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Immediate Implant-based Prepectoral Breast Reconstruction Using a Vertical Incision.

Becker H, Lind JG, Hopkins EG - Plast Reconstr Surg Glob Open (2015)

Bottom Line: This technique, when combined with an adjustable implant, addresses the complications related to subpectoral implant placement of traditional expanders.Adjustable smooth round saline implants and mesh/acellular dermal matrix were used for fixation in all cases.Postoperative complications occurred in 9 patients, 6 of which were resolved with postoperative intervention while only 2 cases resulted in implant loss.

View Article: PubMed Central - PubMed

Affiliation: Hilton Becker Clinic of Plastic Surgery, Boca Raton, Fla.; Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, Fla.; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Fla.; and Florida Atlantic University, Boca Raton, Fla.

ABSTRACT

Background: Ideally, breast reconstruction is performed at the time of mastectomy in a single stage with minimal scarring. However, postoperative complications with direct-to-implant subpectoral reconstruction remain significant. These include asymmetry, flap necrosis, animation deformity, and discomfort. We report on a series of patients who have undergone immediate single-stage prepectoral, implant-based breast reconstruction with a smooth, adjustable saline implant covered with mesh/acellular dermal matrix for support using a vertical mastectomy incision. This technique, when combined with an adjustable implant, addresses the complications related to subpectoral implant placement of traditional expanders. Our follow-up time, 4.6 years (55 months), shows a low risk of implant loss and elimination of animation deformity while also providing patients with a safe and aesthetically pleasing result.

Methods: All patients who underwent immediate implant-based prepectoral breast reconstruction using a vertical mastectomy incision as a single-staged procedure were included. Charts were reviewed retrospectively. Adjustable smooth round saline implants and mesh/acellular dermal matrix were used for fixation in all cases.

Results: Thirty-one patients (62 breasts) underwent single-staged implant-based prepectoral breast reconstruction using a vertical mastectomy incision. Postoperative complications occurred in 9 patients, 6 of which were resolved with postoperative intervention while only 2 cases resulted in implant loss.

Conclusions: There can be significant morbidity associated with traditional subpectoral implant-based breast reconstruction. As an alternative, the results of this study show that an immediate single-stage prepectoral breast reconstruction with a smooth saline adjustable implant, using a vertical incision, in conjunction with mesh/matrix support can be performed with excellent aesthetic outcomes and minimal complications.

No MeSH data available.


Related in: MedlinePlus

A, Intraoperative photograph immediately following bilateral vertical mastectomy. B, Following insertion of dermal graft and de-epithelialization of lateral flap and temporary intraoperative expander within subdermal pocket. C, Following prepectoral placement of adjustable spectrum implant into the subdermal pocket partially filled and final skin closure.
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Figure 1: A, Intraoperative photograph immediately following bilateral vertical mastectomy. B, Following insertion of dermal graft and de-epithelialization of lateral flap and temporary intraoperative expander within subdermal pocket. C, Following prepectoral placement of adjustable spectrum implant into the subdermal pocket partially filled and final skin closure.

Mentions: A retrospective review was performed on all patients who had undergone an immediate implant-based prepectoral breast reconstruction as a single-staged procedure. Vertical mastectomy incisions were used in all patients. All patients had adjustable smooth round saline implants placed and complete implant coverage with either Vicryl or FlexHD Pliable mesh (ADM) used for fixation. All patients meeting these criteria were included. There were no exclusion criteria. The cases were all performed by a single surgeon in a private practice setting. Informed verbal and written consent were given by all of the patients. The Declaration of Helsinki principles were strictly followed. Aggressive clinical follow-up was performed in all cases. Follow-up was done daily for the first 3 days and then twice weekly for the first 2 weeks. All charts were reviewed in a retrospective fashion. Data collected included the patient’s age, the diagnosis, the type of mesh/matrix used, any history of radiation, postoperative complications, need for postoperative interventions, implant loss, conversion to silicone gel implants, and follow-up time (Table 1) (See Video 1, Supplemental Digital Content 1, which demonstrates the operative technique used for prepectoral breast implant placement with complete ADM coverage using a vertical incision. This video is available in the “Related Videos” section of the full-text article at http://www.PRSGO.com or available at http://links.lww.com/PRSGO/A98).


Immediate Implant-based Prepectoral Breast Reconstruction Using a Vertical Incision.

Becker H, Lind JG, Hopkins EG - Plast Reconstr Surg Glob Open (2015)

A, Intraoperative photograph immediately following bilateral vertical mastectomy. B, Following insertion of dermal graft and de-epithelialization of lateral flap and temporary intraoperative expander within subdermal pocket. C, Following prepectoral placement of adjustable spectrum implant into the subdermal pocket partially filled and final skin closure.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494482&req=5

Figure 1: A, Intraoperative photograph immediately following bilateral vertical mastectomy. B, Following insertion of dermal graft and de-epithelialization of lateral flap and temporary intraoperative expander within subdermal pocket. C, Following prepectoral placement of adjustable spectrum implant into the subdermal pocket partially filled and final skin closure.
Mentions: A retrospective review was performed on all patients who had undergone an immediate implant-based prepectoral breast reconstruction as a single-staged procedure. Vertical mastectomy incisions were used in all patients. All patients had adjustable smooth round saline implants placed and complete implant coverage with either Vicryl or FlexHD Pliable mesh (ADM) used for fixation. All patients meeting these criteria were included. There were no exclusion criteria. The cases were all performed by a single surgeon in a private practice setting. Informed verbal and written consent were given by all of the patients. The Declaration of Helsinki principles were strictly followed. Aggressive clinical follow-up was performed in all cases. Follow-up was done daily for the first 3 days and then twice weekly for the first 2 weeks. All charts were reviewed in a retrospective fashion. Data collected included the patient’s age, the diagnosis, the type of mesh/matrix used, any history of radiation, postoperative complications, need for postoperative interventions, implant loss, conversion to silicone gel implants, and follow-up time (Table 1) (See Video 1, Supplemental Digital Content 1, which demonstrates the operative technique used for prepectoral breast implant placement with complete ADM coverage using a vertical incision. This video is available in the “Related Videos” section of the full-text article at http://www.PRSGO.com or available at http://links.lww.com/PRSGO/A98).

Bottom Line: This technique, when combined with an adjustable implant, addresses the complications related to subpectoral implant placement of traditional expanders.Adjustable smooth round saline implants and mesh/acellular dermal matrix were used for fixation in all cases.Postoperative complications occurred in 9 patients, 6 of which were resolved with postoperative intervention while only 2 cases resulted in implant loss.

View Article: PubMed Central - PubMed

Affiliation: Hilton Becker Clinic of Plastic Surgery, Boca Raton, Fla.; Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, Fla.; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Fla.; and Florida Atlantic University, Boca Raton, Fla.

ABSTRACT

Background: Ideally, breast reconstruction is performed at the time of mastectomy in a single stage with minimal scarring. However, postoperative complications with direct-to-implant subpectoral reconstruction remain significant. These include asymmetry, flap necrosis, animation deformity, and discomfort. We report on a series of patients who have undergone immediate single-stage prepectoral, implant-based breast reconstruction with a smooth, adjustable saline implant covered with mesh/acellular dermal matrix for support using a vertical mastectomy incision. This technique, when combined with an adjustable implant, addresses the complications related to subpectoral implant placement of traditional expanders. Our follow-up time, 4.6 years (55 months), shows a low risk of implant loss and elimination of animation deformity while also providing patients with a safe and aesthetically pleasing result.

Methods: All patients who underwent immediate implant-based prepectoral breast reconstruction using a vertical mastectomy incision as a single-staged procedure were included. Charts were reviewed retrospectively. Adjustable smooth round saline implants and mesh/acellular dermal matrix were used for fixation in all cases.

Results: Thirty-one patients (62 breasts) underwent single-staged implant-based prepectoral breast reconstruction using a vertical mastectomy incision. Postoperative complications occurred in 9 patients, 6 of which were resolved with postoperative intervention while only 2 cases resulted in implant loss.

Conclusions: There can be significant morbidity associated with traditional subpectoral implant-based breast reconstruction. As an alternative, the results of this study show that an immediate single-stage prepectoral breast reconstruction with a smooth saline adjustable implant, using a vertical incision, in conjunction with mesh/matrix support can be performed with excellent aesthetic outcomes and minimal complications.

No MeSH data available.


Related in: MedlinePlus