Download PDF
J Reconstr Microsurg 2015; 31(04): 254-260
DOI: 10.1055/s-0034-1395416
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Delayed Implant Augmentation of Breast Free Flaps

Irene J. Pien
1   Department of Plastic and Reconstructive Surgery, Duke University Hospital System, Durham, North Carolina
,
Rachel Anolik
1   Department of Plastic and Reconstructive Surgery, Duke University Hospital System, Durham, North Carolina
,
Jared Blau
1   Department of Plastic and Reconstructive Surgery, Duke University Hospital System, Durham, North Carolina
,
Scott T. Hollenbeck
1   Department of Plastic and Reconstructive Surgery, Duke University Hospital System, Durham, North Carolina
› Author Affiliations
Further Information

Publication History

29 July 2014

06 September 2014

Publication Date:
18 March 2015 (online)

Also available at
   Permissions and Reprints

Abstract

Background Two commonly used breast reconstruction techniques are (1) implant-based and (2) abdominal tissue-based procedures. When the two modalities are combined, the result is a unique construct that shares advantages and disadvantages of both approaches. Combining breast flaps and implants has been reported, yet the specific techniques associated with a reliable outcome remain unclear.

Materials and Methods Between July 2010 and 2014, a review of all patients who underwent delayed implant augmentation of a breast free flap reconstruction by the senior author was performed. Data were collected on patient characteristics, implants used, timing of reconstruction, and position of implant relative to the flap.

Results During the study period, 101 patients underwent breast reconstruction with 161 abdominal free flaps. Of these, 12 patients (12%) and 17 flaps (11%) had delayed implant augmentation. Of the 17 augmented flaps, 12 had expanders placed before final implant placement. Eleven implants were placed in the subflap position and 6 in the subpectoralis major position. The mean final implant size was 296.5 mL (range, 125–510 mL). At a mean follow-up of 17.1 months, there was one expander removed before complete expansion for impending extrusion and one silicone gel implant revision for malposition.

Conclusion The results of delayed breast flap implant augmentation can be reliable and generate results that may not be obtainable with flaps or implants alone. Admittedly, the addition of an implant to a flap reconstruction exposes the patient to implant-related complications that would otherwise have been circumvented by a pure autologous reconstruction.

Keywords

breast - flaps - implants
 

  • References

  • 1 Spear SL, Hannan CM, Willey SC, Cocilovo C. Nipple-sparing mastectomy. Plast Reconstr Surg 2009; 123 (6) 1665-1673
    CrossrefPubMedSearch in Google Scholar
  • 2 Albornoz CR, Bach PB, Mehrara BJ , et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg 2013; 131 (1) 15-23
    PubMedSearch in Google Scholar
  • 3 Cemal Y, Albornoz CR, Disa JJ , et al. A paradigm shift in U.S. breast reconstruction: Part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg 2013; 131 (3) 320e-326e
    CrossrefPubMedSearch in Google Scholar
  • 4 Figus A, Canu V, Iwuagwu FC, Ramakrishnan V. DIEP flap with implant: a further option in optimising breast reconstruction. J Plast Reconstr Aesthet Surg 2009; 62 (9) 1118-1126
    CrossrefPubMedSearch in Google Scholar
  • 5 Moran SL, Herceg S, Kurtelawicz K, Serletti JM. TRAM flap breast reconstruction with expanders and implants. AORN J 2000; 71 (2) 354-362 , quiz 363–368
    PubMedSearch in Google Scholar
  • 6 Roehl KR, Baumann DP, Chevray PM, Chang DW. Evaluation of outcomes in breast reconstructions combining lower abdominal free flaps and permanent implants. Plast Reconstr Surg 2010; 126 (2) 349-357
    CrossrefPubMedSearch in Google Scholar
  • 7 Radovan C. Breast reconstruction after mastectomy using the temporary expander. Plast Reconstr Surg 1982; 69 (2) 195-208
    CrossrefPubMedSearch in Google Scholar
  • 8 Atisha DM, Alderman AK, Kuhn LE, Wilkins EG. The impact of obesity on patient satisfaction with breast reconstruction. Plast Reconstr Surg 2008; 121 (6) 1893-1899
    CrossrefPubMedSearch in Google Scholar
  • 9 Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS. Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 2001; 33 (Suppl. 02) S69-S77
    CrossrefPubMedSearch in Google Scholar
  • 10 Leong G, Wilson J, Charlett A. Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect 2006; 63 (3) 255-262
    CrossrefPubMedSearch in Google Scholar
  • 11 Blechman KM, Broer PN, Tanna N, Ireton JE, Ahn CY, Allen RJ. Stacked profunda artery perforator flaps for unilateral breast reconstruction: a case report. J Reconstr Microsurg 2013; 29 (9) 631-634
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 DellaCroce FJ, Sullivan SK, Trahan C. Stacked deep inferior epigastric perforator flap breast reconstruction: a review of 110 flaps in 55 cases over 3 years. Plast Reconstr Surg 2011; 127 (3) 1093-1099
    CrossrefPubMedSearch in Google Scholar
  • 13 Figus A, Fioramonti P, Ramakrishnan V. Stacked free SIEA/DIEP flap for unilateral breast reconstruction in a thin patient with an abdominal vertical midline scar. J Reconstr Microsurg 2007; 23 (8) 523-525
    Thieme ConnectPubMedSearch in Google Scholar