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
