Salvage (tertiary) breast reconstruction after implant failure

Background: Salvage breast reconstruction is defined as a complete revision of a previous reconstruction in case of unsatisfactory results or failure of primary or secondary breast reconstruction. We have termed this ‘tertiary breast reconstruction’. This article presents our experience with tertiary reconstructions, including the indications, method of reconstruction and outcomes. Methods: A retrospective note review was performed for all patients who underwent breast reconstruction with autologous tissue under one surgeon between 2002 and 2009 at the University Hospital, Ghent. Out of these 688 patients, 54 patients (7.8%) required tertiary surgery with autologous tissue after failure of implant breast reconstruction. Results: The first reconstructive surgery involved 38 unilateral and 16 bilateral cases with a total of 70 operated breasts. A further 11 breasts were reconstructed following risk-reducing mastectomy or at the patient’s request for aesthetic reasons. Out of 81 free-flap reconstructions, the deep inferior epigastric artery perforator (DIEAP) flap was the most harvested at 66 (81%). The mean SD operating time was 7.2 1.8 h and the mean hospital stay was 7.2 1.9 days. One total flap loss (1.2%) occurred. The mean follow-up was 31 months with a range between 3 months and 6 years. During follow-up, 30 patients (55.5%) needed secondary procedures to improve the aesthetic outcome. Donor-site corrections were performed in 18 patients (33%). Revisions of the breast flap were performed in 29 patients (53%). Conclusions: Restoring the breast envelope and footprint, in addition to excision of scar tissue, is the key step in breast reconstruction. Further corrections are required depending on the amount of the initial damage to the breast or subsequent postoperative complications.