Pedicled Myocutaneous Flap Breast Reconstruction in the Community Hospital Setting: An Analysis of Cost and Complications.

Background Free tissue transfer breast reconstruction is an option for breast cancer patients that is precluded by a number of factors. The authors' objective was to assess the use of pedicled myocutaneous breast reconstruction in the community hospital setting, with more limited resources, as a viable option with comparable rates of complications, cost, and outcomes. Methods The authors performed a retrospective cohort review of pedicled myocutaneous breast reconstructions of a single surgeon at a community-based institution from 2015 to 2019. Rates of complications, including partial and total flap failure, infection, seroma/hematoma, and reoperation were evaluated, as well as initial hospital cost, readmission cost, and subjective patient satisfaction. Statistical analysis was performed on the data and compared to published data on free flap breast reconstruction with regards to similar data points. Results There were ten patients included in the analysis. This data demonstrated an immediate reoperation rate of 0%, with no incidence of partial or total flap loss, infection, seroma, hematoma, or medical complication. Delayed complications included delayed wound healing of the donor site (10%), abdominal wall bulge (10%), and umbilical partial necrosis (10%). The average length of initial stay was 5.7 days and the average initial hospital costs were $94,717. Conclusions As demonstrated at St. Barnabas Hospital, this type of breast reconstruction does not require the presence of a microsurgery fellowship program, high volumes, significant ancillary staff training, or other costly resources to monitor the patient, yet yields comparable or favorable rates of complications when compared to free tissue reconstruction. This allows more reconstructive options to be available to patients who may not have access to large tertiary centers for free flap reconstruction.