Secondary Revision after Breast Reconstruction with Free Abdominal Perforator Flap: Flap Liposuction and Inframammary Fold Reconstruction.

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In breast reconstruction using the abdominal perforator flap, if the flap capacity is too large, secondary revision procedures can be performed to reduce flap volume and reconstruct the inframammary fold (IMF). We examined the various revision methods and cosmetic results. This study included 28 patients who underwent secondary revision among 216 patients who had breast reconstruction using the abdominal perforator flap between April 2012 and March 2019. The revision method, removal ability, and the inferior breast point (IBP) were analyzed using medical records. Revision methods included incision resection in 4 cases, liposuction (LS) in 22 cases, LS and simultaneous IMF reconstruction in 2 cases, and post-LS IMF reconstruction in 1 case. The average LS amount was 317 mL (range, 100 --700 mL). In 22 patients who underwent LS, the difference in preoperative IBP was 1 cm or more in 19 (86.4%) cases and 1 cm or less in 3 (13.6%) cases. The difference in postoperative IBP was 1 cm or more in 12 (54.5%) cases and 1 cm or less in 10 (45.5%) cases. The receiver operating characteristic curve analysis revealed that the cutoff LS amount for a postoperative IBP difference of 1 cm or less was 375 mL. The IBP was increased due to the decrease in flap volume. Revisions were completed with no difference in the LS-only IBP, especially when the LS amount was less than 375 mL. If the removal of 375 mL or more is necessary, removal or reformation of the IMF can be considered. These findings can potentially guide the planning of surgical procedures.