Optimizing donor site closure following bilateral breast reconstruction with abdominal-based free flaps

The abdomen is the primary donor site for autologous free flap breast reconstruction, but violation of the rectus abdominus complex can result in significant morbidity.1, 2 Abdominal hernias and bulges are the most concerning donor site complications in the long term, but early wound complications also contribute to significant morbidity during the initial postoperative period. In order to minimize the risk of hernias and bulges, reinforcement of the abdominal wall with placement of mesh may be necessary particularly in the setting of bilateral breast reconstruction.