Effects of an autologous flap combined with an implant for breast reconstruction: An evaluation of 1000 consecutive reconstructions of previously irradiated breasts

BACKGROUND: The goal of the authors' study was to determine whether an autologous tissue flap, when combined with an implant for breast reconstruction, reduces the incidence of implant-related complications in previously irradiated breasts. METHODS: The authors reviewed 1000 consecutive cases of implant-based breast reconstructions performed in 706 patients at the authors' institution. The median age was 49.5 years, and mean follow-up was 22.2 months. Eighty-six patients (8.6 percent) received preoperative radiation therapy and 43 patients (4.3 percent) received postoperative radiation therapy to the reconstructed breast. Breast reconstructions were performed using an expander/implant alone in 776 cases, a latissimus dorsi flap/implant in 146 cases, and a free transverse rectus abdominis musculocutaneous (TRAM) flap/implant in 78 cases. Implant-based reconstructions were considered to have failed if an implant was lost because of extrusion, infection, or rupture or if implant exchange was required because of a severe capsular contracture. RESULTS: In patients who had undergone preoperative irradiation, patients with free TRAM flap/implant reconstructions had a significantly lower implant loss rate than patients with expander/implant-only reconstructions (5.0 percent versus 30.3 percent, p < 0.04). Also, significantly fewer reconstructions failed in patients with latissimus dorsi flap/implant reconstructions or TRAM flap/implant reconstructions than in patients with expander/implant-only reconstructions (15.2 percent or 10.0 percent versus 42.2 percent, p < 0.03). CONCLUSION: An autologous flap, when combined with an implant for breast reconstruction, appears to reduce the incidence of implant-related complications in previously irradiated breasts.