Soft Underbelly of Breast Reconstruction: Management of Donor Site and Donor Site Defects After Autologous, Abdominal-Based Breast Reconstruction | Sponsored by BD Phasix™ Mesh | Insights from Industry-Soft Underbelly of Breast Reconstruction: Management of Donor Site and Donor Site Defects After Autologous, Abdominal-Based Breast Reconstruction (Sponsored by BD Phasix™ Mesh)

Soft Underbelly of Breast Reconstruction: Management of Donor Site and Donor Site Defects After Autologous, Abdominal-Based Breast Reconstruction (Sponsored by BD Phasix™ Mesh) | Insights from Industry

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Video Transcription

Video Summary

Dr. Stephen Kovach presented a detailed discussion on donor site management and complications following autologous abdominal-based free-flap breast reconstruction, focusing on abdominal wall stewardship. Emphasizing the importance of patient counseling and surgical decision-making, he highlighted risks associated with mesh use, particularly permanent synthetic mesh, which can lead to long-term complications and increased surgical risks during future operations. Dr. Kovach advocates for biosynthetic mesh, specifically poly-4-hydroxybutyrate (Phasix) mesh, for reinforcing the abdominal wall during reconstruction, noting its advantages in reducing hernia and bulge rates, promoting gradual tensile strength gain, and minimizing mesh-related complications due to its resorbable nature.<br /><br />He reviewed the evolution from pedicled TRAM to DIEP flaps, aiming to minimize abdominal wall morbidity by preserving muscle, fascia, and nerves. Despite advances, complications such as bulges, hernias, wound breakdown, and fat necrosis remain significant and are major drivers of patient dissatisfaction. Dr. Kovach recommends reinforcing donor sites with onlay Phasix mesh, as it is rapid, effective, and avoids additional dissection planes, with evidence showing marked reduction in abdominal wall complications.<br /><br />He also stressed early, aggressive management of wound complications to prevent hernia/bulge development and detailed surgical techniques for treating established defects, including mesh placement and “corset repair” involving external oblique aponeurosis. Dr. Kovach shared his clinical experience, citing over five years of successful Phasix use in breast reconstruction, and provided practical insights into perioperative care, infection management, and postoperative rehabilitation strategies to optimize outcomes and patient quality of life.

Keywords

autologous abdominal-based free-flap breast reconstruction

donor site management

abdominal wall stewardship

biosynthetic mesh

poly-4-hydroxybutyrate (Phasix) mesh

hernia and bulge prevention

DIEP flap

wound complication management

corset repair technique