Autogenous tissue breast reconstruction in the silicone-intolerant patient

BACKGROUND: Concerns regarding the safety of silicone gel breast implants have motivated many patients with complications from their silicone breast implants to search for alternatives for breast reconstruction. Although autogenous tissue has been used for primary breast reconstruction after mastectomy, few studies have described its use in the patient in whom silicone-implant breast reconstruction has failed. METHODS: Between 1988 and 1993, 33 patients who had previous unsuccessful breast reconstruction with silicone breast implants underwent implant removal and autogenous tissue reconstruction. Preoperative evaluation included implant-related problems, such as capsular contracture, pain, and loss of implant shell integrity. Systemic symptoms that developed after implantation also were evaluated. Three types of myocutaneous flaps were used for breast reconstruction: the latissimus dorsi pedicle flap, the transverse rectus abdominis free flap, and the superior gluteus maximus free flap. Follow-up evaluation was done for both implant-related problems and issues related to patient satisfaction after autogenous tissue reconstruction. RESULTS: The overall flap survival rate for 33 women who underwent flap reconstruction was 94%. All flap losses occurred in the first nine flaps. Ninety-two percent of patients felt their autogenous tissue reconstructions were aesthetically superior to their previous implant reconstruction. All but one patient felt complete resolution in their chest wall discomfort and pain. Eighty-one percent of patients with systemic symptoms also felt improvement in their systemic symptoms. CONCLUSIONS: Autogenous tissue reconstruction from multiple areas of the body is an effective and aesthetically superior alternative for the patient who no longer desires the silicone implant option.