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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e31817d6303
Breast: Original Articles

Effects of an Autologous Flap Combined with an Implant for Breast Reconstruction: An Evaluation of 1000 Consecutive Reconstructions of Previously Irradiated Breasts

Chang, David W. M.D.; Barnea, Yoav M.D.; Robb, Geoffrey L. M.D.

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Abstract

Background: The goal of the authors’ study was to determine whether an autologous tissue flap, when combined with an implant for breast reconstruction, reduces the incidence of implant-related complications in previously irradiated breasts.

Methods: The authors reviewed 1000 consecutive cases of implant-based breast reconstructions performed in 706 patients at the authors’ institution. The median age was 49.5 years, and mean follow-up was 22.2 months. Eighty-six patients (8.6 percent) received preoperative radiation therapy and 43 patients (4.3 percent) received postoperative radiation therapy to the reconstructed breast. Breast reconstructions were performed using an expander/implant alone in 776 cases, a latissimus dorsi flap/implant in 146 cases, and a free transverse rectus abdominis musculocutaneous (TRAM) flap/implant in 78 cases. Implant-based reconstructions were considered to have failed if an implant was lost because of extrusion, infection, or rupture or if implant exchange was required because of a severe capsular contracture.

Results: In patients who had undergone preoperative irradiation, patients with free TRAM flap/implant reconstructions had a significantly lower implant loss rate than patients with expander/implant-only reconstructions (5.0 percent versus 30.3 percent, p < 0.04). Also, significantly fewer reconstructions failed in patients with latissimus dorsi flap/implant reconstructions or TRAM flap/implant reconstructions than in patients with expander/implant-only reconstructions (15.2 percent or 10.0 percent versus 42.2 percent, p < 0.03).

Conclusion: An autologous flap, when combined with an implant for breast reconstruction, appears to reduce the incidence of implant-related complications in previously irradiated breasts.

©2008American Society of Plastic Surgeons

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