Combining Abdominal Flaps and Implants in the Breast Reconstruction Patient: A Systematic and Retrospective Review of Complications and Outcomes.

MedStar author(s):
Citation: Plastic & Reconstructive Surgery. 143(3):495e-503e, 2019 03.PMID: 30589827Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: Surgery/Plastic SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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 OutcomeYear: 2019ISSN:
  • 0032-1052
Name of journal: Plastic and reconstructive surgeryAbstract: 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.All authors: Black CK, Defazio MV, Fan KL, Graziano FD, Nahabedian MYFiscal year: FY2019Digital Object Identifier: Date added to catalog: 2019-01-18
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Journal Article MedStar Authors Catalog Article 30589827 Available 30589827

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.

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