Explantation With Concomitant Autologous Augmentation Mammoplasty Utilizing De-epithelialized Intercostal Perforator Flaps.

Abstract

Purpose: Women undergo breast explantation surgery for a variety of reasons. Some do not want to have reaugmentation with implants. Autologous augmentation mammoplasty with de-epithelialized intercostal perforator (IP) flaps have shown improved long-term breast shape. However, previous breast augmentation may disrupt the circulation to IP flaps and increase the risk of postoperative complications. We have developed a technique incorporating medial, anterior, and lateral IPs to create reliable IP flaps in patients undergoing concomitant explantation.

Methods: We retrospectively reviewed our database between January 2016 and January 2024. All patients who underwent simultaneous explantation and autologous augmentation mammoplasty were identified. Outcomes were tabulated, and photometric analysis was performed.

Results: Thirty-six patients underwent explantation of 69 breasts with concomitant IP flaps. Thirteen patients had simultaneous or subsequent fat grafting, 2 patients had concomitant reduction mammoplasty, and the majority had some form of mesh fixation. None of the patients had any major complications. Review of preoperative and postoperative photographs and photometric analysis showed visible and statistically significant lasting improvement in breast shape.

Conclusion: Breast explantation with concomitant autologous augmentation mammoplasty utilizing de-epithelialized IP flaps can be done safely with long-lasting improvements in breast shape and proportions.