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CC BY-NC-ND 4.0 · Indian J Plast Surg 2024; 57(01): 016-023
DOI: 10.1055/s-0044-1779479
Original Article

Conversion to Autologous Breast Reconstruction with Latissimus Dorsi and Immediate Fat Grafting in Patients with Previous Implant Failure: An Efficient, Reproducible, and Safe Technique

Ivan Couto-González 
1   Department of Plastic and Reconstructive Surgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
,
Beatriz Brea-García
1   Department of Plastic and Reconstructive Surgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
,
Adrián Ángel Fernández-Marcos
2   Department of Plastic and Reconstructive Surgery, Centro Médico Povisa, Vigo, Spain
,
Antonio Taboada-Suárez
1   Department of Plastic and Reconstructive Surgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Abstract

Introduction Implant-based breast reconstructions (IBBRs) increased last years despite the growing indications for radiotherapy in the treatment of breast cancer. As a result, complications and reconstructive failures associated to IBBR have increased. Autologous breast reconstruction (ABR) using fat-augmented latissimus dorsi (FALD) has become popular in recent years.

Methods We aimed to evaluate conversion to ABR using latissimus dorsi and immediate fat grafting in 61 cases with IBBR failure.

Results Immediate reconstruction was found significatively related with an increased number of surgeries resulting from IBBR complications (p < 0.001). Note that 41% of the cases presented a grade III/IV Baker and Palmer capsular contracture, 29% implant extrusion, and 21% implant infection. Mean survival of the first implant was 16.95 months. ABR process was completed in 47% of cases with a single surgery. Statistically significant differences were observed between this fact and previous IBBR failure due to infection (p = 0.03) or extrusion (p = 0.01). Mean volume of fat graft was 429.61 mL, mean length of the surgical procedure was 3.17 hours, and the average length of hospital stay after surgery was 2.67 days. Only 3.3% of the cases developed some major complication. None of the cases presented reconstructive failure.

Conclusion FALD is a very safe total ABR technique, an important fact in patients with previous reconstructive failures. The large volume of fat that can be grafted in a single surgery allows the reconstruction of breast in a reasonable size. The reduced length of surgery and hospital stay make the FALD technique an option to consider when an autologous but efficient and safe reconstruction is desired.

Keywords

breast reconstruction - latissimus dorsi - fat-grafting - implant failure - postoperative complication - lipofilling

Supplementary Material



Publication History

Article published online:
09 February 2024

© 2024. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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