Preoperative Computed Tomography Angiogram (CTA) Measurement of Abdominal Muscles is a Valuable Risk Assessment for Bulge Formation after Microsurgical Abdominal Breast Reconstruction.

Background: A major shortcoming associated with abdominal tissue breast reconstruction is the long-term abdominal wall morbidity. Although abdominal core muscle size on computed tomography angiogram (CTA) has been correlated with morbidity following many abdominal surgeries, it has not been studied for abdominal breast reconstruction. Therefore, we evaluated the association between preoperative CTA-derived measurements of abdominal core muscles and postoperative abdominal wall morbidity after abdominal tissue breast reconstruction. Methods: In this retrospective matched case control study of women who underwent microsurgical abdominal breast reconstruction at one institution between January 2011 and June 2015, we evaluated all the cases of postoperative bulge/hernia, matched by type of abdominal flap and body mass index in a ratio of 1:2 to controls without bulge/hernia. We retrospectively obtained morphometric measurements of abdominal core muscles on their preoperative CTAs. Using univariable and multivariable logistic regressions, we examined the effects of clinical risk factors and CTA morphometric measurements on postoperative bulge/hernia formation. Results: Of the 589 patients who underwent abdominal free flap breast reconstruction, symptomatic bulges/hernias were identified in 35 (5.9%) of patients. When compared to the 70 matched controls, multivariable analysis showed that decreased area of rectus abdominus muscle(OR 0.18, P

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