Russell J Bramhall1, Izaro Hernan2, Paul A Harris2. 1. Department of Plastic and Reconstructive Surgery, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ. Electronic address: russellbramhall@nhs.net. 2. Department of Plastic and Reconstructive Surgery, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ.
Abstract
INTRODUCTION: Implant-based breast reconstruction has relatively high complication rates. Removal of infected implants and immediate autologous reconstruction is a safe single-stage procedure that preserves the native breast skin envelope. METHODS: A single-centre, retrospective proof-of-concept review of all salvage procedures performed for acute/chronic infected or exposed implant-based reconstructions by a single surgeon over a 6-year period. RESULTS: We present 13 cases of a particularly difficult subgroup of acute/chronic infection/extrusion over a 6-year period. All were successfully salvaged in a single procedure by implant removal and immediate free flap reconstruction with no significant complications. All patients had a change of pocket from subpectoral to subcutaneous and partial capsulectomies. Four patients had unilateral DIEP flaps for unilateral reconstruction, 3 bi-pedicle DIEP flaps for unilateral reconstruction, 2 bilateral TUG flaps for unilateral reconstruction, 3 bilateral DIEP flaps for bilateral reconstruction and 1 unilateral DIEP and implant for unilateral reconstruction. CONCLUSIONS: These patients are often slim with limited donor sites and pose technical challenges, often requiring double free flap reconstructions. Single-stage implant removal and autologous reconstruction preserves the breast skin envelope to maximise cosmesis in a single procedure. The introduction of healthy, well-vascularised tissue may also help treat the infection.
INTRODUCTION: Implant-based breast reconstruction has relatively high complication rates. Removal of infected implants and immediate autologous reconstruction is a safe single-stage procedure that preserves the native breast skin envelope. METHODS: A single-centre, retrospective proof-of-concept review of all salvage procedures performed for acute/chronic infected or exposed implant-based reconstructions by a single surgeon over a 6-year period. RESULTS: We present 13 cases of a particularly difficult subgroup of acute/chronic infection/extrusion over a 6-year period. All were successfully salvaged in a single procedure by implant removal and immediate free flap reconstruction with no significant complications. All patients had a change of pocket from subpectoral to subcutaneous and partial capsulectomies. Four patients had unilateral DIEP flaps for unilateral reconstruction, 3 bi-pedicle DIEP flaps for unilateral reconstruction, 2 bilateral TUG flaps for unilateral reconstruction, 3 bilateral DIEP flaps for bilateral reconstruction and 1 unilateral DIEP and implant for unilateral reconstruction. CONCLUSIONS: These patients are often slim with limited donor sites and pose technical challenges, often requiring double free flap reconstructions. Single-stage implant removal and autologous reconstruction preserves the breast skin envelope to maximise cosmesis in a single procedure. The introduction of healthy, well-vascularised tissue may also help treat the infection.
Authors: Miguel De La Parra Marquez; Ricardo Fernandez-Riera; Hector Vela Cardona; Jesus María Rangel Flores Journal: World J Surg Oncol Date: 2018-04-17 Impact factor: 2.754