25.0: Thursday, March 17, 2005

Aesthetic Breast Reconstruction after Failed Bilateral Implant Reconstruction

Juliet V. Porch, MD, MPH and James S. Andersen, MD.

Purpose: Evaluation of salvage treatment after failed bilateral implant reconstruction of the breasts.

Patients and Methods: Retrospective review was conducted of eleven patients who underwent implant removal and bilateral autogenous breast reconstruction after unsatisfactory bilateral implant reconstruction. The patients had undergone bilateral implant reconstruction after bilateral mastectomies for unilateral (8) or bilateral breast cancer (3). The patients presented an average of seven years after bilateral implant reconstruction, and had undergone an average of one revision procedure prior to presentation. On presentation, chief complaints included deformity (2), discomfort (3), and asymmetry secondary to implant removal (6) for infection or deflation.

Results: Surgical treatment included implant removal and bilateral TRAM reconstruction (pedicle TRAM = 9, free TRAM = 1, unilateral free TRAM/unilateral DIEP = 1). Three patients required revision for fat necrosis. Three patients required operative repair of ventral diastasis. Patients underwent an average of one subsequent procedure for symmetry and NAC reconstruction. Mean follow-up after autogenous reconstruction was 2.3 years, at which time all eleven patients were satisfied with their reconstruction.

Conclusion: Bilateral implant breast reconstruction failures can be salvaged with excellent aesthetic result.