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Leach et al. Plast Aesthet Res 2023;10:39 Plastic and
DOI: 10.20517/2347-9264.2023.32
Aesthetic Research

Review Open Access

Chest complications in autologous breast
reconstruction

Candice M. Leach, Meredith S. Collins

Department of Plastic and Reconstructive Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
Correspondence to: Dr. Meredith S. Collins, MD, FACS, Department of Plastic and Reconstructive Surgery, University of Kansas
Medical Center, 4000 Cambridge Street, MS 3015, Kansas City, KS 66160, USA. E-mail: mcollins7@kumc.edu

How to cite this article: Leach CM, Collins MS. Chest complications in autologous breast reconstruction. Plast Aesthet Res
2023;10:39. https://dx.doi.org/10.20517/2347-9264.2023.32

Received: 15 Apr 2023 First Decision: 5 Jul 2023 Revised: 19 Jul 2023 Accepted: 31 Jul 2023 Published: 9 Aug 2023

Academic Editor: Gordon Kwanlyp Lee Copy Editor: Dan Zhang Production Editor: Dan Zhang

Abstract
Complications from autologous free flap reconstruction of the breast can present with both common surgical
complications and unique complications at the chest recipient site. This review covers complications at the chest
recipient site, including chest wall deformity, chronic pain, mastectomy skin flap necrosis, infection, pyoderma
gangrenosum, bleeding complications, pneumothorax, chyle leak, and positive internal mammary lymph node
metastasis.

Keywords: Autologous breast reconstruction, complications, chest wall deformity, pneumothorax, mastectomy
skin flap necrosis, chyle leak, internal mammary node metastasis

INTRODUCTION
The deep inferior epigastric artery perforator (DIEP) flap remains the gold standard in autologous breast
reconstruction. DIEP flap surgery poses many challenges and potential for complications, which can be
related to the flap itself, the flap donor site, the chest recipient site, or systemic. This review will focus on
complications of the chest from the internal mammary recipient vessel dissection, including chest wall
deformity from rib resection and chronic pain, mastectomy skin flap necrosis, infection, pyoderma
gangrenosum, bleeding complications, pneumothorax, chyle leak, and positive internal mammary lymph
node metastasis. Each topic will explore current literature and recommendations based on clinical

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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