Background: Microsurgical free flaps are a common method of breast reconstruction. Our institutional experiences with 706 lower abdomen based free perforator flaps are reported with special interest in presenting a therapeutic algorithm for efficient decision-making.
Material/Methods: A retrospective chart review was performed. All patients undergoing free flap surgery for breast reconstruction between July 2004 and November 2009 were included.
Results: Seven hundred and six free flaps were performed in 635 patients: 451 DIEAP-flaps, 254 fasciasparing (fs) TRAM-flaps and one SIEA flaps were performed. Five hundred sixty four women had a unilateral and 71 a bilateral reconstruction (142 flaps). The complication rate was 0.84% (6 flaps) for total flap loss, 1.27% (9 flaps) for partial flap loss and 2.40% (17 flaps) for partial flap loss less than 20%. 7 patients (1.11%) underwent microsurgical revision, where venous problems occurred. 3 of them were successful, in two cases a partial flap loss less than 30% occurred after the revision. In 2 cases a complete flap loss appeared. Other minor complications included: 23 patients (3.65%) had breast hematomas, 18 patients (2.54%) presented with delayed wound healing (9 abdominal and 9 breast delayed wound healings), and 3 patients (0.42%) with abdominal hernias, 14 patients (1.98%) complained of weakness of abdominal wall.
Conclusions: Abdominally based free flaps a safe and reliable method and should therefore be offered as a standard method in a breast cancer center. The protocol and algorithm presented here can reduce complications in microsurgical breast reconstructive surgery.

Keywords: Postoperative Complications, Mammaplasty - methods, Free Tissue Flaps, Decision Making, Breast Diseases - surgery, Algorithms, Wound Healing