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Myers et al. Plast Aesthet Res 2023;10:38 Plastic and
DOI: 10.20517/2347-9264.2022.150
Aesthetic Research

Review Open Access

Management after flap failure: a narrative review

Paige L. Myers, Sherry Y. Q. Tang, Noah H. Saad, Adeyiza O. Momoh

Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA.

Correspondence to: Adeyiza O. Momoh, Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E.
Medical Center Drive, Ann Arbor, MI 48109, USA. E-mail: amomoh@med.umich.edu

How to cite this article: Myers PL, Tang SYQ, Saad NH, Momoh AO. Management after flap failure: a narrative review. Plast
Aesthet Res 2023;10:38. https://dx.doi.org/10.20517/2347-9264.2022.150

Received: 27 Dec 2022 Revised: 19 Jun 2023 Accepted: 20 Jul 2023 Published: 4 Aug 2023

Academic Editors: Gordon Kwanlyp Lee, Peter Henderson Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Autologous free tissue transfer for breast reconstruction is a well-established and reliable form of reconstruction
for women undergoing mastectomies. These surgeries are performed with high rates of success; however, the
consequences of flap failure can be devastating to patients and surgeons. Breast reconstruction decision making
following flap loss is a uniquely individualized process, based on considerations of safety, patient goals and
preferences, as well as the surgeon’s skillset. The first priority following flap failure is to provide thoughtful patient
counseling and support through this difficult time. The aims of reconstruction salvage after flap loss are to excise
unhealthy tissue and restore a breast mound of normal anatomical shape. We present an algorithm as a possible
approach to managing flap failures. We also review the management of breast reconstruction following free flap
failure, including the role of hematologic investigation, anticoagulation recommendations and secondary or tertiary
reconstruction with both prosthetic and autologous techniques.

Keywords: Microsurgery, breast reconstruction, flap failure

INTRODUCTION
Autologous free tissue transfer for breast reconstruction is a well-established and reliable form of
reconstruction for women undergoing mastectomies. Free tissue flaps provide a versatile and natural
reconstructive option, with greater longevity of results and evidence of improved patient-reported quality of
[1,2]
life compared to implant-based reconstruction . Free flap breast reconstructions are performed with high

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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