AUTOGENOUS TISSUE BREAST RECONSTRUCTION IN THE SILICONE-INTOLERANT PATIENT

Background. Concerns regarding the safety of silicone gel breast impla nts have motivated many patients with complications from their silicon e breast implants to search for alternatives for breast reconstruction . Although autogenous tissue has been used for primary breast reconstr uction after mastectomy, few studies have described its use in the pat ient in whom silicone-implant breast reconstruction has failed. Method s. Between 1988 and 1993, 33 patients who had previous unsuccessful br east reconstruction with silicone breast implants underwent implant re moval and autogenous tissue reconstruction. Preoperative evaluation in cluded implant-related problems, such as capsular contracture, pain, a nd loss of implant shell integrity. Systemic symptoms that developed a fter implantation also were evaluated. Three types of myocutaneous fla ps were used for breast reconstruction: the latissimus dorsi pedicle f lap, the transverse rectus abdominis free nap, and the superior gluteu s maximus free nap. Follow-up evaluation was done for both implant-rel ated problems and issues related to patient satisfaction after autogen ous tissue reconstruction. Results. The overall flap survival rate for 33 women who underwent flap reconstruction was 94%. All flap losses o ccurred in the first nine flaps. Ninety-two percent of patients felt t heir autogenous tissue reconstructions were aesthetically superior to their previous implant reconstruction. All but one patient felt comple te resolution in their chest wall discomfort and pain. Eighty-one perc ent 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.