Effects of an autologous flap combined with an implant for breast reconstruction: an evaluation of 1000 consecutive reconstructions of previously irradiated breasts.
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).


CONCLUSIONS
An autologous flap, when combined with an implant for breast reconstruction, appears to reduce the incidence of implant-related complications in previously irradiated breasts.
Chang
David W
DW
Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.
Barnea
Yoav
Y
Robb
Geoffrey L
GL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000528:radiation effects*; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D011475:Prosthesis Failure; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps