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EL-Sabawi et al. Restoration of failed breast reconstruction

Table 1: Study characteristics and patient demographics of included studies
Years of Mean Mean Prior Prior Follow-
Patients Smoking
Authors Study type patient age BMI chemotherapy radiation up
(n) 2 (%)
inclusion (year) (kg/m ) (%) (%) (month)
Munhoz et al. 2016 Retrospective 12 1999-2013 47.3 - - 66.6 66.6 42.5
[16]
[10]
Roostaeian et al. 2016 Retrospective 89 2005-2014 51.3 26.5 5 - 48.7 10.2
[18]
Pülzl et al. 2015 Retrospective 33 2006-2011 46* - - - - 51.6
[19]
Mioton et al. 2014 Retrospective 18 2004-2010 50.5 29.4 0 58.8 41.4 -
[20]
Mohan et al. 2013 Retrospective 29 2004-2010 50.5 26.1 16.1 - 52.3 20
[21]
Rabey et al. 2013 Retrospective 14 2000-2012 50* - 7.1 50.0 85.7 21
[6]
Spear et al. 2013 Retrospective 7 2005-2010 - 28.5 - - 43.3 -
[22]
Peled et al. 2012 Prospective 5 2005-2007 45.4 25.9 3.5 52.0 51.8 52.5
[9]
Levine et al. 2011 Prospective 191 1998-2008 49* - - - 20.0 -
[7]
Hamdi et al. 2010 Retrospective 54 2002-2009 46.8 - 7.4 72.2 74.0 31
[8]
Hamdi et al. 2010 Retrospective 8 2002-2009 46.7 24 21.4 86.0 35.7 37
[11]
Visser et al. 2010 Retrospective 42 2001-2007 53* 26* - - 27.9 24*
[28]
Hammond et al. 2007 Retrospective 14 1992-2002 48 - 14.3 - 35.7 -
[23]
Gurunluoglu et al. 2005 Retrospective 7 1994-2001 45.7 - - - - 57.6
[24]
Mosahebi et al. 2005 Retrospective 5 - 55 - - - 0 15
[29]
Karanas et al. 2002 Retrospective 7 - 54 - - - 14.3 -
[25]
Spear and Onyewu 1999 Retrospective 19 1990-1997 - - - - 100 -
[26]
Weiss and Ship 1995 Retrospective 26 - 47.4 - - - -
[27]
Feng et al. 1994 Retrospective 33 1988-1993 47 - 33 - - -
*median. BMI: body mass index
[11]
flaps (3.2%; range 0-3.7%). Complications requiring NAC complex . Another study utilized a 4-point scale
surgery were reported in 10.0% (range 0-17.4%) of (4, excellent; 1, poor) to evaluate 14 irradiated implant
flaps and total complications were reported in 21.7% reconstructions with later addition of a TRAM or LD
(range 10.0-34.4%) of flaps. Of these complications, flap [25] . They reported a mean overall aesthetic score
hematoma was reported in 18 flaps (2.7%; range of 3.25, which was similar to the mean score of 3.28
0-7.7%), seroma in 9 flaps (1.9%; range 0-2.5%), in patients with non-irradiated implant reconstruction.
infection in 10 flaps (3.5%; range 0-11.1%), wound A validated 3-point scale (0-2) of 5 distinct aesthetic
healing problems in 9 flaps (3.7%; range 0-7.1%), domains was used by another study, which reported
and fat necrosis 18 in flaps (3.5%; range 0-4.8%). mean scores of 1.6 for volume, 1.6 for contour, 1.75
Breast related revisional surgery to improve aesthetic for placement, 1.80 for inframammary fold, and
outcome was reported in 84 patients (26.5%; range 1.35 for scarring in 18 patients who had autologous
4.6-80%). A single study compared outcomes of conversion after experiencing complication with initial
patients with free flap breast reconstruction following expanderimplant reconstruction [19] . They reported
complicated prosthetic reconstruction to those with superior scores across 4 of these domains (volume,
de novo autologous reconstruction (n = 178) [10] . No contour, placement, and inframammarry fold) as
difference was observed in flap loss (2.5% vs. 2.4%, compared to patients completed expander implant
P = 1.00) or total complications (27.2% vs. 26.0%, P = reconstruction without complication. Two of the studies
0.89) between the two cohorts. (71 patients) reported proportions of patients satisfied
with the aesthetic result following tertiary reconstruction,
Measures of aesthetic outcome or patient satis- with satisfaction rates ranging 84-89% [11,20] . Lastly, one
faction were reported by 5 studies including 147 study noted that 92% of their sample of 25 patients
patients [11,19,20,25,27] . Review of these studies demon- reported improved cosmesis with autologous conversion
[27]
strated significant heterogeneity in methods of than with prior implant reconstruction .
evaluation, rating scales, and reporting of aesthetic
outcomes. Aesthetic means based on numerical Autologous salvage of prior unsuccessful
rating scales were reported in 3 studies [11,19,25] . Utilizing autologous breast reconstruction
a 5-point Likert scale (5, very satisfied; 1, very Five studies (54 patients) evaluated outcomes
dissatisfied), one study reported numerical means of following autologous salvage of prior unsuccessful
self-reported assessments in 29 patients with scores autologous breast reconstruction [Table 3] [8,16,20,28,29] . All
of 4.24 for breast volume, 4.16 for breast shape, 3.83 of these studies were small retrospective case series.
for symmetry, 3.92 for breast scars, and 3.42 for nipple/ Study size weighted mean age was 48.6 and mean

198 Plastic and Aesthetic Research ¦ Volume 4 ¦ October 31, 2017