Both breast reconstruction with alloplastic materials and autologous tissues can present postoperative complications. However, poor long-term results are more common with the use of implants and even more so if there is post-reconstruction radiotherapy. This is a frequent cause of consultation, where the patient requests the extraction of this material and the use of a flap for secondary or tertiary reconstruction.
In this study, we analyzed a group of 62 patients who required conversion of alloplastic material to autologous tissue. This practice accounted for 7.2% of the 853 patients undergoing breast reconstruction in my free flap surgical practice, over the last 18 years.
The indications for performing this surgery were aesthetic discomfort in 38% of cases, capsular contracture in 29%, BMI alterations in 19%, and infection and/or extrusion of the implant in 15% of cases.
The time elapsed between the first and second surgery was approximately 51 months, except in those patients in whom there was exposure of the expander or implant, in which it was an average of 11 months.
In all patients, a free flap was used for secondary breast reconstruction, which was obtained from the abdomen in 57 cases and from another donor area in 5 cases. There were 8 cases of bilateral breast reconstruction, and the rest (54 patients) were unilateral breast reconstructions. Which represented a total of 70 free flaps. There was venous thrombosis in 3 flaps and arterial thrombosis in 2. Only one free flap was lost, after a failed re-exploration.
In this work, the technical details of the surgical technique and representative cases with uni- pedicled and bi-pedicled free flaps are presented.

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