by Coriddi, Michelle;
Shenaq, Deana; Kenworthy, Elizabeth; Mbabuike, Jacques; Nelson, Jonas; Pusic,
Andrea; Mehrara, Babak; Disa, Joseph J.
Background:
There is a subset of patients who initially undergo implant-based breast
reconstruction but later change to autologous reconstruction after failure of
the implant reconstruction. The purpose of this study was to examine outcomes
and quality of life in this group of patients.
Methods: After
institutional review board approval, a retrospective chart review of a
prospectively maintained database was performed and BREAST-Q surveys were
evaluated.
Results: One
hundred thirty-seven patients underwent autologous breast reconstruction
following failed implant-based reconstruction with 192 total flaps. Failure of
implant reconstruction was defined as follows: capsular contracture causing
pain and/or cosmetic deformity [n = 106 (77 percent)], dissatisfaction with the
aesthetic result [n = 15 (11 percent)], impending exposure of the
implant/infection [n = 8 (6 percent)], and unknown [n = 8 (6 percent)].
Complications requiring operative intervention included partial flap loss [n =
5 (3 percent)], hematoma [n = 5 (3 percent)], vascular compromise requiring
intervention for salvage [n = 2 (1 percent)], and total flap loss [n = 1 (1
percent)]. Thirty-four patients (23 percent) had BREAST-Q surveys. There was a
statistically significant increase in overall outcomes (p < 0.001),
satisfaction with appearance of breasts (p < 0.001), psychosocial well-being
(p < 0.001), and physical well-being of the chest (p = 0.003). A
statistically significant decrease in physical well-being of the abdomen was
observed (p = 0.001). Conclusions:
Autologous breast reconstruction after failed implant-based reconstruction has
an acceptable complication rate and is associated with significantly improved
patient satisfaction and quality of life. CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
