INTRODUCTION: Breast augmentation using the artificial injectable materials has represented significant clinical and social problems due to their late complications particularly in Asian countries. Since 1991 we have treated those who want not only to remove these materials within breast tissue but also to maintain the contour of the bilateral breasts with autologous tissue transfer. The purpose of this study is to review the clinical outcome of the reconstruction procedures retrospectively. MATERIALS AND METHODS: Totally 38 breasts of 19 our consecutive cases treated from 1991 to 2002 were reviewed retrospectively. Patients were all female ranging from 41 to 70 y/o (mean age; 53.4 y/o). The average period from injection to reconstruction was 26.5 years (range; 10 - 30 years). After the injectable materials were completely removed from breast tissue, bilateral breasts were simultaneously re-augmented with de-epithelialized rectus abdominis flaps, which were completely buried subcutaneously. The incidence of major and/or minor complications, which include flap necrosis, hematoma, infection, abdominal bulging, etc, was examined. RESULTS: The ingredient analysis revealed that these materials consist of silicone gel in 15 cases, silicone fluid in 1 case, hydrocarbon fluid in 1 case and both of these fluid in 2 cases. The details of the 38 flaps transferred were 31 of free TRAM flaps, 5 of pedicled TRAM flaps and 2 of pedicled VRAM flaps. 3 flaps of total necrosis (7.9 %)were found in 2 cases due to venous congestion. Partial flap necrosis was observed in 6 flaps (15.8 %), 2 of which was occurred in 1 case bilaterally. Hematoma occurred in 1 case (2.6 %). Salvage operation was performed in 7 cases. CONCLUSIONS: Complication rate seemed to be relatively higher compared with that of breast reconstruction after mastectomy due to breast cancer (data not shown). In conclusion, the autologous tissue transfer may be one of the ideal procedures for breast re-augmentation after the injectable material removal, although care must be taken particularly in adjusting the volume of the flaps or insetting flaps for preventing them from total necrosis due to subcutaneous tension.
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