Simultaneous Bilateral Breast Reconstruction with Autologous Tissue Transfer after the Removal of Injectable Artificial Materials: A 12-Year Experience

Abstract

Over the years, breast augmentation with injectable artificial materials has presented significant clinical and social problems, particularly in Japan, because of later complications. The authors have used autologous tissue to treat patients who want not only to have these materials removed but also to maintain breast contour. The purpose of this study was to review the clinical outcome of the authors' reconstruction procedures retrospectively. A total of 38 breasts in 19 consecutive cases treated between 1991 and 2002 were reviewed. The patients were all women, ranging in age from 41 to 70 years old (mean age, 53.4 years). The average period from injection to reconstruction was 26.5 years. After removal of the injected materials, both breasts were simultaneously reaugmented with deepithelialized rectus abdominis flaps. The incidence of associated complications was investigated. The 38 flaps consisted of 31 free transverse rectus abdominis musculocutaneous flaps, five pedicled transverse rectus abdominis musculocutaneous flaps, and two pedicled vertical rectus abdominis musculocutaneous flaps. Three flaps with total necrosis (7.9 percent) because of venous thrombosis were found in two cases. Partial flap necrosis was observed in six flaps (15.8 percent). Hematoma requiring a surgical procedure occurred in one case (5.3 percent). Negligible abdominal bulging requiring no additional procedure was found in seven cases (36.8 percent). The complication rate seemed to be relatively high compared with that for breast reconstruction after mastectomy. Nevertheless, autologous tissue transfer may be one of the ideal procedures for breast reaugmentation after the removal of injectable materials, because affected patients prefer not to undergo reaugmentation with other artificial materials.