Effect of Prior Abdominal Surgery on Abdominal-based Free-flap Breast Reconstruction Outcomes: A Systematic Review and Meta-analysis.

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.