Intercostal Artery Perforator Flap for Salvage Breast Reconstruction with Exposed Breast Implants

Abstract

Background: Multiple techniques have been described for breast reconstruction surgery after breast implant exposure; breast implant removal and delayed breast reconstruction is the procedure of choice. However, in some mild exposures and infections, we propose an alternative treatment. Methods: This is a case series of a 14-year study in 16 female patients with mild exposure of a breast implant after breast reconstruction surgery. Salvage surgery was performed on these cases. The defects were between 1 and 6 cm, with a median size of 3.9 × 2.9 cm. Eighteen intercostal artery perforator flaps were used with an island of skin from the inframammary fold; 83.3% were anterior intercostal artery perforator flaps‚ and 16.7% were lateral intercostal artery perforator flaps. Results: Thirteen of the 16 patients presented infection (81.25%). There was no necrosis of any flap, and the success rate of salvage surgery was 62.5% of all patients. The success of surgery was 53.8% in patients with breast infection and 100% in patients without infection. Seven patients received chemotherapy and radiotherapy, six received only chemotherapy, and nine patients received only radiotherapy. Five of the six patients whose salvage surgery failed were treated with radiotherapy. Conclusion: This technique can be used as an alternative when there is exposure of the implant‚ even in cases with a mild breast infection and in patients undergoing radiotherapy and chemotherapy.

Evaluation of the Efficacy and Safety of Pedicled Perforator Flap Technique for Salvage Nipple Reconstruction in Breast Cancer Patients: A Pilot Study

“…In recent years, some studies have been published related to a pedicled perforator flap technique for initial nipple reconstruction and exposed breast implants. 12,26 However, these studies do not address the situation of salvage nipple reconstruction after initial reconstructed nipple fails. We did not find published studies with large series using LICAP and AICAP in this type of salvage nipple reconstruction.…”

An In Vitro Model of the Efficacy of Breast Implant Irrigant Solutions Against Gram-Negative Infections

“…Although gram-positive bacteria represent the most common pathogens, gram-negative species still represents up to 41% of all positive cultures 17 . Pseudomonas is often accounted for as the most common gram-negative organism isolated in breast implant infections and is clinically difficult to manage, with a higher rate of implant failure compared with its gram-positive counterparts 17,18 . Gram-negative species such as E. coli and Proteus species are also commonly isolated in implant infection cultures but also represent the endogenous breast microbiome 17,29 .…”

“…Gram-negative species such as E. coli and Proteus species are also commonly isolated in implant infection cultures but also represent the endogenous breast microbiome 17,29 . Endogenous bacteria have been implicated in subclinical infections associated with capsular contracture 15–20 . Their presence has also been noted in wider implant complications, such as seromas, cellulitis, and skin necrosis 30 .…”

“…However, this body of research is overrepresented in gram-positive bacteria native to the skin flora 8,11–14 and represents only a limited range of the infective bacterial species encountered in clinical practice 15,16 . Gram-negative infections are often more difficult to manage, leading to greater complications and potential implant loss 17,18 . Furthermore, the source of subclinical infections associated with capsular contracture remains unknown, and it has been suggested to be due to the endogenous, gram-negative breast microbiome 15,16,19–21 .…”

New Applications of the Anterior Intercostal Artery Perforator Flap for Prosthetic Breast Reconstruction in the Setting of Postoperative Radiotherapy

“…For the latter, the AICAP flap has been shown to be a useful alternative, obtaining, in many cases, breast implant salvage following exposure. 9 Even if this useful technique has been described, breast implant removal and delayed breast reconstruction is routinely the procedure of choice when the implant is exposed. 10…”