Page 79 - Read Online

García Nores et al. Plast Aesthet Res 2023;10:33 Plastic and
DOI: 10.20517/2347-9264.2022.146
Aesthetic Research

Review Open Access

Strategies for prevention and management of partial
flap loss or fat necrosis in microvascular autologous

breast reconstruction

Gabriela D García Nores, Angela Cheng
Department of Surgery, Division of Plastic and Reconstructive Surgery, Emory University, Atlanta, GA 30322, USA.

Correspondence to: Dr. Angela Cheng, Department of Surgery, Division of Plastic and Reconstructive Surgery, Emory University,
1364C Clifton Rd NE, Atlanta, GA 30322, USA. E-mail: angelacheng@emory.edu

How to cite this article: García Nores GD, Cheng A. Strategies for prevention and management of partial flap loss or fat necrosis
in microvascular autologous breast reconstruction. Plast Aesthet Res 2023;10:33. https://dx.doi.org/10.20517/2347-
9264.2022.146

Received: 15 Dec 2022 Revised: 20 Jun 2023 Accepted: 27 Jun 2023 Published: 30 Jun 2023

Academic Editor: Gordon Kwanlyp Lee Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Partial flap loss (skin involved) or fat necrosis following autologous breast reconstruction remains a dreaded
postoperative complication despite significant advances in microsurgical techniques. Several strategies have been
proposed in the preoperative and intraoperative period to prevent this complication ranging from preoperative
imaging, intra-operative tissue perfusion assessment, appropriate perforator selection (location and number),
maximizing inflow and outflow with additional anastomoses and/or pedicles, and minimizing ischemia time.
Postoperative management of partial flap loss (when there is skin involvement) and fat necrosis remains a
challenge, with very little published data focusing on classification, timing, and techniques. Early intervention
versus close observation may depend on multiple patient factors and the degree or volume of necrosis. Secondary
intervention options include hyperbaric oxygen therapy, fat aeration with a needle, liposuction, fat grafting, addition
of another flap or implant, depending on the nature of the defect. This review summarizes the current evidence for
each of these strategies to help the current surgeon understand their options in preventing and managing patients
suffering from partial flap loss.

Keywords: Partial flap loss, fat necrosis, prevention of fat necrosis

© 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.

www.parjournal.net