What question did this study set out to answer?

To investigate the relationship between intraoperative microvascular complications and postoperative outcomes in breast reconstruction.

April 23, 2026

Predicting postoperative recovery following intraoperative microvascular complications in autologous breast reconstruction

Puntos clave

To investigate the relationship between intraoperative microvascular complications and postoperative outcomes in breast reconstruction.
Conducted a retrospective chart review from 2017 to 2023 of microsurgical breast reconstruction cases.
Analyzed data on intraoperative and postoperative complications and patient outcomes using statistical methods.
Intraoperative complications occurred in 15.1% of flaps, with pedicle/perforator injury being the most prevalent.
Difficult flap dissection was linked to increased blood transfusion needs and longer hospital stays.
Postoperative complications like flap ischemia and congestion were significantly associated with specific intraoperative complications, particularly arterial thrombosis.

Resumen

Background: Intraoperative microvascular complications in autologous breast reconstruction may increase the risk of immediate postoperative flap complications, such as congestion, thrombosis, and flap loss. The impact of specific intraoperative complications on patient outcomes remains unclear. Methods: A retrospective chart review of microsurgical breast reconstruction cases from 2017 to 2023 was performed to determine intraoperative and postoperative complications, as well as patient outcomes. Statistical analysis was conducted to determine associations between intraoperative complications and outcomes. Results: 1005 flaps were performed in 620 patients, with intraoperative complications experienced in 15.1% (152/1005) flaps. Pedicle/perforator injury was the most common (5.3%). Difficult flap pedicle dissection was a predictor of the need for a blood transfusion (17.7% vs. 8.3%, OR 2.4 95% CI 1.1-5.0, p = 0.04). Hematoma was not associated with any intraoperative complications. In comparison, postoperative flap ischemia was associated only with intraoperative arterial thrombosis (8.3% vs. 0.7%, OR 2.8 95% CI 1.5-113.0, p = 0.003). Postoperative flap congestion was associated with both intraoperative complications of alternate venous outflow (40% vs. 1.9%, OR 34.4 95% CI 5.4-218, p = 0.004) and pedicle/perforator injury (10.5% vs. 1.9%, OR 6.0 95% CI 1.3-27.7, p = 0.01). Prolonged length of stay greater than the expected three days was associated with difficult flap pedicle vessel dissection (52.9% vs. 31.5%, OR 2.4 95% CI 1.4-4.3, p = 0.001) and intraoperative arterial thrombosis (63.6% vs. 32.3%, OR 3.7 95% CI 1.1-12.7, p = 0.04). Length of stay greater than four days was solely associated with intraoperative thrombosis (36.4% vs. 9.9%, OR 5.4 1.6-18.7, p = 0.019). The intraoperative complications of venous anastomosis revision and difficult internal mammary vessel dissection had no significant association with postoperative course. Conclusions: Specific intraoperative complications are associated with higher rates of postoperative complications. Awareness of the tendency for a complex postoperative recovery is warranted.

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