Autologous Breast Reconstruction Implant Augmentation (A.B.R.I.A.): Indications and Outcomes

Background: Autologous tissue has been employed at increasing rates for breast reconstruction due to increasing numbers of young women with normal BMI and advanced stage malignancies. Traditionally, women with a paucity of abdominal soft tissue have been considered candidates for implant reconstruction alone or LDMC flaps +/- breast implants. These reconstructive options associated with avoidable morbidity, making them less than ideal. The aim of this study is to describe ABRIA and its indications and outcomes in order to satisfy soft tissue implant coverage, volume and contour problems in this breast reconstruction patient population.

Materials and Methods: An IRB-approved retrospective study of consecutive patients undergoing ABRIA from 2011 to 2014 was conducted. Outcomes related to patient demographics, indications for surgery, radiotherapy, operative procedure, implant type, size, location and timing of placement, and complications were analyzed.

Results: Six patients with a mean age of 49.5 years and a mean BMI of 22.1 underwent breast reconstruction with 8 autologous flaps. Muscle sparing free TRAM was used in 63% (5/8) of cases followed in frequency by DIEP flaps (2/8) and a single pedicled TRAM. Indication for the use of autologous tissue included previous radiation (4/6), failed implant reconstruction and level of activity. All patients underwent delayed augmentation with a mean implant volume of 190 mL. Placement of implants was distributed equally between sub-flap (4/8) and sub-pectoral (4/8) pockets. Median time from breast reconstruction to implant augmentation was 5.5 months. There were no implant/flap complications. Average follow up was 8.5 months.

Discussion: We describe a technique that employs standard microsurgical techniques followed by implant augmentation similar to that employed for cosmetic breast augmentation. Benefits of ABRIA include: a straight forward secondary procedure breast augmentation, excellent implant soft tissue coverage, hidden donor site scarring, improved abdominal contour, and minimal donor site functional loss. This study demonstrates that delayed autologous breast reconstruction implant augmentation can be a safe and effective option for optimizing breast reconstruction with autologous tissue.