The hybrid implant-flap breast reconstruction-pearls and pitfalls: a narrative review.

BACKGROUND AND OBJECTIVE: Autologous free tissue transfer is considered to be the gold-standard for breast reconstruction. The abdomen, thighs, buttocks and other donor sites have been well described in the literature. In slender patients with larger breasts who desire autologous reconstruction, breast asymmetry or insufficient volume may compromise the aesthetic or desired outcome. In these situations, hybrid reconstruction, in which the flap is combined with an implant, can provide desirable outcomes. The aim of this study to review of the available evidence and help guide clinical decision-making and optimization of outcomes. METHODS: A review of the literature using keywords was performed by query of MEDLINE (PubMed), Embase, Cochrane Library. Inclusion criteria included retrospective and prospective studies that used free flaps for breast reconstruction (abdominal and other sources), studies that categorized their data into immediate and staged placement of implant, case series, case reports and review of literature. Studies from the last 30 years were included [1995-2025]. Studies that did not analyzed the use of free flaps combined with implants for breast reconstruction were not included. KEY CONTENT AND FINDINGS: Seventeen studies were identified. Of these 13 reported on patients who had free flaps augmented with an implant for breast reconstruction. Key findings included: A total of 359 patients and 598 breasts were reviewed. The majority of the of the free flaps (590) were abdominally based. The timing for implant placement was roughly evenly split between delayed (52%, 300 breasts) and immediate (48%, 298 breasts). Tissue expanders were used with the flap prior to the silicone implant in a minority of cases-11% of cases. Silicone implants were used 92% of cases. Mesh support (acellular dermal matrix or synthetic) was used in approximately 57% of cases. CONCLUSIONS: Performing hybrid flap-implant breast reconstruction has been established as a safe and reliable approach on patients with larger breasts who desire autologous reconstruction and have paucity of autologous donor tissue.