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. 2015 Jul 8;3(6):e412.
doi: 10.1097/GOX.0000000000000384. eCollection 2015 Jun.

Immediate Implant-based Prepectoral Breast Reconstruction Using a Vertical Incision

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Free PMC article

Immediate Implant-based Prepectoral Breast Reconstruction Using a Vertical Incision

Hilton Becker et al. Plast Reconstr Surg Glob Open. .
Free PMC article

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.

Conflict of interest statement

Disclosure: Hilton Becker, MD, is a paid consultant of Mentor Worldwide LLC, receives royalties from Mentor Worldwide LLC, and is a consultant for Novus Scientific and Greer Medical. Neither of the other authors has any financial disclosures. The Article Processing Charge was paid for by the authors.

Figures

Video 1.
Video 1.
See video, 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.
Fig. 1.
Fig. 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.
Fig. 2.
Fig. 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.
Fig. 3.
Fig. 3.
A, Preoperative view of a 42-year-old patient with carcinoma of the right breast. B, Intraoperative view after right areolar sparing mastectomy with a vertical incision. C, FlexHD sutured to the periphery of the mastectomy pocket. Adjustable implant placed in the prepectoral position beneath the ADM, and the medial edge of lateral flap de-epithelialized. D, Dermal flap advanced beneath the medial flap.
Fig. 4.
Fig. 4.
A, Early postoperative result following right areolar sparing mastectomy and left nipple-sparing mastectomy with immediate bilateral prepectoral implant placement. B, Saline added to adjustable implant. C, Postoperative anterior view of final result with definitive adjustable saline implants. D, No postoperative animation deformity upon muscle contraction.
Fig. 5.
Fig. 5.
Preoperative anterior (A) and side (B) views of a 52-year-old patient with ductal carcinoma in situ of the right breast.
Fig. 6.
Fig. 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.
Fig. 7.
Fig. 7.
A, Preoperative view of a 40-year-old BRCA-positive patient. B, Adjustable implant placed beneath mesh support. C, Postoperative result at 6 months.
Fig. 8.
Fig. 8.
A, Adjustable saline implants replaced with smooth round silicone gel implants medial edge of lateral flap further advanced to elevate breasts. Anterior (B) and side (C) views of final postoperative result.
Fig. 9.
Fig. 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.

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