Nipple-Sparing Mastectomy and Prepectoral Implant/Acellular Dermal Matrix Wrap Reconstruction in Large Ptotic Breasts

Abstract

Summary: Nipple-sparing mastectomy (NSM) with simultaneous prepectoral direct to implant reconstruction and acellular dermal matrix (ADM) is increasingly offered to patients opting for prophylactic or therapeutic mastectomies. The recent introduction of prepectoral implant/ADM in the armamentarium of breast reconstruction has proven to reduce pain and animation deformity. Despite this promising method, patients with macromastia and ptotic breasts remain a challenging group to treat. More often they would require secondary corrective procedures and can experience high failure rate and unsatisfactory outcomes. The authors present their experience in utilizing a bipedicled nipple-areola complex dermal flap through Wise pattern to achieve a successful NSM with prepectoral implant/ADM (Braxon) wrap (IBW) as a single stage in patients with large ptotic breasts. Patients seeking NSM with large ptotic breasts were included in the study in the period between 2016 and 2018. They were offered a single-stage Wise pattern NSM and immediate prepectoral IBW breast reconstruction. The technique and outcomes were recorded. Sixteen reconstructions were performed in 8 women with a median age of 32 years (range, 27–50 years) and a median body mass index of 32 kg/m2 (range, 29–39 kg/m2). The resected breasts weight ranged from 750 to 1,600 g (median, 890 g). All procedures were completed successfully with no nipple-areola complex necrosis or failure experienced during the follow-up period (range, 3–24 months) with all patients reported excellent satisfaction. The authors’ results demonstrate that this technique could be safely planned for NSM in large ptotic breasts with excellent durable outcomes.

Braxon®-assisted prepectoral breast reconstruction: A decade later

“…Beyond the issues already discussed exhaustively here, this porcine-derived matrix collects extremely heterogeneous clinical experiences such as implants in association with polyurethane prostheses ( 39 ), revision treatments ( 30 , 42 , 43 , 66 ), comparisons with other collagen-based scaffolds on the market ( 60 ), and also several publications that are now proposed to expand the selection criteria for elderly patients ( 46 , 71 ), skin-reducing surgeries ( 35 , 37 , 38 , 131 ), as well as risk-reducing operations ( 61 ).…”

The Dermal Nipple-Areola-Complex Flap Method in Female-to-Male Gender Affirming Surgery

“…The main focus with our paper was to propose an alternative operative approach that could be implemented in future patients. A similar technique has previously been applied in patients with grade III gynecomastia [7][8], and as the hammock technique in immediate breast reconstructive surgery [9][10].…”

Dermal nipple-areola complex flap method in female to male gender affirming surgery

“…The main focus with our paper was to propose an alternative operative approach that could be implemented in future patients. A similar technique has previously been applied in patients with grade III gynecomastia [7][8], and as the hammock technique in immediate breast reconstructive surgery [9][10].…”