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

Felipe Mesa, MD, PhD; Sara Mesa, MD; Federico López, MD

Disclosures

Plast Reconstr Surg Glob Open. 2022;10(10):e4548 

In This Article

Abstract and Introduction

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.

Introduction

Breast reconstruction surgery after an oncological or prophylactic mastectomy is a common procedure in plastic surgery; perforator, myocutaneous, and muscular flaps are the most used techniques for such reconstruction. These flaps can be pedunculated or free, de-epithelialized or with an island of skin, and may or may not be accompanied by the placement of a breast implant.[1–10] In addition to flaps, lipografts have gained popularity in breast reconstruction in recent years.[11]

Breast infection and wound dehiscence are the most common postoperative complications associated with breast reconstruction surgery with implants and may occur in up to 35% of these patients. Other possible complications are tissue necrosis, hematomas, and seromas.[1,12–15] Although the implants used for breast reconstruction are covered by the muscle, adipose tissue, or acellular dermal matrix, wound dehiscence can lead to implant exposure and to local breast infections.[12–16]

Breast implant removal and delayed breast reconstruction is the procedure of choice when the implant is exposed, and even more so if there is some degree of infection.[1,15,16] Nevertheless, in this study, we kept the implant and salvaged the breast reconstruction as an alternative in those cases where there was a mild local infection of the breast tissue. The dehiscence defect can be covered with multiple locoregional or distant flaps, depending on the site and size of the wound. The reports that have been published are short series with mainly thoracodorsal, intercostal, pedicled, or free latissimus dorsi flaps, among others. This study evaluates the results of this new procedure to solve a common problem in breast reconstruction and to evaluate the feasibility of maintaining the implant in cases of infection.

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