Direct to Implant Reconstruction in Nipple Sparing Mastectomy: Patient Selection by Preoperative Digital Mammogram

Abstract

Background:Digital mammography clearly distinguishes gland tissue density from the overlying nonglandular breast tissue coverage, which corresponds to the existing tissue between the skin and the superficial layer of the fascia superficialis surrounding the gland (i.e., dermis and subcutaneous fat). Preoperative digital imaging can determine the thickness of this breast tissue coverage, thus facilitating planning and reducing the rate of necrotic complications after direct to implant (DTI) reconstruction in nipple sparing mastectomy (NSM).Methods:Thirty NSMs in 22 patients with type 3 tissue coverage (subcutaneous tissue thickness of 2 cm or more) were selected for DTI reconstruction after NSM to evaluate immediate skin flap/nipple areola complex ischemic complications and patient satisfaction.Results:We experienced no wound healing problems or ischemic complications immediately after surgery in our population. Only 1 seroma was observed as a short-term complication. Quality of life and patients’ satisfaction level were optimal at 3 and 6 months follow-up, respectively. The aesthetic results have been evaluated as good/excellent in all cases.Conclusions:DTI immediate reconstruction with silicone implants following NSM appears to be a safe option in selected cases with enough tissue coverage, also providing a high level of patient satisfaction. The possibility of selecting cases for this procedure according to the preoperative digital mammogram showing more than 2 cm of superficial tissues thickness may help reducing the risk of immediate ischemic complications.

Prepectoral implant-based breast reconstruction: a joint consensus guide from UK, European and USA breast and plastic reconstructive surgeons

“…Preservation of the subcutaneous layer of the mastectomy flaps and the perforators that vascularise them is the key to success of this surgery. To a degree, the thickness of the subcutaneous layer can be evaluated preoperatively using digital mammography or magnetic resonance imaging [6, 7]. A well-vascularised mastectomy flap is vital for integration and neo-vascularisation.…”

Immediate Prosthetic Breast Reconstruction after Nipple-Sparing Mastectomy: Traditional Subpectoral Technique versus Direct-to-Implant Prepectoral Reconstruction without Acellular Dermal Matrix

“…A specific algorithm shared with the plastic surgeons, based on anamnestic, morphological, functional, and oncological criteria, was used to define the most appropriate reconstruction technique [ 7 , 8 ]. The Rancati classification, based on digital mammographic imaging, was used to predict thickness of post-mastectomy skin flaps [ 9 ].…”

“…(c,d) Six-month postoperative pictures after right nipple-sparing mastectomy through a radial lateral incision (mastectomy specimen 190 g) and prepectoral reconstruction using a definitive anatomical implant (Polytech 30746, 295cc) with a micropolyurethane-foamcoated shell surface, placed in the subcutaneous plane. A single-stage SM reconstruction was performed using total coverage of the implant beneath the pectoralis major and serratus anterior [7]; PP-IPBR was realized with the placement of the prosthesis into the same anatomical space of the excised mammary gland [2,5]; textured implants were used for SM-IPBR and Polytech implants with a micropolyurethane-foam-coated shell surface for PP-IBPR [2,5]; and a contralateral procedure to achieve better symmetry was performed when deemed necessary [10,11].…”

“…We chose to position a prepectoral implant every time we had good soft-tissue coverage after mastectomy (defined as flap thickness of at least 1 cm and good perfusion with indocyanine green dye fluoroangiography and the photodynamic eye imaging system). A single-stage SM reconstruction was performed using total coverage of the implant beneath the pectoralis major and serratus anterior [7]; PP-IPBR was realized with the placement of the prosthesis into the same anatomical space of the excised mammary gland [2,5]; textured implants were used for SM-IPBR and Polytech implants with a micropolyurethanefoam-coated shell surface for PP-IBPR [2,5]; and a contralateral procedure to achieve better symmetry was performed when deemed necessary [10,11].…”

Additive manufacturing and technical strategies for improving outcomes in breast reconstructive surgery

“…The patient's wishes must drive every choice in the decisionmaking for breast reconstruction, aiming at tailored surgical treatments [8], [9].…”