Delayed implant augmentation of breast free flaps

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Breast Reconstruction

Background:

• Breast reconstruction commonly utilizes implant-based or abdominal tissue-based (flap) procedures.
• Combining flaps and implants creates a unique reconstructive approach with shared advantages and disadvantages.
• Techniques for reliable outcomes in combined flap and implant breast reconstruction remain incompletely defined.

Purpose of the Study:

• To evaluate the reliability and outcomes of delayed implant augmentation in patients who previously underwent breast free flap reconstruction.

Main Methods:

• A retrospective review of patients undergoing delayed implant augmentation of a breast free flap reconstruction between July 2010 and 2014.
• Data collected included patient characteristics, implant details, reconstruction timing, and implant positioning relative to the flap.

Main Results:

• 101 patients underwent breast reconstruction with 161 abdominal free flaps; 12 patients (12%) received delayed implant augmentation (17 flaps, 11%).
• Of the 17 augmented flaps, 12 initially received expanders. Implants were placed in subflap (11) or subpectoralis major (6) positions, with a mean final size of 296.5 mL.
• At a mean follow-up of 17.1 months, complications included one expander removal due to extrusion and one implant revision for malposition.

Conclusions:

• Delayed breast flap implant augmentation can yield reliable results, potentially achieving outcomes superior to flaps or implants used independently.
• This combined approach introduces implant-specific complications that are avoided in purely autologous reconstructions.