Management after flap failure: a narrative review

Abstract

Autologous free tissue transfer for breast reconstruction is a well-established and reliable form of reconstruction for women undergoing mastectomies. These surgeries are performed with high rates of success; however, the consequences of flap failure can be devastating to patients and surgeons. Breast reconstruction decision making following flap loss is a uniquely individualized process, based on considerations of safety, patient goals and preferences, as well as the surgeon’s skillset. The first priority following flap failure is to provide thoughtful patient counseling and support through this difficult time. The aims of reconstruction salvage after flap loss are to excise unhealthy tissue and restore a breast mound of normal anatomical shape. We present an algorithm as a possible approach to managing flap failures. We also review the management of breast reconstruction following free flap failure, including the role of hematologic investigation, anticoagulation recommendations and secondary or tertiary reconstruction with both prosthetic and autologous techniques.