Evaluation of outcomes in breast reconstructions combining lower abdominal free flaps and permanent implants

Background: The purpose of this study was to evaluate outcomes in breast reconstruction combining lower abdominal flaps with implants and to compare the impact of timing of implant placement on complication and revision rates. Methods: A retrospective review of all patients who underwent free transverse rectus abdominis musculocutaneous, muscle-sparing transverse rectus abdominis musculocutaneous, deep inferior epigastric perforator, or superficial inferior epigastric perforator flaps with implants at a single center over the past decade was performed. Patients were classified as having implant placement at the time of flap reconstruction or during a second procedure. The flap types, implant types/planes, flap and implant-related complications, and revision rates were compared between the groups. Results: Sixty-nine patients underwent 110 abdominal free flap breast reconstructions with an implant (immediate placement group, 35 patients; staged placement group, 34 patients). The mean follow-up periods were 32 months and 43 months for the immediate placement and staged placement groups, respectively. There was no statistically significant difference in flap type, implant type or plane, flap-related complications, or early implant-related complications between groups. The immediate placement group had a significantly higher rate of late implant-related complications: 25 percent (15 of 59) versus 4 percent (two of 51) in the staged placement group (p = 0.007). The implant revision rate was 63 percent (22 of 35) in the immediate placement group versus 26 percent (nine of 34) in the staged placement group (p = 0.081). Conclusions: The authors conclude that it is safe to combine implants with autologous lower abdominal free flaps for breast reconstruction. However, it may be preferable to perform this procedure in a staged fashion to minimize late complications and the need for future revisions because of complications or dissatisfaction with the aesthetic result.