Background:
Autologous microvascular breast reconstruction has become an increasingly common reconstructive
procedure. The venous anastomoses are commonly completed with a coupler device. While
its efficacy has been shown using 3.0 mm size and greater, little is known about the
consequences of using coupler sizes less than 2.5 mm.
Methods:
A retrospective chart review of all patients undergoing autologous breast reconstruction
was conducted at New York University Medical Center (2007 – 2011). Flaps were divided
based on coupler size used: 1.5 mm, 2.0 mm, 2.5 mm, 3.0 mm, and 3.5 mm. Outcomes were
measured by incidence of arterial or venous insufficiency, hematoma, fat necrosis,
partial flap loss, full flap loss, and need for future fat grafting.
Results:
197 patients (392 flaps) were evaluated. Patients were similar in age, type of flap,
smoking status, and radiation history. Coupler size less than or equal to 2.0 mm was
found to be a significant risk factor for venous insufficiency (p =.038); risk reduction
with coupler size greater than or equal to 2.5 mm 87%) as well as for development
of fat necrosis (p =.041; 73% risk reduction) and need future need for fat grafting
(45% reduction).
Conclusions:
Postoperative complications are significantly increased in patients requiring the
use of 2.0 mm venous coupler. Vessel modification including beveling or fish-mouthing,
as well as more aggressive vessel exposure through rib harvest should be considered.
Additionally, the use of thoracodorsal vessels or hand-sewn anastomosis should be
considered in cases of IMV caliber of 2.0 mm or less.
