Implant salvage in an irradiated breast reconstruction patient with periprosthetic infection and implant exposure

Abstract

Analysing the trends over the last 2 decades, we can observe a steady increase in the percentage of women who choose to undergo breast reconstruction procedures following mastectomy. This is indisputably attributed to the high quality modern breast cancer multimodality treatment protocols, which currently allow not only for achieving a disease-free status but also for improving on patients’ general well-being by restoring one’s image and self-esteem. Case report. A 55 year-old non-smoking, former breast cancer female patient, presented to our clinic, in full accordance with the oncological department, requesting a unilateral breast reconstruction procedure. Patient’s history revealed a multimodality treatment comprising radio-, chemo- and hormonotherapy following mastectomy. After having signed the informed consent, the patient opted for a two-stage expander-implant reconstruction. Six weeks after expander replacement the patient presented with sudden onset cellulitis on the reconstructed breast accompanied by wound dehiscence and minor implant exposure. Implant salvage was attempted, initially through additional flap dissection and readvancement, afterwards by means of a myocutaneous latissimus dorsi flap and later on in an acceptable manner through a fasciocutaneous loco-regional perforator flap using infrared thermal imaging. The reconstructive procedure will be resumed 6 months after surgery when nipple-areolar complex reconstruction and contralateral symmetrisation mammaplasty are envisaged. Conclusion. Whilst a large array of breast reconstruction options are currently available, it is impossible to recur to a one-size fits all procedure from which all breast cancer patients may benefit. Adequate patient selection is regarded as a major contributing factor to overall procedure success.