Assessment of the risk of bulge/hernia formation after abdomen-based microsurgical breast reconstruction with the aid of preoperative computed tomographic angiography-derived morphometric measurements.

Abstract

No preoperative risk assessment tool is available to predict postoperative bulge formation after abdomen-based breast reconstruction. The authors evaluated the association between clinical variables and morphometric measurements on preoperative computed tomographic (CT) angiography and postoperative abdominal wall morbidity. The authors evaluated all cases of postoperative bulge/hernia and normal controls in patients who underwent preoperative CT angiography and abdomen-based microsurgical breast reconstruction between July 2009 and January 2018. CT-based abdominal wall profiles, including abdominal wall protrusion, abdominopelvic cavity cross-sectional area (CSA), and abdominopelvic cavity-to-total body CSA ratio, were obtained and analyzed. A novel risk stratification scoring system to stratify the risk of bulge/hernia was developed. Among 463 patients who underwent abdomen-based breast reconstruction, 23 were diagnosed as having a bulge/hernia. Age (OR 2.912; 95% CI 1.157-7.333), lateral row perforator (OR 5.065; 95% CI 1.834-13.986), and abdominal wall protrusion (OR 3.687; 95% CI 1.494-9.100) were significant risk factors associated with postoperative bulge/hernia in the multivariate analysis. Using the risk stratification scoring system, the incidence rates of postoperative bulge/hernia were 1.7%, 4.8%, and 19.0% for low-, intermediate-, and high-risk patients, respectively (p<0.001). Age, lateral row perforator, and abdominal wall protrusion were significantly associated with postoperative bulge/hernia formation after abdomen-based microsurgical breast reconstruction. The authors' risk score based on the three variables may help predict and minimize donor-site morbidity.