Complete tissue expander coverage by musculo-fascial flaps in immediate breast mound reconstruction after mastectomy

Abstract

Immediate breast reconstruction with tissue expander has become an increasingly popular procedure. Complete coverage of the expander by a musculofascial layer provides an additional well-vascularised layer, reducing the rate of possible complications of skin necrosis, prosthesis displacement, and the late capsular contracture. Complete expander coverage can be achieved by a combination of pectoralis major muscle and adjacent thoracic fascia in selected patients. Seventy-five breast mounds in 59 patients were reconstructed, in the first stage a temporary tissue expander inserted immediately after mastectomy and a musculofascial layer composed of the pectoralis major muscle, the serratus anterior fascia, and the superficial pectoral fascia were created to cover the expander. The first stage was followed months later by implant insertion. Minor and major complications were reported in a period of follow-up ranging from 24-42 months (mean 31 months). Complete musculofascial coverage of the tissue expander was a simple and easy to learn technique providing that the patient has a well-formed and intact superficial pectoral and serratus anterior fascia. From a total of 75 breast mounds reconstructed, major complications rate was 4% (overall rate of 19.8%), including major seroma (n = 4), haematoma (n = 1), partial skin loss (n = 3), wound dehiscence (n = 1), major infection (n = 2), severe capsule contracture (n = 1), and expander displacement (n = 3). The serratus anterior fascia and the superficial pectoral fascia flaps can be effectively used as an autologous tissue layer to cover the lower and the lateral aspect of tissue expanders in immediate breast reconstruction after mastectomy.

Breast Reconstruction after Mastectomy with the Use of an Implant and Serratus Anterior Fascia Flap—Initial Clinical Evaluation

“…A total of of them had comorbidities, including obesity, diabetes, and hypertension, and 7 of them were smokers. The mean follow-up period was 17.45 months (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Patient ages ranged between 37-62 (mean 48) and the average BMI was 26 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

“…The mean follow-up period was 17.45 months (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Patient ages ranged between 37-62 (mean 48) and the average BMI was 26 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). The average time of postoperative permanence drain was 15 days.…”

“…The advantages of using serratus fascial flap are implant position control avoiding lateralization and definition of the lateral inframammary fold, allowing adequate inferior pole fullness or expansion, and at the same time offloading mechanical stress on the inferior skin envelope, particularly in case of vascular compromise of mastectomy skin flaps. It is an autologous well-vascularized barrier between the implant and the skin, shows better tolerance to postoperative radiation, and in comparison with serratus anterior muscle, results in less post-operative pain, drainage, and loss of mobility [17][18][19][20][21][22][23][24]. Although SF elevation shows similar complication rates to SM during the first stage breast reconstruction, Seth et al [19] reported an absolute increase in postoperative hematomas and seromas in SM elevation, related to a more elaborate dissection of harvesting SM flap.…”

Immediate breast reconstruction with omental flap for luminal breast cancer patients

“…[ 8 ] Similarly, inferior dermal flap, serratus anterior fascia, and the superficial pectoral fascia flaps can be served as an excellent single-stage reconstruction option for women with ptotic breast. [ 9 , 10 ] The superior gluteal artery perforator flap is also a possible choice for autologous breast reconstruction and autologous skin can be provided for inadequate skin coverage. [ 11 , 12 ] Despite the promising application, we have to notice that not all patients are ideal candidates, clinicians should take inadequate volume of donor sites into consideration.…”

Complete coverage of a tissue expander by a musculofascial pocket including the sternalis muscle during breast reconstruction

“…The sternalis muscle is a vestigial muscle that is vertically long with a rectangular shape, courses parallel or oblique to the long axis of the medial sternocostal part of the pectoralis major, and presents in rare cases (1.3%) [ 1 , 2 ]. It often has a major effect on the insertion of a tissue expander during breast reconstruction; however, there has only been a single report of the sternalis muscle and the pectoralis major muscle being elevated as a lower mastectomy flap, and no reports have been published about repairing intraoperative trauma [ 3 ].…”