ABSTRACT
Salvage or revision surgery may be required for complications of previously failed reconstruction, unsatisfactory outcomes from conservative breast surgery, or recurrent disease. Not infrequently, when these patients present for revisional surgery, there are several technical issues that may complicate the revision such as tissue thickness, capsular contracture, implant malposition, rippling, and even synmastia. Implant-based reconstruction is one of the most common forms of breast reconstruction following mastectomy. However, long-term results can be suboptimal, especially following radiotherapy. In patients with attenuated subcutaneous tissue, irregularities of the implant surface become noticeable. Thus, implant replacement and subcutaneous placement of autologous fat graft where needed provides extra soft tissue that reinforces thin tissue, thus masking surface irregularities. The implants are placed in a partially submuscular pocket associated with mixed mesh on the inferior edge of the pectoralis major muscle depending upon the patient’s anatomy and condition of the muscle/skin flaps.
