title: Impact of Prior Tissue Expander/Implant on Postmastectomy Free Flap Breast Reconstruction.
abstract: BACKGROUND
  Implant-based breast reconstructions can result in unsatisfactory results requiring surgical revision or salvage reconstructive surgery with autologous tissue. This study compares the outcomes and complications of salvage (tertiary) flap reconstruction after failed prosthesis placement to those of primary/secondary flap reconstruction.
  
  
  METHODS
  All patients undergoing free flap breast reconstruction after failed prosthesis between July 1, 2005, and June 30, 2014, were identified. A matched number of patients who underwent a de novo free flap breast reconstruction were selected randomly for review. The indication for prosthesis removal, demographic and operative data, flap type and inset, and complication rates were evaluated.
  
  
  RESULTS
  Eighty-nine women with a history of failed implant-based reconstruction required free flap reconstruction for salvage in 121 breasts. Capsular contracture was the most common indication for prosthesis removal (62.0 percent). Recipient vessel scarring was 5.23 times more likely to occur in the prior prosthesis group (p < 0.001). Alternate flap types other than deep inferior epigastric perforator and transverse rectus abdominis myocutaneous flaps were more frequently used in this cohort. Major complications requiring operative management were more common in the experimental group (17.4 percent versus 8.1 percent; p = 0.035). No difference was noted in flap loss rates, operative take back, or operative time.
  
  
  CONCLUSIONS
  Salvage breast reconstruction with autologous tissue after failed prosthesis can be safely performed, with success rates similar to those of primary free flap breast reconstruction. However, these procedures may have increased complexity because of recipient vessel scarring, higher rates of prior radiation therapy, and major complications, which may warrant appropriate preoperative planning and patient counseling.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Los Angeles, Calif.|From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.
authors.forename: Jason
authors.initials: J
authors.lastname: Roostaeian
authors.affiliation: Los Angeles, Calif.|From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.
authors.forename: Alfred P
authors.initials: AP
authors.lastname: Yoon
authors.affiliation: Los Angeles, Calif.|From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.
authors.forename: Shannon
authors.initials: S
authors.lastname: Ordon
authors.affiliation: Los Angeles, Calif.|From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.
authors.forename: Chris
authors.initials: C
authors.lastname: Gold
authors.affiliation: Los Angeles, Calif.|From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.
authors.forename: Christopher
authors.initials: C
authors.lastname: Crisera
authors.affiliation: Los Angeles, Calif.|From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.
authors.forename: Jaco
authors.initials: J
authors.lastname: Festekjian
authors.affiliation: Los Angeles, Calif.|From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.
authors.forename: Andrew
authors.initials: A
authors.lastname: Da Lio
authors.affiliation: Los Angeles, Calif.|From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.
authors.forename: Joan E
authors.initials: JE
authors.lastname: Lipa
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000295:instrumentation; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011475:Prosthesis Failure; D012086:Reoperation; D016879:Salvage Therapy / Q000295:instrumentation / Q000379:methods*; D015625:Tissue Expansion Devices