Implant salvage in an irradiated breast reconstruction patient with periprosthetic infection and implant exposure

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Published Dec 30, 2015
DOI: https://doi.org/10.22551/2015.08.0204.10057
Alexandru Daniel Hernic Iulia Cristina Filip Ioana Dogaru Silviu Constantin Badoiu Cristian Radu Jecan

Abstract

Analysing the trends over the last 2 decades, we can observe a steady increase in the percentage of women who choose to undergo breast reconstruction procedures following mastectomy. This is indisputably attributed to the high quality modern breast cancer multimodality treatment protocols, which currently allow not only for achieving a disease-free status but also for improving on patients general well-being by restoring ones image and self-esteem. Case report. A 55 year-old non-smoking, former breast cancer female patient, presented to our clinic, in full accordance with the oncological department, requesting a unilateral breast reconstruction procedure. Patients history revealed a multimodality treatment comprising radio-, chemo- and hormonotherapy following mastectomy. After having signed the informed consent, the patient opted for a two-stage expander-implant reconstruction. Six weeks after expander replacement the patient presented with sudden onset cellulitis on the reconstructed breast accompanied by wound dehiscence and minor implant exposure. Implant salvage was attempted, initially through additional flap dissection and readvancement, afterwards by means of a myocutaneous latissimus dorsi flap and later on in an acceptable manner through a fasciocutaneous loco-regional perforator flap using infrared thermal imaging. The reconstructive procedure will be resumed 6 months after surgery when nipple-areolar complex reconstruction and contralateral symmetrisation mammaplasty are envisaged. Conclusion. Whilst a large array of breast reconstruction options are currently available, it is impossible to recur to a one-size fits all procedure from which all breast cancer patients may benefit. Adequate patient selection is regarded as a major contributing factor to overall procedure success.

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Keywords

breast reconstruction, implant salvage, thermal imaging, periprosthetic infection, multimodality treatment, expander-based reconstruction, latissimus dorsi

References
1. Jecan CR, Hernic AD, Filip IC, Raducu L. Clinical data related to breast reconstruction: looking back on the 21th century and forward to the next steps. JMMS 2015; II(1):34e-42e.
2. Trabulsy PP, Anthony JP, Mathes SJ. Changing trends in postmastectomy breast reconstruction: a 13-year experience. Plast Reconstr Surg 1994; 93(7):1418-27.
3. Zhong T, McCarthy CM, Price AN, Pusic AL. Evidence-based medicine: breast reconstruction. Plast Reconstr Surg 2013; 132(6):1658-69.
4. Serletti JM, Fosnot J, Nelson JA, Disa JJ, Bucky LP. Breast reconstruction after breast cancer. Plast Reconstr Surg 2011; 127(6):124e-35e.
5. Kronowitz ST. State of the art and science in breast reconstruction. Plast Reconstr Surg 2015; 135(4):755e-71e.
6. Harmer V. Breast reconstruction: one size does not fit all. Br J Hosp Med 2015; 76(4):209-10.
7. Disa JJ, McCarthy CM, Mehrara BJ, Pusic AL, Hu QY, Cordeiro PG. Postmastectomy reconstruction: an approach to patient selection. Plast Reconstr Surg 2009; 124(1):43-52.
8. Spear SL, Spittler CJ. Breast Reconstruction with implants and expanders. Plast Reconstr Surg 2001; 107(1):177-87.
9. Sigurdson L, Lalonde DH. Breast Reconstruction Plast Reconstr Surg 2008; 121(1 Suppl):1-12.
10. Heller L, Miller MJ. Patient education and decision making in breast reconstruction. Semin Plast Surg 2004; 18(2): 139–147.
11. Nahabedian MY. Breast reconstruction: a review and rationale for patient selection. Plast Reconstr Surg 2009; 124(1):55-62.
12. Revol M, Binder J-P, Danino A, May P, Servant J-M. Manuel de chirurgie plastique, reconstructice et esthétique 2éme edition. Montpellier: Sauramps Medical, Septembre 2012.
13. Slezak S. An evidence-based approach to breast reconstruction. Plast Reconstr Surg 2010; 126(6):2177-83.
14. Morrow M. Trends in the surgical treatment of breast cancer. Breast J 2010; 16 (Suppl 1):S17-9.
15. Beier JP, Horch RE, Bach AD. Breast reconstruction after breast- cancer surgery. N Engl J Med 2009; 360(4):418-9.
16. Jecan CR, Filip CI, Hernic AD, Raducu L. Advanced polymeric biomaterials – an integrated solution for plastic, reconstructive and aesthetic surgery. Key Engineering Materials 2015; 638 (2015):197-204.
17. Yu SC, Kleiber GM, Song DH. An algorithmic approach to total breast reconstruction with tissue transfer. Plast Surg 2013; 40(3):173-180.
18. Platt J, Baxter N, Zhong T. Breast reconstruction after mastectomy for breast cancer. CMAJ 2011; 183(18): 2109–2116.
19. Spear SL, Boehlmer JH, Taylor NS, Prada C. The role of the latissius dorsi flap in reconstruction of the irradiated breast. Plast Reconstr Surg 2007; 119(1): 1-9.
20. Momoh AO, Hons RA, Kelley BP, Aliu O, Kidwell KM Kozlow JH. A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy. Ann Surg Oncol 2014; 21:118–124.
21. Kearney AM, Brown MS, Soltanian HT. Timing of radiation and outcomes in implant-based breast reconstruction. J Plast Reconstr Aesthet Surg 2015; 68(12):1719-26.
22. Prince MD, Suber JS, Aya-ay ML, et al. Prosthesis salvage in breast reconstruction patients with periprosthetic infection and exposure. Plast Reconstr Surg 2012; 129(1):42-8129.
23. Yii NW, Khoo CT. Salvage of infected expander prostheses in breast reconstruction. Plast Reconstr Surg 2003; 111:1087– 1092.
24. Spear SL, Seruya M. Management of the infected or exposed 
breast prosthesis: A single surgeons 15-year experience with 
69 patients. Plast Reconstr Surg 2010; 125:1074–1084.
25. Alderman AK, Wilkins EG, Kim HM, Lowery JC. Complications in postmastectomy breast reconstruction: Two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 2002; 109:2265–2274.
26. McCarthy C, Mehrara B, Riedel E, et al. Predicting complications following expander/implant breast reconstruction: An outcomes analysis based on preoperative clinical risk. Plast Reconstr Surg 2008; 121:1886–1892.
27. Hirsch EM, Seth AK, Kim JY, et al. Analysis of risk factors for complications in expander/implant breast reconstruction by stage of reconstruction. Plast Reconstr Surg 2014; 134(5):692e–699e.
28. Reish RG, Damjanovic B, Austen WGJ et al. Infection following Implant-based reconstruction in 1952 consecutive breast reconstructions: salvage rates and predictors of succes. Plast Reconstr Surg 2013; 131(6):1223-30.
29. Hubenak JR, Zhang Q, Branch CD, Kronowitz SJ. Mechanisms of injury to normal tissue after radiotherapy: a review. Plast Reconstr Surg 2014; 133(1):49e-56e.
30. Peled AW, Foster RD, Esserman LJ, Park CC, Hwang ES, Fowble B. Increasing the time to expander-implant exchange after postmastectomy radiation therapy reduces expander-implant failure. Plast Reconstr Surg 2012; 130(3):503-9.
31. Rabey NG, Malata CM. Succesful salvage of exposed breast implants in previously irradiated patients using local fasciocutaneous flaps. Eur J Plast Surg 2013; 36:195–198.
32. Spear SL, Howard MA, Boehmler JH, Ducic I, Low M, Abbruzzesse MR. The infected or exposed breast implant: management ant treatment strategies. Plast Reconstr Surg 2004; 113(6):1634-44.
33. Wilkinson TS, Swartz BE, Toranto IR. Resolution of late-developing periprosthetic breast infections without prosthesis removal. Aesth Plast Surg 1985; 9:79-85.
34. Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981; 67(2):177-87.
35. De Mey A, Lejour M, Declety A, Meythiaz AM. Late results and current indications of latissimus dorsi breast reconstructions; Brit J Plast Surg 1991, 44(1):1-4.
36. Sheena Y, Jennison T, Hardwicke JT, Titley OG. Detection of perforators using thermal imaging. Plast Reconstr Surg 2013; 132(6):1603-10.
37. Bagavathiappan S, Saravanan T, Phillip J, Jayakumar T, Raj B, Karunanithi R. Infrared thermal imaging for detection of peripheral vascular disorders. J Med Phys 2009; 34(1): 43–47.
38. Mercer JB, Weerd L, Miland ÅO, Weum S. Pre-, intra-, and postoperative use of dynamic infrared thermography (DIRT) provides valuable information on skin perfusion in perforator flaps used in reconstructive surgery. FLIR Technical Series, Application note for Research & Science, 2011 FLIR Systems, Inc. [‪http://www.flir.jp/WorkArea/DownloadAsset.aspx?id=50050‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬. available at 12/27/2015]
39. Taylor GI, Palmer JH. Angiosome theory. JPRAS 1992; 45(4):327-328.
How to Cite
Hernic, A. D., Filip, I. C., Dogaru, I., Badoiu, S. C., & Jecan, C. R. (2015). Implant salvage in an irradiated breast reconstruction patient with periprosthetic infection and implant exposure. Archive of Clinical Cases, 2(4), Arch Clin Cases 2015; 2(4):232-241. https://doi.org/10.22551/2015.08.0204.10057
Issue
Vol. 2 No. 4 (2015)
Section
Case Reports

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How to Cite

Hernic, A. D., Filip, I. C., Dogaru, I., Badoiu, S. C., & Jecan, C. R. (2015). Implant salvage in an irradiated breast reconstruction patient with periprosthetic infection and implant exposure. Archive of Clinical Cases, 2(4), Arch Clin Cases 2015; 2(4):232-241. https://doi.org/10.22551/2015.08.0204.10057