Autologous Breast Reconstruction Success Rates in Hypercoagulable Patients

• Published in: Plastic and reconstructive surgery (1963) Vol. 153; no. 3; pp. 516e - 522e
• Main Authors: Egan, Katie G, Elver, Ashlie A, Birney, Jalee M, Nazir, Niaman, Butterworth, James A, Lai, Eric C
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-03-2024
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/PRS.0000000000010708

Hypercoagulable disorders may adversely affect microsurgical outcomes, including increased flap failure and complication rates. Outcomes specific to autologous breast reconstruction are not well described.
A retrospective review was performed of autologous breast reconstructions between 2009 and 2020. Patients with either a thrombophilic disorder (TD) diagnosis or a previous thrombotic event (TE) were identified. The analysis compared perioperative complications and flap success rates.
In this series, 23 patients with a TD underwent 39 flaps, and 78 patients who had experienced a TE underwent 126 flaps, compared with 815 control patients, who underwent 1300 flaps. In logistic regression models, a TD diagnosis was an independent predictor of early total flap loss [OR, 8.42 (95% CI, 1.59 to 44.47); P = 0.01], late partial flap loss [OR, 3.9 (95% CI, 1.0 to 15.22); P = 0.05], and delayed healing [OR, 2.26 (95% CI, 1.02 to 5.04); P = 0.04]. TE history trended toward an association only with late partial flap loss ( P = 0.057). Flap salvage rates (25%) and flap success rates (92.3%) were statistically lower in patients with a TD but normal in patients who had experienced a TE.
Microsurgical breast reconstruction is a reasonable option for patients with hypercoagulation disorders. No increased risk of flap complications was associated with a previous TE; however, TDs carried increased risk.
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