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

Publication date: Available online 18 October 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Russell J. Bramhall, Izaro Hernan, Paul A. Harris
IntroductionImplant-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.MethodsA 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.ResultsWe present 13 cases of a particularly difficult subgroup over a 6 year period that were for acute/chronic infection/extrusion. All were successfully salvaged in one 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. 4 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 patient had a unilateral DIEP and implant for unilateral reconstruction.ConclusionsThese 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 to treat the infection.