TY - BOOK AU - Black, Cara K AU - DeFazio, Michael AU - Fan, Kenneth L AU - Nahabedian, Maurice Y TI - Combining Abdominal Flaps and Implants in the Breast Reconstruction Patient: A Systematic and Retrospective Review of Complications and Outcomes SN - 0032-1052 PY - 2019/// KW - *Breast Implants/ae [Adverse Effects] KW - *Breast Neoplasms/su [Surgery] KW - *Mammaplasty/ae [Adverse Effects] KW - *Postoperative Complications/ep [Epidemiology] KW - *Surgical Flaps/ae [Adverse Effects] KW - Breast/su [Surgery] KW - Combined Modality Therapy/ae [Adverse Effects] KW - Combined Modality Therapy/mt [Methods] KW - Female KW - Humans KW - Mammaplasty/mt [Methods] KW - Mastectomy/ae [Adverse Effects] KW - Postoperative Complications/et [Etiology] KW - Reoperation/sn [Statistics & Numerical Data] KW - Retrospective Studies KW - Time Factors KW - Treatment Outcome KW - MedStar Health Research Institute KW - MedStar Washington Hospital Center KW - Surgery/Plastic Surgery KW - Journal Article N2 - 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 UR - https://dx.doi.org/10.1097/PRS.0000000000005373 ER -