Implant augmentation after perforator flap breast reconstruction.

We congratulate Figus and colleagues on their series of 14 patients with DIEP flap breast reconstruction who underwent immediate (14 implants) or delayed (four implants) augmentation. We concur that implant augmentation offers an effective option for optimising the results of autologous tissue breast reconstruction but have independently taken a different approach. We would like to share our recent experience with delayed augmentation of abdominal perforator flap reconstructions and comment on several important issues raised by their paper. In our unit, three patients have undergone delayed augmentation of perforator flap reconstructions with a total of five implants (Table 1). The internal mammary vessels were the recipients in all patients. Both round and anatomical fixed-volume silicone gel implants were used and all were placed in the subpectoral position. There were no intra-operative complications and the vascular pedicles were easily identified and preserved in all patients. At most recent follow-up (5, 24 and 40 months), a satisfactory