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EL-Sabawi et al. Plast Aesthet Res 2017;4:195-203 Plastic and
DOI: 10.20517/2347-9264.2017.20
Aesthetic Research

www.parjournal.net
Topic: Complex Reconstruction of the Face, Breast and Wounds with Microvascular Free Flaps Open Access

Microsurgical restoration of failed or

unsatisfactory breast reconstruction: a

systematic review and pooled-analysis of

outcomes

Bassim EL-Sabawi, Anna C. Howell, Ketan M. Patel
Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033-4680, USA.

Correspondence to: Dr. Ketan M. Patel, Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern
California, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033-4680, USA. E-mail: ketanmpatel.md@gmail.com
How to cite this article: EL-Sabawi B, Howell AC, Patel KM. Microsurgical restoration of failed or unsatisfactory breast reconstruction: a systematic
review and pooled-analysis of outcomes. Plast Aesthet Res 2017;4:195-203.
ABSTRACT
Article history: Aim: Autologous tissue transfer to salvage breast reconstruction following a previously failed
Received: 3 Mar 2017 or unsatisfactory reconstruction has been described by previous studies to be an effective
Accepted: 21 Oct 2017 strategy to optimize outcomes. The purpose of this systematic review is to assimilate the
Published: 31 Oct 2017 relevant literature to evaluate surgical and aesthetic outcomes following autologous breast
reconstruction in the setting of a prior unsuccessful reconstruction. Methods: A systematic
Key words: review of the English literature was performed on Pubmed/MEDLINE to identify all manuscripts
Autologous, reporting surgical outcomes, aesthetic outcomes, or patient satisfaction of autologous breast
prosthetic, reconstruction in the setting of a previously failed or unsatisfactory breast reconstruction.
salvage, Results: Nineteen studies met the criteria for inclusion. Of these, 15 studies reported
tertiary, outcomes following autologous conversion of unsuccessful prosthetic reconstruction (778
breast reconstruction breasts). Pooled-analysis of these studies demonstrated total flap loss in 1.6%, microsurgical
revision in 3.2%, total complications in 21.7%, and revision surgery in 26.5%. Review of these
studies demonstrated high rates of positive aesthetic outcomes and patient satisfaction. Five
studies (54 patients) evaluated outcomes following autologous salvage of prior unsuccessful
autologous breast reconstruction. Pooled-analysis of these studies demonstrated no instances
of microsurgical revision, total complications in 42.2%, and revision surgery in 70.0%.
Total flap failure following tertiary reconstruction utilizing microsurgical free flaps occurred
in 9.5%. Data describing aesthetic outcomes or patient satisfaction was lacking in these
studies. Conclusion: Autologous conversion in the setting of unsuccessful prosthetic breast
reconstruction appears to be valuable option to improve outcomes. There is little evidence to
suggest that prior prosthetic reconstruction negatively impacts outcomes of autologous breast
reconstruction. Data describing autologous breast reconstruction following prior flap loss is
limited but suggests it is viable method to salvage breast reconstruction in appropriate patients.

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