Comparison of subcutaneous versus submuscular expander placement in the first stage of immediate breast reconstruction

Zhu, Lin; Mohan, Anita T.; Abdelsattar, Jad M.; Wang, Zhen; Vijayasekaran, Aparna; Hwang, Soyun M.; Tran, Nho V.; Saint‐Cyr, Michel

doi:10.1016/j.bjps.2016.01.006

Cited by 100 publications

(142 citation statements)

References 41 publications

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“…Recently, the long-term results of clinical studies on the pre-pectoral reconstructions by means of a synthetic matrix were published (11,12). Several other studies reported similar results with biological matrixes (8,(13)(14)(15)(16)(17)(18)(19). A pre-pectoral approach showed, in all these series, a highly documented surgical safety, comparable to the standard full muscular coverage and to the dual-plane coverage.…”

Section: Surgical Techniquementioning

confidence: 80%

Selective pectoralis major muscle denervation in breast reconstruction: a technical modification for more effective and cosmetic results

2017

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The use of pectoralis major muscle (PMM) in breast reconstruction has been a mainstay for decades. In recent years, although, a novel approach, the so-called subcutaneous or pre-pectoral breast reconstruction, has been introduced advocating the advantages of sparing the pectoralis muscle. Such advantages include more natural implant ptosis and appearance, significant reduction of capsular contracture and also avoidance of implant animation and animation deformities. These are all drawbacks that the use of muscles in implant coverage inevitably involves overtime. Nonetheless, there are clinical situations which definitely require the use of a muscle coverage either for surgical safety or for a better cosmetic outcome.In such cases a slight and simple modification of the standard technique can be adopted to prevent these drawbacks. While performing the muscular pocket two of the three main nerve trunks of the PMM can be severed, thus leaving innervated only the upper portion of the muscle. The remaining two thirds, basically the part covering a tissue expander (TE) or an implant, will therefore retain a status of a viable soft tissue without any muscular contraction. A significant atrophy will definitely ensue, but a sufficiently vascularized and floppy cushion will cover the prosthetic breast reconstruction device, protecting and masking it.

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Section: Surgical Techniquementioning

confidence: 80%

Selective pectoralis major muscle denervation in breast reconstruction: a technical modification for more effective and cosmetic results

2017

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“…One study was removed due to duplicate data and 2 were added from references of relevant articles, yielding a total of 6 studies published from 2014 to 2016 (Table 1). 25–28,30,34 …”

Section: Resultsmentioning

confidence: 99%

“…The majority of studies were level IV evidence case series (66.7%) with the exception of one retrospective cohort study 30 and one nonrandomized controlled trial. 27 Pooling data from all studies resulted in a total of 120 patients and 186 reconstructions.…”

Section: Resultsmentioning

confidence: 99%

“…25,27,34 Of the 2 studies that utilized mastectomy flap perfusion as inclusion criteria, one study only performed clinical assessment 26 and the other utilized indocyanine green angiography and clinical assessment. 30 Exclusion criteria encompassed various patient demographics and characteristics that would preclude the decision to pursue subcutaneous reconstruction. Almost all articles (80.0%) reported exclusion criteria for subcutaneous reconstruction (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…27,28 Although the early experience with subcutaneous reconstruction was associated with higher rates of CC, implant exposure, and implant loss, 12,29 advances in mastectomy techniques and the use of ADM and synthetic mesh have been suggested to decrease the risk of these complications. 28,30 …”

mentioning

confidence: 99%

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Subcutaneous Implant-based Breast Reconstruction with Acellular Dermal Matrix/Mesh: A Systematic Review

Salibian

Frey

Choi

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:The availability of acellular dermal matrix (ADM) and synthetic mesh products has prompted plastic surgeons to revisit subcutaneous implant-based breast reconstruction. The literature is limited, however, with regards to evidence on patient selection, techniques, and outcomes.Methods:A systematic review of the Medline and Cochrane databases was performed for original studies reporting breast reconstruction with ADM or mesh, and subcutaneous implant placement. Studies were analyzed for level of evidence, inclusion/exclusion criteria for subcutaneous reconstruction, reconstruction characteristics, and outcomes.Results:Six studies (186 reconstructions) were identified for review. The majority of studies (66.7%) were level IV evidence case series. Eighty percent of studies had contraindications for subcutaneous reconstruction, most commonly preoperative radiation, high body mass index, and active smoking. Forty percent of studies commenting on patient selection assessed mastectomy flap perfusion for subcutaneous reconstruction. Forty-five percent of reconstructions were direct-to-implant, 33.3% 2-stage, and 21.5% single-stage adjustable implant, with ADM utilized in 60.2% of reconstructions versus mesh. Pooled complication rates included: major infection 1.2%, seroma 2.9%, hematoma 2.3%, full nipple-areola complex necrosis 1.1%, partial nipple-areola complex necrosis 4.5%, major flap necrosis 1.8%, wound healing complication 2.3%, explantation 4.1%, and grade III/IV capsular contracture 1.2%.Conclusions:Pooled short-term complication rates in subcutaneous alloplastic breast reconstruction with ADM or mesh are low in preliminary studies with selective patient populations, though techniques and outcomes are variable across studies. Larger comparative studies and better-defined selection criteria and outcomes reporting are needed to develop appropriate indications for performing subcutaneous implant-based reconstruction.

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Early assessment of post‐surgical outcomes with pre‐pectoral breast reconstruction: A literature review and meta‐analysis

Chatterjee

Nahabedian

Gabriel

et al. 2018

Journal of Surgical Oncology

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Comparison of subcutaneous versus submuscular expander placement in the first stage of immediate breast reconstruction

Cited by 100 publications

References 41 publications

Selective pectoralis major muscle denervation in breast reconstruction: a technical modification for more effective and cosmetic results

Selective pectoralis major muscle denervation in breast reconstruction: a technical modification for more effective and cosmetic results

Subcutaneous Implant-based Breast Reconstruction with Acellular Dermal Matrix/Mesh: A Systematic Review

Early assessment of post‐surgical outcomes with pre‐pectoral breast reconstruction: A literature review and meta‐analysis

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