A single-centre, retrospective proof-of-concept review of salvage of infected or exposed implant breast reconstructions with explantation and one-stage free flap replacement

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2018-02, Vol.71 (2), p.194-200
• Main Authors: Bramhall, Russell J., Hernan, Izaro, Harris, Paul A.
• Format: Article
• Language: English
• Subjects: Autologous free flap; Breast reconstruction; DIEP; Implant failure salvage; TUG
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2017.10.009

Implant-based breast reconstruction has relatively high complication rates. Removal of infected implants and immediate autologous reconstruction is a safe single-stage procedure that preserves the native breast skin envelope. A single-centre, retrospective proof-of-concept review of all salvage procedures performed for acute/chronic infected or exposed implant-based reconstructions by a single surgeon over a 6-year period. We present 13 cases of a particularly difficult subgroup of acute/chronic infection/extrusion over a 6-year period. All were successfully salvaged in a single procedure by implant removal and immediate free flap reconstruction with no significant complications. All patients had a change of pocket from subpectoral to subcutaneous and partial capsulectomies. Four patients had unilateral DIEP flaps for unilateral reconstruction, 3 bi-pedicle DIEP flaps for unilateral reconstruction, 2 bilateral TUG flaps for unilateral reconstruction, 3 bilateral DIEP flaps for bilateral reconstruction and 1 unilateral DIEP and implant for unilateral reconstruction. These patients are often slim with limited donor sites and pose technical challenges, often requiring double free flap reconstructions. Single-stage implant removal and autologous reconstruction preserves the breast skin envelope to maximise cosmesis in a single procedure. The introduction of healthy, well-vascularised tissue may also help treat the infection.