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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

Illustration (A) following mastectomy, pocket is empty. B, The ADM (shown in magenta) is sutured to the periphery of the mastectomy pocket and the underfilled adjustable implant is placed beneath the ADM in the prepectoral position. C, The implant is filled postoperatively using the remote injection port. D, After 5 or 6 months, the injection port can be removed using a local anesthetic. E, Filled implant.
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Figure 2: Illustration (A) following mastectomy, pocket is empty. B, The ADM (shown in magenta) is sutured to the periphery of the mastectomy pocket and the underfilled adjustable implant is placed beneath the ADM in the prepectoral position. C, The implant is filled postoperatively using the remote injection port. D, After 5 or 6 months, the injection port can be removed using a local anesthetic. E, Filled implant.

Mentions: Two drains are inserted through long subcutaneous tunnels and sutured to the skin. The pocket is again irrigated with an antibiotic solution to further minimize the risk of infection. Gloves are changed and the adjustable smooth round saline implant (Spectrum, Mentor Corp., Goleta, Calif.) is sterilely prepared. Air is evacuated from the implant, and it is then inserted in to the newly created subacellular dermal pocket (Fig. 2A). The implant may be left virtually empty if there is concern regarding the circulation of blood supply to the skin flaps. If the circulation is satisfactory, saline may be added to a volume that will not result in undue tension on the skin flaps, using a closed filling system (Aseptic Transfer System, Mentor) (Fig. 2B). The filling tube is then shortened and attached to the injection dome. A subcutaneous pocket is dissected inferolaterally, and the injection dome is secured in this pocket with 2 absorbable sutures.


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

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

Illustration (A) following mastectomy, pocket is empty. B, The ADM (shown in magenta) is sutured to the periphery of the mastectomy pocket and the underfilled adjustable implant is placed beneath the ADM in the prepectoral position. C, The implant is filled postoperatively using the remote injection port. D, After 5 or 6 months, the injection port can be removed using a local anesthetic. E, Filled implant.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Illustration (A) following mastectomy, pocket is empty. B, The ADM (shown in magenta) is sutured to the periphery of the mastectomy pocket and the underfilled adjustable implant is placed beneath the ADM in the prepectoral position. C, The implant is filled postoperatively using the remote injection port. D, After 5 or 6 months, the injection port can be removed using a local anesthetic. E, Filled implant.
Mentions: Two drains are inserted through long subcutaneous tunnels and sutured to the skin. The pocket is again irrigated with an antibiotic solution to further minimize the risk of infection. Gloves are changed and the adjustable smooth round saline implant (Spectrum, Mentor Corp., Goleta, Calif.) is sterilely prepared. Air is evacuated from the implant, and it is then inserted in to the newly created subacellular dermal pocket (Fig. 2A). The implant may be left virtually empty if there is concern regarding the circulation of blood supply to the skin flaps. If the circulation is satisfactory, saline may be added to a volume that will not result in undue tension on the skin flaps, using a closed filling system (Aseptic Transfer System, Mentor) (Fig. 2B). The filling tube is then shortened and attached to the injection dome. A subcutaneous pocket is dissected inferolaterally, and the injection dome is secured in this pocket with 2 absorbable sutures.

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