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Surgical Results, Aesthetic Outcome, and Patient Satisfaction after Microsurgical Autologous Breast Reconstruction following Failed Implant Reconstruction

Visser, Noortje J. M.Sc.; Damen, Tim H. C. M.D.; Timman, Reinier Ph.D.; Hofer, Stefan O. P. M.D., Ph.D.; Mureau, Marc A. M. M.D., Ph.D.

Plastic and Reconstructive Surgery: July 2010 - Volume 126 - Issue 1 - p 26-36
doi: 10.1097/PRS.0b013e3181da87a6
Breast: Outcomes Article

Background: The majority of breast reconstructions are performed using implant material. Implants have some major long-term disadvantages. Long-term implant-related complications and improved microsurgical techniques have led to an increased number of women requesting conversion of their implant breast reconstruction to autologous breast reconstruction. The aim of this study was to evaluate surgical and aesthetic outcome and patient satisfaction after tertiary autologous breast reconstruction.

Methods: Between 2001 and 2007, 42 women underwent 61 tertiary autologous breast reconstructions. Surgical outcome and complications were evaluated. Patient satisfaction was assessed using a study-specific questionnaire. Aesthetic result was rated by an expert panel using standardized photographs.

Results: Forty-seven deep inferior epigastric artery perforator, 10 mini–transverse rectus abdominis musculocutaneous, and four transverse musculocutaneous gracilis flaps were performed. Eight patients required reoperation because of complications (19 percent). Total flap loss did not occur. Nineteen patients underwent one or more additional operations to improve aesthetic outcome. Physical discomfort caused by implants and dissatisfaction with the aesthetic result were the main patient motivations to opt for autologous breast reconstruction. Reduction or disappearance of physical discomfort was noted in the vast majority of patients. Most patients were very satisfied with the aesthetic result (mean, 8 of 10), but the mean panel satisfaction score was lower (7 of 10). However, the panel noted a significant improvement of the aesthetic result after conversion to autologous breast reconstruction (from 5 of 10 to 7 of 10).

Conclusion: Autologous breast reconstruction after failed implant reconstruction is a technically feasible and reliable procedure that leads to improved physical condition and aesthetic results and a high degree of patient satisfaction.

Rotterdam, The Netherlands; and Toronto, Ontario, Canada

From the Departments of Plastic and Reconstructive Surgery and Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center, and the Division of Plastic Surgery, University Health Network, University of Toronto.

Received for publication September 28, 2009; accepted January 5, 2010.

Poster presentation at the Annual Meeting of the American Society of Reconstructive Microsurgery, in Maui, Hawaii, January 10 through 13, 2009.

Disclosure: The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article.

Marc A. M. Mureau, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, P.O. Box 2040, NL-3000 CA Rotterdam, The Netherlands,

©2010American Society of Plastic Surgeons