Scientific Abstract Presentations: Poster Session Day 1 (Not for CME) Friday, October 10 Fri, Oct 10 9:30 a.m.-5:00 p.m. CDT

Background: In bilateral deep inferior epigastric perforator (DIEP) flap reconstruction procedures, the microsurgical anastomoses are usually performed consecutively, where one side is completed before the other side is started. However, when a co-surgeon model and loupe magnification are used, it is possible to perform both sides simultaneously. While simultaneous microsurgery is expected to reduce total ischemia time for both flaps, this has not yet been studied. In addition, its impact on postoperative complications has not been studied either. Therefore, the objective of this study is to compare simultaneous and consecutive microsurgery in bilateral DIEP flap reconstruction, focusing on their effects on ischemia time and postoperative outcomes.

Methods: A retrospective chart review was conducted on patients who had undergone bilateral DIEP flap breast reconstruction between 2017 and 2023. Patients with documented bilateral ischemia start times and stop times were included in the analysis. Patient's missing bilateral data or precise ischemia times were excluded. Ischemia time was used to categorize the timing of microsurgical anastomosis, with an overlap of 10 or more minutes between sides classified as "simultaneous microsurgery", and an overlap of less than 10 minutes (or no overlap) classified as "consecutive microsurgery". Data was collected on patient demographics, total ischemia time (defined as the time when one or both sides of the abdomen were undergoing microsurgical anastomoses), total operating time, postoperative complications, 90-day postoperative events, hospital length of stay (LOS), and millimeter morphine equivalents (MME) required for pain management. Regression analyses assessed the impact of simultaneous microsurgery versus consecutive microsurgery on key outcomes. Statistical significance was set at p < 0.05.

Results: Seventy-four patients met inclusion criteria for this study. Thirty-one (42%) had undergone simultaneous microsurgery, and 43 (58%) had undergone consecutive microsurgery. There were no significant differences between the two groups in age, body mass index, race, ethnicity, or baseline comorbidities. Univariate regression analysis revealed a statistically significant reduction in total ischemia time associated with simultaneous microsurgery (111 minutes vs. 147 minutes; p<0.001), and no differences in operating time (P=0.508), hospital LOS (P=0.098), or total MME (P=0.236). These findings were unchanged on multivariate regression, adjusting for age, BMI, comorbidities, and total flap weight, showing simultaneous microsurgery significantly reduced ischemia time (P<0.001) without affecting other outcomes (P>0.05).

Discussion: This study demonstrates that simultaneous microsurgery significantly reduces ischemia time compared to consecutive microsurgery. Additionally, the lack of differences in postoperative complications, 90-day unplanned reoperations, and readmissions suggests that expanding the operative field for simultaneous microsurgery does not negatively impact outcomes. These findings align with prior studies showing that co-surgeon models enhance surgical efficiency without compromising patient safety. Furthermore, while outcomes were comparable, prolonged ischemia has been associated with increased flap-related complications and ischemic injury in existing literature. As such, future prospective studies with larger cohorts should seek to validate these ischemia time reductions and assess their impact on long-term patient-reported outcomes, including satisfaction, flap aesthetics, and functional recovery.

Conclusion: Simultaneous microsurgery in bilateral DIEP flap reconstruction significantly reduces total ischemia time without increasing postoperative complications, LOS, or pain management needs.

Background: With rising rates of breast cancer, elective and reconstructive breast surgeries have become essential treatment options. However, these procedures carry the risk of inadvertent injuries, most commonly nerve transection or entrapment. Damage to chest wall nerves, including the intercostal, pectoral, long thoracic, thoracodorsal, and intercostobrachial nerves, may cause chronic neuropathic pain, potentially necessitating further treatment. This study aims to characterize post-operative peripheral nerve injuries associated with breast surgery and the outcomes of peripheral nerve surgery for chronic post-operative pain.

Methods: From 2003 to 2024, a systematic review was conducted using PubMed, Embase, Web of Science, and Scopus, followed by two rounds of independent author screening. The search strategy included terms related to nerve injury symptoms and breast procedures, combined with the Boolean operators AND and OR. The inclusion criteria consisted of patients experiencing peripheral nerve injuries after mastectomy, breast reconstruction, breast reduction, breast augmentation, or mastopexy. For each study, data were extracted on the number of patients, age, history of chemotherapy or radiotherapy, type of breast procedure, pain symptoms, treatment utilization rate, and treatment outcomes. Statistical analysis was performed using pooled statistics from all included studies.

Results: Out of 514 unique studies, 41 (n = 9282 patients) met the inclusion criteria. The average age of patients was 47.1 ± 14.8, ranging from 18 to 92. The most common procedure was breast augmentation with implants (n = 4940, 49.9%), followed by mastectomy (n = 2297, 23.2%), breast augmentation without implants (n = 1447, 14.6%), breast reconstruction (n = 776, 7.8%), breast reduction (n = 427, 4.3%), and mastopexy (n = 4, 0.04%). After these procedures, 2,339 patients (25.2%) experienced nerve-related symptoms. Among these patients, 105 (4.5%) underwent surgical intervention for pain, leading to complete resolution of pain (n = 9, 8.6%), reduction of pain (n = 54, 51.4%), or no change in pain (n = 7, 6.7%).

Conclusion: Peripheral nerve injury is a known post-operative risk following breast surgery; however, the results of this study show a low rate of peripheral nerve surgery being utilized for pain treatment (7.5%). This indicates that many patients who could benefit from surgery are left without options when non-surgical or conservative management approaches fail to resolve chronic post-operative pain. To tackle this public health issue, standardized protocols and assessment tools are needed to determine whether patients are suitable candidates for surgical pain treatment.