Stabilization of Microsurgical Anastomosis Using Fat-piece Graft With Autologous Fibrin Glue in Autologous Breast Reconstruction

Flap loss is a severe complication of autologous breast reconstruction. Most flap losses are caused by thrombosis of the anastomosed artery or vein. To prevent vascular disorders, we placed a fat-piece graft around the vessel anastomosis and stabilized the graft and the vessel with autologous fibrin glue. From February 2020 to September 2023, 163 patients underwent autologous breast reconstruction, including 179 breasts, using a deep inferior epigastric perforator flap and autologous fibrin glue to stabilize the internal mammary artery and vein at the Toyama University Hospital. Information on complications was collected retrospectively. No flap losses were observed during the study period; however, 1 hematoma and 1 infection occurred. Stabilization of the pedicle geometry may reduce the risk of kinking, and filling the dead space around the anastomosis reduced vessel spasms. Moreover, autologous fibrin glue may decrease complications such as hematoma, infection, and wound healing disturbance. The factors that may lower the risk of complications include flap design, assessment using multidetector computed tomography, selection of perforator and recipient vessels, vascular anastomosis method, postoperative management, and so on. In addition to these factors, this technique, stabilization of vessels using a fat-piece graft and fibrin glue, may lead to fewer complications during autologous breast reconstruction.