Combining abdominal flaps and implants in the breast reconstruction patient: a systematic and retrospective review of complications and outcomes


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Abstract

Background:Implants offer a method for augmenting abdominal flaps in the setting of deficient volume in breast reconstruction. They may be placed immediately at the time of reconstruction or on a delayed basis. We seek to compare outcomes from a single surgeon and previously published studies.Methods:A systematic review was performed, querying multiple databases. A retrospective review was conducted for patients who underwent abdominal based flap breast reconstruction and implant placement between July 2005 and August 2015 by the senior author(MYN).Results:A systematic review of the literature yielded four articles, for a total of 96 patients(142 breasts) included for systematic review. 87 breasts(61%) were reconstructed with immediate implant at the time of flap reconstruction and 55 breasts(39%) had a staged approach to implant placement. Complications were noted in 28 breasts(32%) following immediate placement and in 10 breasts(18%) following staged placement. A total of 53 patients(79 breasts) were retrospectively reviewed, all of which were reconstructed in a staged manner. Twelve breasts(15%) were found to have a flap or implant related complication. 97.5% of implants/flap reconstructions were successful, with a 54% revision rate. When pooling systematic and retrospective data, there was a significant difference in complication rates between the staged and immediate reconstruction cohorts(p < 0.001) in favor of the staged approach.Conclusions:The literature supports a higher rate of implant-related complications following immediate implantation at the time of flap reconstruction. Our experience with implant placement highlights the safety and effectiveness of the staged approach.

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