Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures

Abstract

BackgroundThe increased incidence of conservative mastectomy operations (nipple- and skin- sparing) has increased the frequency of immediate breast reconstructions (IBR). In order to guarantee patients the best possible aesthetic outcome, the least chance of complications and moreover, the least postoperative pain, the technique with prepectoral prosthetic pocket was recently reconsidered with the use of ADM. This is the first study using Fortiva® in prepectoral breast reconstruction, and it compares the outcomes of three different patient populations (undergoing retromuscular, prepectoral and prepectoral reconstruction with ADM). The authors suggest that prepectoral breast reconstruction with ADM may bring benefits compared to the current standard technique (retromuscular) as well as compared to the prepectoral reconstruction without ADM.MethodsRetrospective data analysis of patients who underwent mastectomy followed by immediate breast reconstruction with silicone implants (DTI), performed by a team of breast surgeons and plastic surgeons. Logistic factor regressions were performed in order to investigate the effects of the three different intervention techniques on the incidence of complications. Fisher's exact test was used to analyze the differences in the occurrence of each complication. Mann Whitney test was used to compare the averages of referred pain. A p value <0.05 was considered significant.ResultsA total of 67 patients underwent DTI reconstruction, of which 43 with retromuscular prosthesis, 13 prepectoral and 11 prepectoral with ADM. We found a significantly lower incidence of surgical complications with ADM, exclusively in comparison with retromuscular reconstruction (p = 0.028). It emerges prepectoral reconstruction with ADM involves significantly less visibility of the implant than both the prepectoral surgery without ADM (p = 0.013) and the retromuscular technique (p = 0.029). Finally, postoperative pain referred at twelfth month is significantly less relevant in the group with prepectoral prosthesis and ADM, both in the group with retromuscular (p < 0.001) and prepectoral without ADM (p = 0.001).ConclusionsThis study demonstrates that immediate prepectoral breast reconstruction with ADM is a safe and reliable technique, able to exceed some type of limits imposed by prepectoral reconstruction. Moreover, it provides benefits if compared to the current standard technique. In the future, this technique could also be added to it, after a proper selection of patients in pre- and intraoperative time.

Examination of Outcome Disparities in Reports of Prepectoral and Subpectoral Direct-to-Implant Reconstruction

“…Eighteen studies reported postoperative infection rates 3,4,11–26 . Overall, the rate of surgical site infections was 2.6% (n = 35/1369) and 4.1% (n = 73/1767) after prepectoral and subpectoral implants, respectively.…”

“…Fifteen studies reported postoperative hematoma 3,11–13,15–18,20–26 . Overall, the rate of hematoma was 2.1% (n = 25/1207) and 3.5% (n = 56/1580) after prepectoral and subpectoral implant reconstruction, respectively.…”

“…Thirteen studies reported postoperative capsular contracture rates 3,11,12,15–19,22–26 . Overall, the rate of contracture was 6.4% (n = 62/976) and 7.8% (n = 109/1391) after prepectoral and subpectoral reconstruction, respectively.…”

“…Seventeen studies reported postoperative skin necrosis rates 3,4,11–24,26 . Overall, skin necrosis was reported in 4.7% (n = 55/1162) and 5.1% (n = 64/1258) of breasts after receiving prepectoral and subpectoral implants, respectively.…”

“…Seventeen studies reported postoperative skin necrosis rates. 3,4,[11][12][13][14][15][16][17][18][19][20][21][22][23][24]26 Overall, skin necrosis was reported in 4.7% (n = 55/1162) and 5.1% (n = 64/ 1258) of breasts after receiving prepectoral and subpectoral implants, respectively. Our pooled analysis demonstrated that the odd of skin necrosis was comparable between the 2 reconstruction methods (OR, 0.81; 95% CI, 0.55-1.18; P = 0.28; Fig.…”