe and effective option for patients with prior abdominal surgery, with preserved flap viability and comparable recipient-site outcomes. However, prior abdominal scarring is associated with an increased risk of donor-site wound dehiscence and abdominal wall laxity, emphasizing the need for careful preoperative planning and optimized donor-site management.