Direct-to-Implant, Prepectoral Breast Reconstruction: A Single-Surgeon Experience with 201 Consecutive Patients

Abstract

Background: The resurgence of prepectoral breast reconstruction has brought strict patient inclusion and exclusion criteria by numerous authors. This article provides an overview of a single surgeon’s experience with 201 patients, 313 breasts using immediate, direct-to-implant prepectoral breast reconstruction. The article compares surgical outcomes of different patient cohorts to elucidate risk factors that may predispose patients toward developing complications. Methods: A retrospective chart review was performed, identifying all patients who underwent prepectoral, direct-to-implant breast reconstruction from June of 2016 to June of 2018. Results: A total of 201 patients representing 313 breasts were included. A midlateral incision was used in 157 breasts (50.2 percent), followed by a skin-reducing, Wise-pattern in 90 breasts (28.8 percent). Acellular dermal matrix was used in 243 breasts (77.6 percent), free nipple grafts were used in 39 breasts (12.5 percent), and postmastectomy radiation therapy was used in 58 breasts (18.5 percent). Complications requiring operative intervention occurred in 24 breasts (7.7 percent), and minor complications occurred in 23 breasts (7.3 percent). There were no significant differences in complication rates for (1) acellular dermal matrix use versus non–acellular dermal matrix use, (2) Wise-pattern versus other incision, or (3) postmastectomy radiotherapy (p > 0.05). Conclusions: This represents the largest single-surgeon, direct-to-implant prepectoral cohort in the literature. Surgical complications did not differ with acellular dermal matrix use, incision selection, and the use of postmastectomy radiation therapy. There may be an association between acellular dermal matrix use and major complications and radiotherapy with minor complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Comparison of Ischemic Complications with Direct-to-Implant versus Immediate Free Flap Reconstruction After Nipple Sparing Mastectomy: A Propensity-Score Matched Analysis

“…Similar to previous reports in the literature, our subanalysis looking at the DTI group to compare subpectoral versus prepectoral DTI found no significant difference in ischemic outcomes. 27,28 Our analysis showed no ischemic complications in the prepectoral group as compared with a 15.8% mastectomy flap necrosis rate and an 15.8% partial NAC necrosis rate in the subpectoral group. This significant decrease in ischemic complications is likely a product of both breast and the plastic surgeons' efforts and refinements in technique.…”

Short-Term Surgical Complications of Skin-Sparing Mastectomy and Direct-to-Implant Immediate Breast Reconstruction in Women Concurrently Treated with Adjuvant Radiotherapy for Breast Cancer

“…5 Two more recent studies on ADM-assisted prepectoral DTI-IBR both reported PMRT not to significantly influence the rate of postoperative complications. 24 25 Still, we have been unable to trace an unambiguous recent report on the influence of PMRT on the short-term surgical outcome of non-ADM-assisted combined [N]SSM/SDTI-IBR.…”

“Direct-to-Implant, Prepectroal Breast Reconstruction: Geometric Breast Measurements and Changes at 2-Years of Follow-Up”

“…3 If ADM was used, it was as a medium-thickness, fenestrated, anterior-only coverage of the implant without any chest wall fixation. 3 [See Video (online), which shows mastectomy dissection with flap thickness. ]…”

“…1,2 Prepectoral breast reconstruction has thus experienced a resurgence in popularity, because of a growing body of evidence demonstrating reliable clinical outcomes, limited complications, favorable economic profile, and enhanced patient recovery relative to the traditional, subpectoral approach. 1–3…”