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Aesthetic outcomes of inframammary fold recreation in two-stage, implant-based, breast reconstruction

View Article: PubMed Central - PubMed

ABSTRACT

Background: When the inframammary fold (IMF) is excised in mastectomy procedures for oncologic reasons, it must be recreated to restore a natural breast shape. Despite refinements in surgical techniques, postoperative loss of a well-defined IMF can occur. This study aimed to assess the outcomes of IMF recreation after two-stage, implant-based breast reconstruction.

Methods: We retrospectively reviewed 75 consecutive patients who underwent unilateral, two-stage, implant-based breast reconstruction between 2013 and 2015 at the authors’ institution. Among them, IMF recreation was performed in 37 patients through a modified Nava’s internal method. Aesthetic outcomes of the recreated IMFs were evaluated by observer assessment of two criteria, and critical factors affecting IMF outcomes were also analyzed.

Results: We found that contralateral breast ptosis (p < 0.05) and lack of postmastectomy radiotherapy (PMRT, p < 0.01) were significant predictors of better IMF outcomes. Nipple-sparing mastectomy and skin-sparing mastectomy resulted in better IMF outcomes, as compared with non-skin-sparing mastectomy (p < 0.05 for each), while no significant difference was observed between them in patients who did not undergo PMRT (p = 0.19). Similarly, larger implant volume, but not projection of implant, was a predictor of better IMF outcomes when limited to patients who did not undergo PMRT (p < 0.05). Age, body mass index, timing of reconstruction, and extent of overexpansion had no significant effect on IMF outcomes.

Conclusions: Based on these critical factors, the shape of the reconstructed breast and the need for reshaping the contralateral breast can be predicted. Special attention should be paid to patients with non-skin-sparing mastectomy and PMRT. When these patients desire a medium- to large-sized ptotic breast, conversion to autologous reconstruction can achieve symmetrical breast reconstruction.

No MeSH data available.


Related in: MedlinePlus

A 61-year-old patient who underwent delayed, right breast reconstruction following non-skin-sparing mastectomy. a Preoperative view, b a tissue expander was inflated to 475 mL, c immediate postoperative view after exchange for a 470 mL implant, d postoperative view. A well-defined inframammary fold and a natural breast shape were reconstructed
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Fig2: A 61-year-old patient who underwent delayed, right breast reconstruction following non-skin-sparing mastectomy. a Preoperative view, b a tissue expander was inflated to 475 mL, c immediate postoperative view after exchange for a 470 mL implant, d postoperative view. A well-defined inframammary fold and a natural breast shape were reconstructed

Mentions: Since skin expansion with TEs is a fundamental part of the internal method we used, we suspected that factors related to the amount and elasticity of breast skin might affect the IMF outcome. As expected, PMRT, which induces subcutaneous fibrosis and decreased elasticity (Kim et al. 2013), was predictive of negative IMF outcomes. Similarly, NSM and SSM, in which most of the original breast skin is preserved, were advantageous compared to NSSM, in which a certain amount of breast skin is excised. It is notable that, of the seven patients who underwent both NSSM and PMRT, five and two patients were scored as “poor” and “fair,” respectively. Although good breast shape was obtained immediately after surgery in these patients, natural breast shape was lost during the postoperative process (Fig. 1). When limited to patients without PMRT, the type of breast surgery was not a significant predictor of IMF outcomes. In such a situation, a pendulous breast with a well-defined IMF could be reconstructed via adequate skin expansion even after NSSM (Fig. 2). Regarding skin expansion, overexpansion has been reported as a useful technique for reconstructing large and protuberant breasts (Versaci 1987), but it did not positively affect IMF outcomes in the present study.Fig. 1


Aesthetic outcomes of inframammary fold recreation in two-stage, implant-based, breast reconstruction
A 61-year-old patient who underwent delayed, right breast reconstruction following non-skin-sparing mastectomy. a Preoperative view, b a tissue expander was inflated to 475 mL, c immediate postoperative view after exchange for a 470 mL implant, d postoperative view. A well-defined inframammary fold and a natural breast shape were reconstructed
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037096&req=5

Fig2: A 61-year-old patient who underwent delayed, right breast reconstruction following non-skin-sparing mastectomy. a Preoperative view, b a tissue expander was inflated to 475 mL, c immediate postoperative view after exchange for a 470 mL implant, d postoperative view. A well-defined inframammary fold and a natural breast shape were reconstructed
Mentions: Since skin expansion with TEs is a fundamental part of the internal method we used, we suspected that factors related to the amount and elasticity of breast skin might affect the IMF outcome. As expected, PMRT, which induces subcutaneous fibrosis and decreased elasticity (Kim et al. 2013), was predictive of negative IMF outcomes. Similarly, NSM and SSM, in which most of the original breast skin is preserved, were advantageous compared to NSSM, in which a certain amount of breast skin is excised. It is notable that, of the seven patients who underwent both NSSM and PMRT, five and two patients were scored as “poor” and “fair,” respectively. Although good breast shape was obtained immediately after surgery in these patients, natural breast shape was lost during the postoperative process (Fig. 1). When limited to patients without PMRT, the type of breast surgery was not a significant predictor of IMF outcomes. In such a situation, a pendulous breast with a well-defined IMF could be reconstructed via adequate skin expansion even after NSSM (Fig. 2). Regarding skin expansion, overexpansion has been reported as a useful technique for reconstructing large and protuberant breasts (Versaci 1987), but it did not positively affect IMF outcomes in the present study.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: When the inframammary fold (IMF) is excised in mastectomy procedures for oncologic reasons, it must be recreated to restore a natural breast shape. Despite refinements in surgical techniques, postoperative loss of a well-defined IMF can occur. This study aimed to assess the outcomes of IMF recreation after two-stage, implant-based breast reconstruction.

Methods: We retrospectively reviewed 75 consecutive patients who underwent unilateral, two-stage, implant-based breast reconstruction between 2013 and 2015 at the authors’ institution. Among them, IMF recreation was performed in 37 patients through a modified Nava’s internal method. Aesthetic outcomes of the recreated IMFs were evaluated by observer assessment of two criteria, and critical factors affecting IMF outcomes were also analyzed.

Results: We found that contralateral breast ptosis (p < 0.05) and lack of postmastectomy radiotherapy (PMRT, p < 0.01) were significant predictors of better IMF outcomes. Nipple-sparing mastectomy and skin-sparing mastectomy resulted in better IMF outcomes, as compared with non-skin-sparing mastectomy (p < 0.05 for each), while no significant difference was observed between them in patients who did not undergo PMRT (p = 0.19). Similarly, larger implant volume, but not projection of implant, was a predictor of better IMF outcomes when limited to patients who did not undergo PMRT (p < 0.05). Age, body mass index, timing of reconstruction, and extent of overexpansion had no significant effect on IMF outcomes.

Conclusions: Based on these critical factors, the shape of the reconstructed breast and the need for reshaping the contralateral breast can be predicted. Special attention should be paid to patients with non-skin-sparing mastectomy and PMRT. When these patients desire a medium- to large-sized ptotic breast, conversion to autologous reconstruction can achieve symmetrical breast reconstruction.

No MeSH data available.


Related in: MedlinePlus