The objective of this study was to critically evaluate the use of autologous blood
donation in patients who have surgical breast reconstruction using the fTRAM flap
technique following mastectomy.
A retrospective chart review of 201 patients was performed. They were operated on
at one community and one university hospital. For the analysis, cohorts of 101 blood
donors and 100 control non-donors were established. Demographic and pre-morbid factors,
as well as primary outcome variables, were evaluated.
The autologous donor and non-donor groups were not statistically different in any
demographic categories, including age at operation, hospital in which surgery was
completed, surgeon, timing of reconstruction (delayed vs. immediate), type of reconstruction
(unilateral vs. bilateral), or site of flap harvest (ipsilateral or contralateral).
Additionally, there were no significant differences in pre-morbid factors, including
ASA status, hypertension, diabetes mellitus, obesity, respiratory disease, heart disease,
or smoking history. The mean length of hospital stay was 6.65 days for the autologous
donor group vs. 6.24 days for the control group, which was not statistically significant
(p = 0.389). Total surgical complications, including total flap loss, partial flap
loss, microvascular thrombosis, wound infection and dehiscence, fat necrosis, nerve
pain, hernia, pneumonia, partial mastectomy flap loss, delayed healing, bulge, seroma,
and UTI were more common in the autologous donor group (48% vs. 28%). This was statistically
significant (p < 0.004). In addition, the autologous donor group was also more likely
to receive a transfusion intraoperatively (13% vs. 0%, p < 0.001) or postoperatively
(28% vs. 5%, p < 0.001), compared to the non-donor group. The authors' experience
with autologous blood donation in preparation for free TRAM flap surgery led to the
following conclusions: 1) autologous donation is associated with a significantly higher
rate of transfusion intraoperatively and postoperatively; 2) there is a statistically
significant higher rate of surgical complications associated with autologous blood
donation and transfusion in fTRAM flap surgery. These findings lead the authors not
to recommend autologous blood donation prior to fTRAM flap surgery.
