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Inchauste. Plast Aesthet Res 2023;10:27 Plastic and
DOI: 10.20517/2347-9264.2022.139
Aesthetic Research

Review Open Access

Complications in microsurgical breast
reconstruction: thrombosis prevention and

management

Suzanne M. Inchauste
Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington Medical Center, 1959 NE
Pacific Street, Seattle, WA 98195, USA.

Correspondence to: Dr. Suzanne M. Inchauste, Department of Surgery, Division of Plastic and Reconstructive Surgery, University
of Washington Medical Center, Seattle, WA 98195, USA. E-mail: sinchaus@uw.edu

How to cite this article: Inchauste SM. Complications in microsurgical breast reconstruction: thrombosis prevention and
management. Plast Aesthet Res 2023;10:27. https://dx.doi.org/10.20517/2347-9264.2022.139

Received: 1 Dec 2022 First Decision: 14 Mar 2023 Revised: 18 Apr 2023 Accepted: 5 Jun 2023 Published: 12 Jun 2023

Academic Editor: Christine Hsu Rohde Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Breast reconstruction is one of the largest components of plastic and reconstructive surgery. Autologous free flap
breast reconstruction continues to grow due to exceptionally high flap success rates. It provides patients with a
durable and natural reconstruction with high patient satisfaction. A patent microvascular anastomosis is a key
component to a successful autologous free flap breast reconstruction. Thrombus within the vascular anastomosis
or the distal flap microcirculation is the most common cause of flap failure. This review aims to discuss
microsurgical techniques including atraumatic handling of vessels, appropriate magnification, suture styles,
anastomotic techniques, recipient vessel selection, the role of anticoagulation and antiplatelet therapy used to
minimize the risk of thrombotic events. When microvascular thrombus occurs, early reoperation and reperfusion is
imperative to flap survival. This review will discuss specific maneuvers and intraoperative interventions to
maximize flap salvage.
Keywords: Microsurgery, autologous free flap breast reconstruction, thrombosis, microsurgical anastomosis,
thrombus prevention

© 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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