Salvage of infected implant-based breast reconstructions in morbidly obese patients with explantation and replacement with an autologous muscle-sparing latissimus dorsi flap

Abstract

Morbidly obese patients who undergo reconstruction with implants after mastectomy are at higher risk of reconstructive failure. Prosthetic infection historically required explantation with plans for delayed implant-based reconstruction or conversion to autologous tissue. Loss of the skin envelope in the delayed setting often leads to poor aesthetic outcomes. Recently, several different approaches for salvage of infected implant-based reconstructions with immediate prosthetic replacement have been described. While these strategies have proven useful in many patients, we find a prohibitive risk of failure of this approach in the morbidly obese, especially in those undergoing chemotherapy or who have been radiated. Instead, we have offered these patients salvage of their reconstructions with explantation and immediate autologous conversion to a muscle-sparing latissimus dorsi flap. Here, we report on 11 morbidly obese patients where this strategy was utilized.