Revisions and complications after breast reconstruction using SGAP
Translation of an abstract of a lecture given by Drs. Johannes C. Bruck and Indra Mertz of Martin-Luther-Krankenhaus, Berlin at 49. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPÄRC)
, 42. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen e. V. (DGPRÄC), 16. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen e. V. (VDÄPC) in Innsbruck (Austria) from September, 29 to October, 1, 2011.
The aim of this retrospective data collection was to capture the rate of complications after autologous breast reconstruction with graft taken from the buttocks (SGAP), the number of revision surgeries and the burden on patients.
From 2005 to 2010 we conducted at our Department 35 breast reconstructions using SGAP in 30 patients, 25 of them on one side and 5 on both sides. 14 interventions were made on the right side, 21 on the left side. The postoperative controls were performed after three and six weeks, three months, six months and twelve months.
The average surgical duration (cut/suture time) for the implementation of an s-GAPS's was at 358 minutes (235-565min), the average ischemic time at 106 minutes and the average lobe weight at 403 grams. In the 34 surgeries carried out in 10 cases a vascular thrombosis of the lobe occurred, which corresponds to 28.5%. The average time to revision was 1.8 days. In four cases (11.4%) occurred a complete flap loss. Partial losses, we saw none. Hematoma requiring revision occurred in four cases (11.7%), three (8.8%) of them gluteal (at the buttocks) and one in the area of the neomamma (the reconstructed breast). The average time until revision was one day. Hypertrophic scars, which had to be corrected, were found in 7 cases (20.6%). In five cases (14.7%) the neomamma was affected. Only in two cases (5.9%) a scar at the buttocks had to be corrected. A second surgery took place after an average of 7.6 months. Asymmetries or dogears which had to be corrected occurred in nine cases (26.4%), six of them (17.6%) gluteal and three (8.8%) at the neomamma. Here corrections were made after an average of 8.6 months.
Conclusion: The results of this study show that the implementation of SGAP-lobe for the construction or reconstruction of the breast is a tried and tested method, especially for the reconstruction of both breasts. The benefits are in the expansion of choice for patients, the possibility of a two-sided, two-stage reconstruction and the lack of partial necrosis. Drawback is certainly the four to five times higher loss rate compared to DIEP, which is probably because of the shorter pedicle and the more difficult venous anatomy of the V. glutea sup. The scar of the donor site on the other hand seemed to be regarded as a disadvantage in any case.
Link to the abstract (in German).