Combining Abdominal Flaps and Implants in the Breast Reconstruction Patient: A Systematic and Retrospective Review of Complications and Outcomes.
Combining Abdominal Flaps and Implants in the Breast Reconstruction Patient: A Systematic and Retrospective Review of Complications and Outcomes.
- 2019
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. The authors seek to compare outcomes from a single surgeon and previously published studies. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. CONCLUSIONS: The literature supports a higher rate of implant-related complications following immediate implantation at the time of flap reconstruction. The authors' experience with implant placement highlights the safety and effectiveness of the staged approach. METHODS: A systematic review was performed, querying multiple databases. A retrospective review was conducted for patients who underwent abdominally based flap breast reconstruction and implant placement between July of 2005 and August of 2015 performed by the senior author (M.Y.N.). RESULTS: A systematic review of the literature yielded four articles, for a total of 96 patients (142 breasts) included for systematic review. Eighty-seven breasts (61 percent) were reconstructed with immediate implant at the time of flap reconstruction and 55 breasts (39 percent) had a staged approach to implant placement. Complications were noted in 28 breasts (32 percent) following immediate placement and in 10 breasts (18 percent) following staged placement. A total of 53 patients (79 breasts) were retrospectively reviewed, all of whom underwent reconstruction in a staged manner. Twelve breasts (15 percent) were found to have a flap- or implant-related complication; 97.5 percent of implants/flap reconstructions were successful, with a 54 percent 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.
English
0032-1052
10.1097/PRS.0000000000005373 [doi]
*Breast Implants/ae [Adverse Effects]
*Breast Neoplasms/su [Surgery]
*Mammaplasty/ae [Adverse Effects]
*Postoperative Complications/ep [Epidemiology]
*Surgical Flaps/ae [Adverse Effects]
Breast/su [Surgery]
Combined Modality Therapy/ae [Adverse Effects]
Combined Modality Therapy/mt [Methods]
Female
Humans
Mammaplasty/mt [Methods]
Mastectomy/ae [Adverse Effects]
Postoperative Complications/et [Etiology]
Reoperation/sn [Statistics & Numerical Data]
Retrospective Studies
Time Factors
Treatment Outcome
MedStar Health Research Institute
MedStar Washington Hospital Center
Surgery/Plastic Surgery
Journal Article
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. The authors seek to compare outcomes from a single surgeon and previously published studies. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. CONCLUSIONS: The literature supports a higher rate of implant-related complications following immediate implantation at the time of flap reconstruction. The authors' experience with implant placement highlights the safety and effectiveness of the staged approach. METHODS: A systematic review was performed, querying multiple databases. A retrospective review was conducted for patients who underwent abdominally based flap breast reconstruction and implant placement between July of 2005 and August of 2015 performed by the senior author (M.Y.N.). RESULTS: A systematic review of the literature yielded four articles, for a total of 96 patients (142 breasts) included for systematic review. Eighty-seven breasts (61 percent) were reconstructed with immediate implant at the time of flap reconstruction and 55 breasts (39 percent) had a staged approach to implant placement. Complications were noted in 28 breasts (32 percent) following immediate placement and in 10 breasts (18 percent) following staged placement. A total of 53 patients (79 breasts) were retrospectively reviewed, all of whom underwent reconstruction in a staged manner. Twelve breasts (15 percent) were found to have a flap- or implant-related complication; 97.5 percent of implants/flap reconstructions were successful, with a 54 percent 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.
English
0032-1052
10.1097/PRS.0000000000005373 [doi]
*Breast Implants/ae [Adverse Effects]
*Breast Neoplasms/su [Surgery]
*Mammaplasty/ae [Adverse Effects]
*Postoperative Complications/ep [Epidemiology]
*Surgical Flaps/ae [Adverse Effects]
Breast/su [Surgery]
Combined Modality Therapy/ae [Adverse Effects]
Combined Modality Therapy/mt [Methods]
Female
Humans
Mammaplasty/mt [Methods]
Mastectomy/ae [Adverse Effects]
Postoperative Complications/et [Etiology]
Reoperation/sn [Statistics & Numerical Data]
Retrospective Studies
Time Factors
Treatment Outcome
MedStar Health Research Institute
MedStar Washington Hospital Center
Surgery/Plastic Surgery
Journal Article