Immediate breast reconstruction with a wise pattern mastectomy and NAC-sparing McKissock vertical bipedicle dermal flap

Lewin, Richard; Jepsen, Christian; Hallberg, Håkan; Hansson, Emma

doi:10.1016/j.bjps.2018.05.027

Cited by 11 publications

(13 citation statements)

References 18 publications

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“…Comparing our complication rates to other studies is difficult as, to the best of our knowledge, this is the first study reporting exclusively on autologous IBR in combination with wise pattern skin reducing mastectomies with an adipocutaneous IBDF in large and ptotic breasts. All other studies focus on alternative reconstructive strategies, such as using the IBDF in skin reducing mastectomies but only implant based IBR [ 12 , 13 , 14 ], or using wise pattern incisions without the IBDF [ 3 , 4 , 11 , 15 , 16 , 17 ]. In a systematic review of 31 studies (1128 cases) by Tondu et al on breast reconstruction after NSM in large and ptotic breasts, the overall complication rate was 29.1%, which is comparable to ours [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The inferiorly based adipocutaneous flap is usually sacrificed in wise pattern mastectomies, despite representing an additional layer of well vascularized tissue and protection to the T-junction. Additionally, the inframammary fold is preserved and the flap provides support and additional volume to the lower quadrants, preventing a boxy shape of the lower pole and providing proper pocket control [ 12 , 13 ]. Furthermore, in cases of flap failure and alloplastic conversion, it can serve as an autoderm, protecting the implant from exposure.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, using IMAPs from the 2nd or 3rd ICS as recipient vessels, was not associated with higher skin envelope complications in the univariate analysis. In this context, it is essential to preserve as many perforators from the ICS as possible to compensate for the reduction in skin perfusion associated with the use of IMAPs for the anastomosis [ 12 , 13 , 18 , 20 , 24 ]. In a previous study, we were able to show that IMAPs can be safely used as recipient vessels in autologous IBR even after radiation therapy [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Identification of Independent Risk Factors for Skin Complications in a Multifactorial Logistic Regression Analysis of Simultaneous Immediate Autologous Breast Reconstruction and Skin Reduction Mastectomy in Large and Ptotic Breasts Using an Inferiorly Based Deepithelialized Dermal Breast Flap

Vollbach

Thomas

Fansa

2022

JPM

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Autologous immediate breast reconstruction in large and ptotic breasts remains challenging. We aimed to identify independent risk factors for impaired wound healing and nipple necrosis after skin reducing wise pattern mastectomy in autologous reconstruction with an auxiliary deepithelialized inferiorly based dermal flap (IBDF). Methods. This retrospective study examined patients with wise pattern mastectomy with autologous immediate breast reconstruction (IBR) between 2017 and 2019. All cases of large and ptotic breasts were included. Demographic, oncologic, reconstructive, and surgical data were compiled, and multifactorial binary logistic regression models identified independent predictors for skin complications and nipple areolar complex (NAC) necrosis. Results. Of 591 autologous breast reconstructions, 62 (11%) met the inclusion criteria. Overall wound complication rate was 32% (n = 20, DIEP 11, thigh 9, p = 0.99), including 26% minor (n = 16, non-surgically treated) and 7% major complications (n = 4, surgically treated). Complete NAC necrosis occurred in one case. Nipple sparing mastectomy (NSM) (p = 0.003), high BMI (p = 0.019), longer operation time (p = 0.044) and higher patient age (p = 0.045) were independent risk factors for skin complications. Using internal mammary artery perforators (IMAP) as recipient vessels did not result in increased complication rates (p = 0.59). Conclusion. Higher patient age, BMI, and operation time (OT) significantly increase the risk for skin complications in combined reduction wise pattern mastectomies with autologous IBR. In this context, IBDFs help preserve the inframammary fold, providing vasculature to the T-junction and the mastectomy skin flaps. Acceptable complication rates can be achieved in large and ptotic breasts, regardless of preoperative chemotherapy or radiation. Gentle tissue handling with minimal thermal trauma preserves internal mammary artery perforators (IMAPs) as recipient vessels. In cases of flap failure and alloplastic conversion, the IBDF can serve as an autoderm, protecting the implant from exposure

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Identification of Independent Risk Factors for Skin Complications in a Multifactorial Logistic Regression Analysis of Simultaneous Immediate Autologous Breast Reconstruction and Skin Reduction Mastectomy in Large and Ptotic Breasts Using an Inferiorly Based Deepithelialized Dermal Breast Flap

Vollbach

Thomas

Fansa

2022

JPM

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“…Kontos et al 29 reported on 30 breasts undergoing a batwing-style mastopexy, NSM, and TE reconstruction, leaving a transverse scar at the level of the repositioned NAC. There was no true directional flow to the adipodermal pedicle supporting the NAC as all the skin within the mastopexy pattern was deepithelialized and imbricated to accomplish the lift.…”

Section: Discussionmentioning

confidence: 99%

Modified Bidirectional Adipodermal Mastopexy, Nipple-sparing Mastectomy, and Direct-to-implant Reconstruction in Patients with Significant Ptosis

Schwartz

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Nipple-sparing mastectomy (NSM) and direct-to-implant reconstruction (DTIR) allow patients to complete their surgical care in one surgery. However, for women with significant ptosis, NSM is frequently not offered or requires multiple procedures. Methods: We performed a retrospective review of a single-surgeon practice from 2016 to 2021 of a single-stage, modified, bidirectional adipodermal mastopexy to facilitate NSM and DTIR in patients with breast cancer and grades 2-3 ptosis. Demographics, intraoperative details, and postoperative outcomes were recorded. We also conducted a literature review and compared our technique to previously published approaches. Results: Sixty breast cancer patients (105 breasts) with grades 2-3 ptosis underwent NSM and prepectoral DTIR using this technique. The average nipple-areola complex (NAC) lift was 9cm (range, 4 -15cm), and the average preoperative nipple to inframammary fold distance was 12cm (range, 8 -17cm). Overall complications included seroma [n = 8 (8%)], T-junction dehiscence [n = 6 (6%)], mastectomy flap necrosis [n = 6 (6%)], and superficial/partial NAC necrosis [n = 2 (2%)] with no incidence of complete NAC necrosis. Comprehensive literature review confirmed that the modified, bidirectional adipodermal mastopexy has a favorable complication profile when compared with other previously described approaches despite its application to more challenging patient populations undergoing DTIR. Conclusions: The modified bidirectional adipodermal mastopexy safely facilitates NSM and DTIR in breast cancer patients with ptosis without requiring multiple procedures or leaving behind breast tissue and, in our hands, is the preferred approach in this difficult patient population.

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“…A subpectoral implant is placed, and the skin flaps are sutured over the deepithelialized skin. The vascularity of the ADF or nipple is rarely compromised due to the wide inferior vascular pedicle [15]. Most papers describing the use of an ADF in preserving the nipple do so by a free nipple graft over de-eplithelialized skin in the upper flaps in the pre-marked position.…”

Section: Reviewmentioning

confidence: 99%

The Benefits and Pitfalls of Using an Autologous Dermal Flap in Immediate Implant-Based Reconstruction

Garibotto¹

2021

Cureus

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One of the challenges of implant breast reconstruction post-subcutaneous mastectomy is coverage of the inferior pole of the implant to provide a barrier between the implant and skin. Numerous biological and synthetic meshes are available on the market for this purpose; however, they are often very costly and carry all the risks of using a foreign body. In patients with large ptotic breast, the skin of the inferior mastectomy flap can be used instead. A number of techniques and variations have been developed over the last 40 years driven by the increasing cost of healthcare and acceptance of breast reconstruction as vital part of breast cancer care and survivorship. This review outline the benefits and pitfalls of using an autologous dermal flap in breast construction and the variations in published use.

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Immediate breast reconstruction with a wise pattern mastectomy and NAC-sparing McKissock vertical bipedicle dermal flap

Cited by 11 publications

References 18 publications

Identification of Independent Risk Factors for Skin Complications in a Multifactorial Logistic Regression Analysis of Simultaneous Immediate Autologous Breast Reconstruction and Skin Reduction Mastectomy in Large and Ptotic Breasts Using an Inferiorly Based Deepithelialized Dermal Breast Flap

Identification of Independent Risk Factors for Skin Complications in a Multifactorial Logistic Regression Analysis of Simultaneous Immediate Autologous Breast Reconstruction and Skin Reduction Mastectomy in Large and Ptotic Breasts Using an Inferiorly Based Deepithelialized Dermal Breast Flap

Modified Bidirectional Adipodermal Mastopexy, Nipple-sparing Mastectomy, and Direct-to-implant Reconstruction in Patients with Significant Ptosis

The Benefits and Pitfalls of Using an Autologous Dermal Flap in Immediate Implant-Based Reconstruction

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