Breast Re-reconstruction: Total Autologous Salvage of Failed Implant-Based Breast Reconstruction
Paul J. Therattil, M.D., Stephen L. Viviano, M.D., Omar M. Mohamed, B.A., Erica Y. Xue, B.A., Edward S. Lee, M.D., Jonathan D. Keith, M.D..
Rutgers New Jersey Medical School, Newark, NJ, USA.
BACKGROUND: The majority of patients undergoing breast reconstruction opt for implant-based procedures. This is due, in part, to surgeon experience, patient education, and preference. While often successful, complications such as infection, exposure, capsular contracture, implant palpability, and animation deformity are often devastating and can diminish the patient's overall satisfaction with the reconstruction. The aim of this study was to demonstrate an effective salvage procedure utilizing autologous tissue to re-reconstruct the breast.
METHODS: A retrospective review of a single-center's experience with autologous tissue re-reconstruction as a salvage procedure for failed implant-based breast reconstruction was performed. Patient were identified from the senior surgeon's prospective database (JDK). Fourteen patients were identified that met inclusion criteria. Charts were reviewed for relevant risk factors, operative details, and outcomes.
RESULTS: Fourteen patients underwent re-reconstruction with a total of 25 free flaps (24 DIEP, 1 muscle-sparing TRAM). Mean age at time of tertiary reconstruction was 48.5 years. Mean BMI at time of reconstruction was 29.2 kg/m2. 21.4% of patients had received chemotherapy, while 78.6% had received radiation. There was history of infection of the reconstructed breast in 29% of cases. All patients had prior tissue expander reconstruction, but only 28.6% of these had exchange to permanent implants prior to seeking autologous reconstruction. The etiology of initial reconstructive failure was contracture in 71.5% of patients, infection in 14.3%, asymmetry in 7.1%, and patient desire for implant removal in 7.1%. The mean time from initial reconstructive failure to autologous salvage was 43 months. Patients required a mean of 2.8 procedures to complete the autologous salvage (including nipple reconstruction and tattooing) with a mean of 12 months between the start and end of the reconstructive process. Mean follow-up time period was 7 months. There were no major complications, urgent returns to the operating room, or flap losses.
CONCLUSIONS: Breast reconstruction revision surgery is often challenging and truly is a sub-speciality within the field of plastic surgery. Many authors have proffered an array of approaches for dealing with failed implant-based reconstruction. Most require multiple procedures, acellular dermal matrix, and continued use of implants. For select patients, re-reconstruction with autologous tissue is a safe and effective way of treating the deformities associated with failed implant-based breast reconstruction.
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