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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, Anterior view of final result following replacement of spectrum adjustable implant with silicone gel implant. B, Postoperative side view. C, No postoperative animation deformity upon muscle contraction.
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Figure 6: A, Anterior view of final result following replacement of spectrum adjustable implant with silicone gel implant. B, Postoperative side view. C, No postoperative animation deformity upon muscle contraction.

Mentions: If the patient is satisfied with the result after 5 or 6 months, the injection port can be removed using a local anesthetic (Figs. 2D, E). Thin skin flaps can be augmented with fat injections and/or the patient can be converted to a silicone gel implant if desired (Figs. 5 and 6).


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

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

A, Anterior view of final result following replacement of spectrum adjustable implant with silicone gel implant. B, Postoperative side view. C, No postoperative animation deformity upon muscle contraction.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4494482&req=5

Figure 6: A, Anterior view of final result following replacement of spectrum adjustable implant with silicone gel implant. B, Postoperative side view. C, No postoperative animation deformity upon muscle contraction.
Mentions: If the patient is satisfied with the result after 5 or 6 months, the injection port can be removed using a local anesthetic (Figs. 2D, E). Thin skin flaps can be augmented with fat injections and/or the patient can be converted to a silicone gel implant if desired (Figs. 5 and 6).

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