Immediate Reaugmentation of the Breasts Using Bilaterally Divided TRAM Flaps After Removing Injected Silicone Gel and Granulomas

Abstract

The authors present eight cases of reconstruction of the breasts using bilaterally divided TRAM flaps after removing the injected silicone gel and granulomas. In Japan, we have the opportunity to examine many patients who have had foreign substance injections to the breasts for purposes of augmentation however, most of them are now suffering from delayed complications. Until now we have reconstructed breasts such cases by use of silicone bag prostheses after removal of granulomas; however, now it is difficult to obtain silicone prostheses. Thus, we have decided to reconstruct by the use of autogenous cutaneous and adipose tissue flaps as presented by us in this article.

Simultaneous Bilateral Breast Reconstruction with Autologous Tissue Transfer after the Removal of Injectable Artificial Materials: A 12-Year Experience

“…5,7 Compared with these reports, the postoperative complication occurrence rate appears to be higher in our series. Moreover, the rate is higher than that in breast recon- struction after mastectomy resulting from breast cancer 17 (data not shown).…”

“…These require total excision of the silicone, which can only be achieved by subcutaneous mastectomy. 5,7 Some of the patients who want to have these injectable materials removed also want to maintain the shape and size of their breasts with another surgical procedure. Although subcutaneous mastectomy followed by reaugmentation with silicone prosthesis has been the most common method of treating the sequelae of silicone injection into the breast, the patients themselves are naturally unhappy about the use of further artificial implants.…”

“…[1][2][3][4] The representative complications associated with such augmentation include subcutaneous indurations, breast deformity, and oily infiltrations of the surrounding skin. 5 In addition, systemic morbidity, including human adjuvant disease, 2 breast cancer, 3 and death, 1 have been reported.…”

Autologous Breast Augmentation by Pedicled Perforator Flaps

“…Classic autologous reconstruction methods, on the other hand, pedicled or free TRAM flaps, are occasionally reported for augmentation but involve rather severe donor site morbidity for an esthetic procedure. [7][8][9][10][11] Considering the functional donor site morbidity, perforator flaps seem to reduce this to the bare essentials, there is no muscle severed, and only skin and subcutis are used. The free perforator flaps (eg, DIEP, SGAP, lumbar artery perforator, anterolateral thigh or medial thigh flap) take advantage of the typical fat deposits in the female patient (abdomen, buttocks, saddle bags, lower flank and back area, and inner thighs) which offer more tissue and hence a bigger augmentation but on the other hand require rather intensive microsurgical procedures.…”

Bilateral Breast Revision Augmentation With Deep Inferior Epigastric Perforators/Superficial Inferior Epigastric Artery Flaps

“…Bilateral pedicled transverse rectus abdominis myocutaneous flaps have been used for volume replace- ment after removal of cosmetic implants 12 and injected silicone 13,14 and paraffin, 15 and pedicled latissimus dorsi musculocutaneous flaps have been used extensively by Hollis for both revision and primary augmentation. 16 Hollis argued that autologous tissue is advantageous in that it can be expected to correlate with weight changes and the aging process, although no long-term data were presented to support this view.…”