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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, Preoperative view of a 47-year-old patient with carcinoma of the left breast. B, Postoperative view s/p bilateral breast reconstruction with adjustable implants in the prepectoral position following nipple reconstruction. C, No postoperative animation deformity upon muscle contraction.
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Figure 9: A, Preoperative view of a 47-year-old patient with carcinoma of the left breast. B, Postoperative view s/p bilateral breast reconstruction with adjustable implants in the prepectoral position following nipple reconstruction. C, No postoperative animation deformity upon muscle contraction.

Mentions: Several benefits seem to be obtained by placing the implant in the prepectoral position. First, prepectoral implant placement eliminates 100% of animation deformities in this series (Fig. 9). Second, as the muscle is not detached and the implant is not placed beneath the muscle, there seems to be less postoperative pain and a faster recovery in our experience. Having cared for many patients following mastectomies without reconstruction, the pain from breast reconstruction seems to arise not from the mastectomy incision but rather due to the typical submuscular dissection and location of the tissue expander. In our experience, subjectively, those patients with breast reconstruction certainly seem to have more pain than the patients who only underwent mastectomies.


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

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

A, Preoperative view of a 47-year-old patient with carcinoma of the left breast. B, Postoperative view s/p bilateral breast reconstruction with adjustable implants in the prepectoral position following nipple reconstruction. C, No postoperative animation deformity upon muscle contraction.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 9: A, Preoperative view of a 47-year-old patient with carcinoma of the left breast. B, Postoperative view s/p bilateral breast reconstruction with adjustable implants in the prepectoral position following nipple reconstruction. C, No postoperative animation deformity upon muscle contraction.
Mentions: Several benefits seem to be obtained by placing the implant in the prepectoral position. First, prepectoral implant placement eliminates 100% of animation deformities in this series (Fig. 9). Second, as the muscle is not detached and the implant is not placed beneath the muscle, there seems to be less postoperative pain and a faster recovery in our experience. Having cared for many patients following mastectomies without reconstruction, the pain from breast reconstruction seems to arise not from the mastectomy incision but rather due to the typical submuscular dissection and location of the tissue expander. In our experience, subjectively, those patients with breast reconstruction certainly seem to have more pain than the patients who only underwent mastectomies.

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