title: Surgical results, aesthetic outcome, and patient satisfaction after microsurgical autologous breast reconstruction following failed implant reconstruction.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Noortje J
authors.initials: NJ
authors.lastname: Visser
authors.forename: Tim H C
authors.initials: THC
authors.lastname: Damen
authors.forename: Reinier
authors.initials: R
authors.lastname: Timman
authors.forename: Stefan O P
authors.initials: SOP
authors.lastname: Hofer
authors.forename: Marc A M
authors.initials: MAM
authors.lastname: Mureau
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000941:ethics / Q000379:methods* / Q000523:psychology; D008866:Microsurgery / Q000941:ethics / Q000379:methods*; D008875:Middle Aged; D009042:Motivation / Q000941:ethics; D017060:Patient Satisfaction; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation*; D012086:Reoperation / Q000941:ethics; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000941:ethics / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply / Q000941:ethics*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome