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J Reconstr Microsurg 2018; 34(09): 685-691
DOI: 10.1055/s-0038-1641680
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Multicenter Analysis Examining Patients Undergoing Conversion of Implant-based Breast Reconstruction to Abdominally based Free Tissue Transfer

Ruya Zhao
1   Duke University School of Medicine, Durham, North Carolina
,
Bao Ngoc N. Tran
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Andres F. Doval
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Gloria Broadwater
3   Biostatistics, Duke Cancer Institute, Durham, North Carolina
,
Kate J. Buretta
1   Duke University School of Medicine, Durham, North Carolina
,
Jonah P. Orr
1   Duke University School of Medicine, Durham, North Carolina
,
Bernard T. Lee
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Scott T. Hollenbeck
1   Duke University School of Medicine, Durham, North Carolina
› Author Affiliations
Further Information

Publication History

11 December 2017

22 February 2018

Publication Date:
07 May 2018 (online)

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Tertiary Breast Reconstruction for Salvage of the Failed Implant-Based Reconstruction Using the Deep Inferior Epigastric Perforator FlapJ Reconstr Microsurg 2018; 34(09): e1-e2
DOI: 10.1055/s-0039-1679885

Abstract

Background Breast implant placement is the most common method for postmastectomy reconstruction. For patients who develop complications associated with implant-based reconstruction, additional surgeries may be challenging. This study examined implant-based reconstruction failure in patients undergoing salvage with abdominal free tissue transfer.

Methods We conducted an Institutional Review Board approved, multicenter retrospective study of patients with implant-based primary breast reconstruction followed by implant removal and subsequent abdominal free tissue transfer between 2006 and 2016. Patient demographics, treatment details, and complications were evaluated. Severity of implant failure was graded as either (1) not severe (delayed salvage reconstruction) or (2) severe (immediate salvage reconstruction).

Results Between 2006 and 2016, 115 patients with 180 mastectomy defects underwent primary implant-based reconstruction with subsequent implant removal and abdominally based free tissue reconstruction. Of these, 68 were delayed and 47 were immediate salvage reconstruction. Factors leading to elective removal were capsular contracture, asymmetry, and implant malposition. Factors leading to obligatory removal were infection, delayed wound healing, and implant extrusion. Postmastectomy radiation was significantly associated with immediate salvage reconstruction (p < 0.001, odds ratio = 3.9) as were large volume implants (p = 0.06). Deep inferior epigastric perforator flaps comprised 78.3% of all abdominally based free tissue reconstructions, while muscle-sparing transverse rectus abdominus myocutaneous flaps comprised 18.3%. Overall flap failure rate was 2.6% (2.94% delayed and 2.13% immediate salvage reconstruction; p = 1.0).

Conclusion Our findings suggest that abdominal free tissue transfer remains a safe and effective salvage modality for implant-based breast reconstruction failure. Patients with severe implant failure were more likely to have received radiation. Surgeons should remain cognizant of this during care of patients.

Keywords

breast reconstruction - abdominal free flap - salvage reconstruction
 

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