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AAPS 2007 Annual Meeting, May 19 - 22, 2007, The Coeur d'Alene Resort, Coeur d'Alene, Idaho.
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Does an Autologous Flap Reduce Implant-Related Complications in an Irradiated Breast Reconstruction? An Evaluation of 1000 Consecutive Cases of Implant-Based Breast Reconstructions in 724 Patients.
David W. Chang, MD, Yoav barnea, MD, Geoffrey L. Robb, MD.
MD Anderson Cancer Center, HOUSTON, TX, USA.

Purpose: An implant-alone breast reconstruction is usually not recommended in patients with previous irradiation due to the high risk of complications. However, many surgeons feel the addition of an autologous flap over the implant does help reduce implant-related complications. It is unclear from existing data whether this is true or not. The purpose of this study was to evaluate whether an autologous flap helps reduce the implant-related complications in patients with previous irradiation undergoing an implant-based breast reconstruction.
Method: 1000 consecutive cases of implant-based breast reconstructions in 724 patients were reviewed. All cases were performed at our institution from Jan. 2001 to Dec. 2005;
59 cases were performed in patients who received preoperative XRT and 908 cases did not receive any XRT.
Results:

Expander/implant
818 cases in 580 patients
LD & implant
134 cases in 111 patients
TRAM & implant
48 cases in 33 patients
No XRTPre XRTNo XRTPre XRTNo XRTPre XRT
Total770 (94.1%)18(2.2%)101(75.4%)30 (22.4%)37 (77.1%)15(31.3%)
Implant loss33 (4.3%)6 (30.0%)3 (3.0%)3 (10.0%)2 (5.4%)2 (13.3%)
Extrusion18 (2.3%)3 (15.0%)4 (4.0%)1 (3.3%)00
Infection41(5.3%)4 (22.2 %)6 (5.9%)2 (6.7%)3 (6.3%)0
Rupture5(0.6%)1 (5.6%)001 (2.7%)2 (13.3%)
Contracture (III & IV)34 (4.4%)10 (55.6%)6 (5.9%)4 (13.3%)5 (13.5%)1 (6.7%)
“Failed” implant-based reconstruction96 (12.5%)14 (77.8%)9 (8.9%)4 (13.3%)9 (24.3%)1 (6.7%)

In patients who received preoperative XRT, a “failed” implant-based reconstruction, defined as removal of the implant due to a poor outcome including implant extrusion, infection and severe capsular contracture, was significantly reduced in LD & implant and TRAM & implant groups compared to the implant-alone group, (13.3%, 6.7% vs. 77.8%; p < 0.0001).
Conclusion: In patients with previous irradiation undergoing an implant-based breast reconstruction, the addition of a latissimus dorsi or TRAM flap significantly reduced the incidence of an implant-related poor outcome.
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