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Updated: Jun 12, 2026
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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Salvage (tertiary) breast reconstruction after implant failure
Moustapha Hamdi1, Bob Casaer, Patricio Andrades
1Department of Plastic Surgery, Ghent University Hospital, De Pintelaan 185, 2K12C, Ghent B9000, Belgium. moustapha.hamdi@UGent.be
Summary
Tertiary breast reconstruction, a revision of prior attempts, is necessary for 7.8% of patients. DIEAP flaps are common, with most patients requiring further procedures for optimal aesthetic outcomes.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Oncology
Background:
- Salvage breast reconstruction, termed tertiary breast reconstruction, addresses unsatisfactory results or failure of prior breast reconstructions.
- This study focuses on the indications, methods, and outcomes of tertiary breast reconstructions.
Purpose of the Study:
- To present the experience with tertiary breast reconstructions.
- To analyze the indications, surgical methods, and patient outcomes in tertiary breast reconstruction.
Main Methods:
- A retrospective review of 688 patients undergoing autologous tissue breast reconstruction between 2002 and 2009.
- Identified 54 patients (7.8%) requiring tertiary surgery after implant reconstruction failure.
Main Results:
- 81 free-flap reconstructions were performed, with the deep inferior epigastric artery perforator (DIEAP) flap being the most common (81%).
- Mean operating time was 7.2 hours, mean hospital stay was 7.2 days, with a low total flap loss rate of 1.2%.
- 55.5% of patients required secondary procedures for aesthetic improvement, including flap revisions (53%) and donor-site corrections (33%).
Conclusions:
- Successful tertiary breast reconstruction hinges on restoring the breast envelope and footprint, alongside scar tissue excision.
- Further corrective procedures are often necessary, depending on the extent of initial damage and postoperative complications.