Should Planned/Desired Pregnancy be Considered an Absolute Contraindication to Breast Reconstruction with Free Abdominal Flaps? A Retrospective Case Series and Systematic Review

Publication date: Available online 9 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Shawn Moshrefi, Suhail Kanchwala, Arash Momeni
BackgroundAutologous breast reconstruction is considered by many to be the gold standard reconstructive modality following mastectomy. Despite the advantages of autologous reconstruction, however, surgeons have been cautious in recommending this approach to patients who desire to becoming pregnant postoperatively due to concerns related to abdominal wall morbidity. While intuitive, this approach does not appear to be based on robust data. Hence, the authors examined the clinical outcome in patients who became pregnant following autologous breast reconstruction.MethodsPatients who underwent autologous breast reconstruction with free abdominal flaps that required an incision in the anterior rectus sheath were identified. Of those, patients who became pregnant post-reconstruction were included for subsequent analysis. Of particular interest were any peri- and post-partal complications that could be attributed to the preceding abdominal flap harvest. Additionally, a systematic review of the literature was performed.ResultsWe identified five patients who met inclusion criteria. All five patients underwent bilateral breast reconstruction with free muscle-sparing transverse rectus abdominis musculocutaneous (MS-TRAM) flaps. None of the patients had any pre-existing abdominal wall morbidity. All five patients proceeded to full-term and successfully delivered newborns, four of which were delivered via normal vaginal delivery and one via Cesarean section. No abdominal wall complications were noted during pregnancy, delivery, or post-partum.ConclusionContemporary data does not support the notion that breast reconstruction with free abdominal flaps is contraindicated in the setting of desired or planned pregnancy.