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

Abstract

The complication rate seemed to be relatively high compared with that for breast reconstruction after mastectomy. Nevertheless, autologous tissue transfer may be one of the ideal procedures for breast reaugmentation after the removal of injectable materials, because affected patients prefer not to undergo reaugmentation with other artificial materials.

Free Silicone-Induced Deep Inferior Epigastric Perforator Flap Failure in the Setting of Silicone Mastitis

“…Complete necrosis was noted in 7.9% of flaps and was secondary to venous thrombosis. 7 In our case, DIEP flap offered an opportunity to use a reliable flap with the lowest risk of hernia development compared with other abdominal-based reconstruction. Use of IM vessels was otherwise expected to be successful as this is the most commonly used recipient site in breast reconstruction.…”

“…Despite the FDA's initial investigation in 1965 concluding free silicone to be safe for soft tissue augmentation, 2 many reports demonstrate that silicone is not biologically inert. 1,5,7,8 Over time, silicone migrates into surrounding tissues, causing a chronic granulomatous inflammatory response and pain. 1,6 To effectively treat these symptoms, most patients with silicone mastitis undergo total mastectomy.…”

“…The transverse rectus abdominis muscle (TRAM), superior gluteal artery perforator (SGAP), and latissimus dorsi (LD) flaps have been used for autologous reconstruction of silicone-related disease, and they have demonstrated comparable results and complications. 3,5,7 Echo et al demonstrated successful free autologous breast reconstructions for silicone mastitis where most microanastomoses were performed with thoracodorsal (TD) vessels. 5 However, silicone infiltration of recipient TD vessels in a few patients left them unsuitable for anastomosis and required anastomoses to IM vessels.…”

“…As silicone infiltration increases the risk of tissue ischemia and infection, autologous tissue reconstruction mitigates these risks and theoretically offers a superior option compared with breast implant-based reconstruction. Various autologous reconstructions have been described, 3,5,7 and in the instances when free tissue transfer has failed, the source of thrombotic-related failure may be unknown. 3,7 To the best of our knowledge, we report the first case of deep inferior epigastric perforator (DIEP) flap loss following silicone mastitis reconstruction as a result of free silicone-precipitated thrombosis.…”

Bilateral breast reconstruction with a pedicled transverse rectus abdominis myocutaneous flap after subcutaneous mastectomy for symptomatic injected breasts

“…Periareolar incision relatively provided more aesthetic results, but it seems not easily to remove all injected material. Mizuno et al [16] reported 38 de-epithelialised rectus abdominis flaps, 31 of 38 for free TRAM myocutaneous flaps, five for pedicle TRAM flaps, and two for pedicle VRAM flaps. They also used bilateral inframammary incisions for subcutaneous removal of all breast tissue and foreign body.…”