After a mastectomy for breast cancer, patients have two options for breast reconstructive surgery: implant-based reconstruction or autologous reconstruction, which uses skin, fat, and sometimes muscle from another location in the body to form a breast shape. Although implant-based reconstruction, which is used in around 80% of patients, generally has high satisfaction rates, it sometimes leaves patients with physical pain, a feeling of tightness, or a poor aesthetic result. Other implant-based reconstructions fail due to infection, requiring removal of the implant. A new study reports that when implant-based breast reconstruction fails or leaves patients dissatisfied, autologous reconstruction can have good results.

"Autologous reconstruction is performed less often, as not all patients are candidates and the complexity of the procedure is greater. The procedures are longer and also have donor-site morbidity," state the researchers in their paper, which was published in Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons. "However, autologous tissue can provide a more naturally shaped breast and eliminate the long-term risks of capsular contracture and implant infection/exposure, which are associated with implant-based reconstruction. Both implant and autologous tissue reconstruction have a high degree of patient satisfaction and quality of life."

The researchers, who are from Memorial Sloan Kettering Cancer Center, examined the results of autologous breast reconstruction following failed implant-based reconstruction in 137 patients, 55 of whom had both breasts reconstructed, resulting in a total of 192 reconstructed flaps. The autologous reconstruction was performed an average of 3.5 years after the initial implant-based reconstruction. Thirty-four patients filled out the BREAST-Q survey, a questionnaire evaluating various aspects of quality of life after breast reconstruction.

"Significant increases were seen in satisfaction with breast appearance, psychosocial well-being, and physical well-being of the chest and upper body," commented the authors of the study. "Improvements in physical well-being of the chest and upper body in many patients could be attributable to removal of a tight implant and firm, painful capsule at the time of autologous tissue reconstruction. Even those that did not perceive pain or tightness when their implants were in place may see improvement when they are removed, as they now have a comparison."

Although the autologous reconstruction did result in a statistically significant decrease in physical well-being of the abdomen, the investigators concluded that "autologous reconstruction after failed implant-based reconstruction has an acceptable complication rate and is associated with significantly improved patient satisfaction and quality of life."

For More Information

Coriddi M, Shenaq D, Kenworthy E, et al (2019). Autologous breast reconstruction after failed implant-based reconstruction: evaluation of surgical and patient-reported outcomes and quality of life. Plast Reconstr Surg, 143(2):373-379. DOI:10.1097/PRS.0000000000005197