Mix and Match: Enhancing Microsurgical Breast Reconstruction Outcomes with Hybrid Techniques

Background: Hybrid breast reconstruction can alleviate the discordance between donor flap and desired breast volume in patients previously excluded from flap-based modalities. The authors review their consecutive experiences with two novel hybrid microsurgical breast reconstruction techniques. Methods: A review of all consecutive patients who received microsurgical flap reconstruction was performed over a five-year period, both with and without hybrid techniques. The HyPAD® technique combines flap reconstruction with stacked pre-pectoral acellular dermal matrix (ADM), while the HyFIL® technique combines a flap, pre-pectoral implant, and fat transfer (lipofilling). Demographic, health-related, surgical, and outcome indicators were measured for comprehensive qualitative and quantitative analysis. Results: During the study period (2018-2023), 101 patients with hybrid breast reconstruction (HyPAD® n=40, HyFIL® n=61) were compared to 208 patients who received DIEP flap reconstruction alone. Hybrid patients were significantly younger (47.3 versus 52.9 years, p < 0.01) had lower BMIs (24.9 versus 30.3 kg/cm^2, p < 0.01), and had reduced mastectomy weights (452.1 versus 652.0 grams, p < 0.01) and flap weights (348.7 versus 683.5 grams, p < 0.01). Hybrid patients had fewer clinically significant readmissions after discharge (1 versus 15, p = 0.02). No significant differences were found for length of stay of index admission (p = 0.56) or returns to the operating room upon index admission (p = 0.64). No implant or ADM extrusions occurred in the hybrid cohort. Conclusions: Hybrid microsurgical breast reconstruction is a safe and reliable method to enhance core projection & volume.