title: Effects of an autologous flap combined with an implant for breast reconstruction: an evaluation of 1000 consecutive reconstructions of previously irradiated breasts.
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).
  
  
  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.
authors.affiliation: Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.
authors.forename: David W
authors.initials: DW
authors.lastname: Chang
authors.forename: Yoav
authors.initials: Y
authors.lastname: Barnea
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Robb
mesh_terms: 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