Immediate implant replacement with DIEP flap: a single-stage salvage option in failed implant-based breast reconstruction

Márquez, Miguel de la Parra; Fernández-Riera, Ricardo; Cardona, Hector Vela; Flores, Jesús María Rangel

doi:10.1186/s12957-018-1387-5

Cited by 9 publications

(14 citation statements)

References 40 publications

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“…For breast-conserving surgery with acellular dermal matrix (ADM), appropriate planning of skin incision that should be performed as far away from the tumor site as possible can minimize the risk of ADM extrusion [ 27 , 28 ]. Immediate free flap reconstruction is a feasible and safe option with low risk of complications that result in a soft and natural-shaped breast [ 29 ]. Lagergren J [ 30 ] had 13% local complications in a 5-year follow-up among 249 women with cancer operated with immediate breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Long-term oncologic safety of immediate reconstructive surgery in patients with invasive breast cancer: a retrospective matched-cohort study

Song

Sun

et al. 2021

World J Surg Onc

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Objective Immediate reconstruction (IR) is a safe and effective surgical treatment for patients with breast cancer. We aimed to assess the prognosis, aesthetic outcomes, and patient satisfaction of IR compared with breast conservation surgery (BCS) and total mastectomy (TM). Methods This retrospective matched-cohort study was conducted between May 2005 and December 2014. We established two cohorts according to the tumor (T) size of breast cancer. In the T≤3cm group, cases (IR) and controls (BCS or TM) were matched for age, pathological tumor size, and pathologic nodal status in a 1:1:1 ratio. In the T>3cm group, cases (IR) and controls (TM) were matched with the same factors and ratio. The primary outcome was the 5-year disease-free survival (DFS). The secondary outcome was patient satisfaction and quality of life. Results A total of 12,678 breast cancer patients were assessed for eligibility, of which 587 were included (T≤3 cm group: 155 IR vs 155 BCS vs 155 TM; T>3cm group: 61 IR vs 61 TM). In the T≤3 cm cohort, patients who underwent IR had no difference compared with those who underwent BCS or TM regarding the 5-year DFS (P=0.539); however, an improved aesthetic satisfaction, psychosocial, and sexual well-being were achieved in the IR group (P<0.001). In the T>3 cm cohort, the IR group had a worse median 5-year DFS (P=0.044), especially for Her2+ or triple-negative breast carcinoma (TNBC) subtypes compared with the TM group. Conclusions IR improves aesthetic satisfaction, psychosocial, and sexual well-being for breast cancer patients with T≤3 cm. For patients with T > 3 cm invasive breast cancer, TM is superior to IR as it predicts a better 5-year DFS.

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Section: Discussionmentioning

confidence: 99%

Long-term oncologic safety of immediate reconstructive surgery in patients with invasive breast cancer: a retrospective matched-cohort study

Song

Sun

et al. 2021

World J Surg Onc

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“…34 The traditional approach has therefore been to delay reconstructive surgery for greater than 6 months to allow for complete resolution of infection and patient recuperation. 4,17,34 In our study, there was a trend toward a higher infection-related complication rate after immediate third-attempt IBR [ n = 2 of 5 (40%)] compared to delayed IBR [ n = 0 of 4 (0%)]. The ultimate decision on the timing of third-attempt IBR is multifactorial and should be based on surgeon and patient preference, infection severity, and clinical status.…”

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Outcomes of Third-attempt Breast Reconstruction Following Infection-Associated Failure of Secondary Implant-Based Reconstruction

Hassan

Tran

Asaad

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Implant-based reconstruction (IBR) is the most common method of breast reconstruction in the United States. Despite ongoing advancements, periprosthetic infection is a serious problem that often results in device explantation. The objective of this study was to evaluate the outcomes of third-attempt reconstruction in patients in whom secondary implant-based reconstruction failed because of infection. Methods: The authors performed a retrospective review of patients who underwent mastectomy followed by IBR from 2000 to 2019. The outcomes of patients in whom secondary IBR failed because of infection and who ultimately underwent third-attempt breast reconstruction were analyzed. Results: Of 6093 patients who underwent primary IBR, 13 patients had third-attempt breast reconstruction following infection-related explantation [median age, 52 years (interquartile range, 51 to 56 years); median body mass index, 23 kg/m2 (interquartile range, 22 to 31 kg/m2); median follow-up, 46 months (interquartile range, 16 to 62 months)]. Nine patients (70%) underwent IBR, two (15%) underwent IBR combined with pedicled latissimus dorsi flap, and two (15%) underwent abdominally based free tissue transfer. Third-attempt breast reconstruction was immediate in 46% of patients and delayed in 54%. The success rate was 78% in the IBR group, with a 23% complication rate. The success rate for autologous breast reconstruction was 100%, with one patient developing venous congestion necessitating return to the operating room. Conclusions: Third-attempt breast reconstruction following infection-associated failed secondary IBR is a safe and feasible option. Although the risk of failure is higher than that for primary implant-based reconstruction, a third attempt after secondary IBR infection had a surprisingly high 78% success rate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

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“…We did not find published studies with large series using AICAP flaps in this type of reconstruction and neither with the presence of breast infection. 18–21…”

Section: Discussionmentioning

confidence: 99%

Intercostal Artery Perforator Flap for Salvage Breast Reconstruction with Exposed Breast Implants

Mesa

López

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Multiple techniques have been described for breast reconstruction surgery after breast implant exposure; breast implant removal and delayed breast reconstruction is the procedure of choice. However, in some mild exposures and infections, we propose an alternative treatment. Methods: This is a case series of a 14-year study in 16 female patients with mild exposure of a breast implant after breast reconstruction surgery. Salvage surgery was performed on these cases. The defects were between 1 and 6 cm, with a median size of 3.9 × 2.9 cm. Eighteen intercostal artery perforator flaps were used with an island of skin from the inframammary fold; 83.3% were anterior intercostal artery perforator flaps‚ and 16.7% were lateral intercostal artery perforator flaps. Results: Thirteen of the 16 patients presented infection (81.25%). There was no necrosis of any flap, and the success rate of salvage surgery was 62.5% of all patients. The success of surgery was 53.8% in patients with breast infection and 100% in patients without infection. Seven patients received chemotherapy and radiotherapy, six received only chemotherapy, and nine patients received only radiotherapy. Five of the six patients whose salvage surgery failed were treated with radiotherapy. Conclusion: This technique can be used as an alternative when there is exposure of the implant‚ even in cases with a mild breast infection and in patients undergoing radiotherapy and chemotherapy.

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Immediate implant replacement with DIEP flap: a single-stage salvage option in failed implant-based breast reconstruction

Cited by 9 publications

References 40 publications

Long-term oncologic safety of immediate reconstructive surgery in patients with invasive breast cancer: a retrospective matched-cohort study

Long-term oncologic safety of immediate reconstructive surgery in patients with invasive breast cancer: a retrospective matched-cohort study

Outcomes of Third-attempt Breast Reconstruction Following Infection-Associated Failure of Secondary Implant-Based Reconstruction

Intercostal Artery Perforator Flap for Salvage Breast Reconstruction with Exposed Breast Implants

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