Secondary Breast Reconstruction with Deepithelialized Free Flaps from the Lower Abdomen for Intractable Capsular Contracture and Maintenance of Breast Volume

Abstract

Although surgical techniques and the quality of mammary prostheses have been improved significantly in recent years, capsular contracture attendant on prosthetic mammary reconstruction remains a major flaw. Although rarely, some patients are confronted with recurrent and intractable capsular contractures with resultant breast deformity, even after multiple attempts at capsulectomies and implant exchange. Patients with recurrent capsular contracture often do not want replacement with a new prosthesis, but desire the maintenance of their breast volume with a safe alternative. In an attempt to maintain breast volume and to improve the aesthetic appearance, secondary breast reconstruction using bilateral deepithelialized free flaps from the lower abdomen was performed in a series of seven patients. Three bilateral muscle-sparing TRAM flaps, two bilateral DIEP flaps, one bilateral SIEA flap, one unilateral SIEA flap, and one unilateral DIEP flap (a total number of 14 flaps) were used following implant removal, total capsulectomy, and prophylactic subcutaneous mastectomy. The early postoperative course was uneventful, and all flaps survived completely with no complications. There were no donor-site problems, except in one patient (case 5), who had partial skin necrosis of the abdominal flap. The long-term results (mean follow-up: 4.8 years) demonstrated an aesthetically satisfactory appearance of the breasts, with no major donor-site problems. Several advantages, as well as drawbacks, are highlighted with this technique.

Long-Term Follow-Up of Breast Capsule Contracture Rates in Cosmetic and Reconstructive Cases

“…Our hope is that the breast contracture "riddle" will be solved in our lifetime so that our patients will not have to confront recurrent and intractable capsular contractures. 87 Marisa Marques, M.D.…”

A literature review and summary of capsular contracture: An ongoing challenge to breast surgeons and their patients

“…Strictly speaking, the only way of treating the capsular contracture and preventing re-occurrence is to remove the implant, without implant replacement [28]. Some patients who have had repeated capsulectomies and implant exchanges have found pleasing results at 5 years according to Gurunluoglu et al when autologous tissue is used to reconstruct the breast [106]. Here, a total of 14 flaps were created to maintain breast volume and aesthetic appearance where new implants were not desired.…”

Current Trends in Breast Reconstruction

“…31Y35 Furthermore, reported long-term implant-related complications and improved microsurgical techniques have led to more women requesting conversion of their implant BR to autologous BR. 35,36 According to ASPS statistics, 14,991 breast implant removals were reported in breast reconstructive patients only in 2010. 5 Despite several advantages of autologous BR, only 14% of plastic surgeons predominantly performed autologous BR.…”