Inframammary Fold Incision Can Reduce Skin Flap Necrosis in Immediate Breast Reconstruction With Implant and Conjoined Fascial Flap

Abstract

Background Immediate breast reconstruction with implant (IBRI) can produce good aesthetic results after nipple-sparing mastectomy (NSM). Various surgical incisions can be used for NSM. The purpose of this study is to compare outcomes of using an IBRI with dual-coverage fascial flap after NSM with an inframammary fold (IMF) or a radial (Rd) incision. Methods We retrospectively reviewed the records of 88 women who underwent IBRI with dual-coverage fascial flap from March 2015 to June 2018. Inframammary fold incision was used in 19 patients (22 breasts) and Rd incision in 69 patients (75 breasts). In the dual-coverage method, acellular dermal matrix covered the inferomedial quadrant of the breast, and conjoined fascial flap covered the remaining inferolateral quadrant. Patient-reported satisfaction was assessed using the Breast-Q questionnaire, and plastic surgeons assessed aesthetic postoperative scores. Results Complications and reoperation rates of 2 incisions were as follows: skin flap necrosis rate showed significant difference between 2 groups (IMF, 0.0% [0/22]; Rd, 16.0% [12/75]; P < 0.05). The other complication rates, hematoma, seroma, infection, capsular contracture, and total reoperations showed no significant difference. Postoperative Breast-Q scores were higher in the IMF group (331.9 ± 10.1) than in the Rd group (311.4 ± 11.0; P < 0.05), indicating higher satisfactory rate in the IMF group than in the Rd group. Surgeon-reported scores for breast symmetry, contour, and scar appearance were also higher in the IMF group (P < 0.05). Conclusions Immediate breast reconstruction with implant with dual-coverage fascial flap after NSM with IMF incision was associated with a lower rate of postoperative skin flap necrosis and improved patient satisfaction, compared with Rd incision. Inframammary fold incisions were associated with improved scar and breast appearance.

Best Practices for BREAST-Q Research: A Systematic Review of Study Methodology

“…We found errors in BREAST-Q administration or insufficient reporting of administration methods in more than half of the studies analyzed (n = 99 [53.5 percent]). Of studies with errors in BREAST-Q administration (n = 36), the most common reasons for improper administration included the addition, deletion, or alteration of scale items (n = 8 [22.2 percent]), [18][19][20][21][22][23][24][25] presenting raw scores rather than the converted Q score (n = 14 [38.9 percent]), [26][27][28][29][30][31][32][33][34][35][36][37][38][39] averaging individual scales into one score (n = 6 [16.7 percent]), 20,34,[40][41][42][43] and patients not completing the BREAST-Q themselves directly (i.e., completed through a telephone interview or with help from a caregiver or interpreter) (n = 7 [19.4 percent]). [44][45][46][47][48][49][50] Most studies (n = 114 [61.6 percent]) did not provide a time horizon for their primary outcome.…”