Flaps: Salvage for Augmentation Catastrophes

Abstract

Introduction:

Massive, uncontrollable capsular fibrosis remains the main problem with silicone-gel implants used for heterologic volume substitution.

Materials and Methods:

The limitation of the standard methods for cosmetic augmentation or oncological-related subcutaneous mastectomies are represented and discussed using 2 typical, problematic cases as examples. Catastrophic results can be salvaged using de-epithelialized distant tissue flaps.

Results:

Of the 34 patients, 84% were treated with latissimus dorsal flaps, and 15% with split transverse abdominis flaps. No severe complications, like total or partial loss of the flaps, were observed in the first or second group. Persistent seroma on the donor site was an annoying but surmountable problem. The achieved cosmetic outcome was satisfying and none of the patients regretted the surgery.

Discussion:

In attempts at correction, the type and site of the implant should only be changed once following capsulectomy in order to avoid further damage to the skin or the remaining glandular tissue already subjected to pressure atrophy. Only through early conversion to autologous de-epithelialized tissue (usually the latissimus dorsi flap, and more seldom the transverse rectus abdominis muscle flap) can very serious permanent damage with the loss of female identity be avoided and, at best, complete recovery achieved. Therefore, proper application of the implant technique during cosmetic or oncological breast surgery always requires competence in and logistics for explantation and autologous conversion. Disabling breast augmentation should be history, which will help defuse the vehement public controversy regarding the silicone-gel implant problem.