Explantation with Concomitant Autologous Augmentation Mammoplasty Utilizing De-epithelialized Intercostal Perforator (IP) Flaps

Purpose: Women undergo breast explantation surgery for a variety of reasons. Some do not want to have re-augmentation with implants. Autologous augmentation mammoplasty with de-epithelialized IP flaps have shown improved long-term breast shape. However, previous breast augmentation may disrupt the circulation to IP flaps and increase the risk of postoperative complications. We have developed a technique incorporating medial, anterior, and lateral intercostal perforators to create reliable IP flaps in patients undergoing concomitant explantation. Methods: We retrospectively reviewed our database between 1/2016 and 1/2024. All patients who underwent simultaneous explantation and autologous augmentation mammoplasty were identified. Outcomes were tabulated and photometric analysis was performed. Results: 34 patients underwent explantation of 67 breasts with concomitant IP flaps. 13 patients had simultaneous or subsequent fat grafting, 3 patients had concomitant reduction mammoplasty and 33 had some form of mesh fixation. None of the patients had any major complications. Pre- and post-operative photographs show significant improvement in overall breast shape. Photometric analysis documented lasting improvement in breast proportions. Conclusion: Breast explantation with concomitant autologous augmentation mammoplasty utilizing de-epithelialized IP flaps can be done safely. Photometric analysis shows lasting improvements in breast shape and proportion.