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A Systematic Review of Techniques to Augment Autologous Tissue Breast Reconstruction
Merisa Piper, MD, Rachel Lentz, MD, Sarosh Zafar, MD, William Hoffman, MD, Hani Sbitany, MD.
University of California, San Francisco, San Francisco, CA, USA.

Purpose: Autologous tissue reconstruction is a popular option for breast reconstruction but challenging in those with previous abdominal operations or the very thin. Various techniques to augment autologous flaps have been proposed: using more than one flap per breast, adding an implant under the flap, or fat grafting the flap. We sought to provide a systematic review of these techniques. Methods: We searched Pubmed and the Cochrane Library database to identify studies which described augmentation of autologous flaps for breast reconstruction. Studies were included if they used more than one flap for unilateral reconstruction, an implant underneath a flap, or fat grafted a flap. Results: We identified 26 articles (535 patients, 1,076 flaps). Eighteen articles used stacked flaps for additional augmentation, seven used a flap with immediate implant, and one article performed fat grafting to the flap. Total flap loss rate was 0.5% (5 patients), and partial flap loss was 0.7% (8 patients). No flaps were lost in the flap plus implant cohort, but seven implants were lost (3.9%) due to exposure/infection and four patients developed capsular contracture (2.2%). Conclusions: The criteria for women to be candidates for autologous tissue breast reconstruction can be expanded by “stacking” autologous flaps, adding an implant underneath the flap, or serially fat grafting a flap. We found overall flap loss comparable with standard autologous flap reconstruction, and implant loss lower than in patients who undergo prosthetic reconstruction alone. We now prefer autologous free flaps with immediate implant placement for further volume augmentation.


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