One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm

Rampazzo, Silvia; Spissu, Noemi; Pinna, Michela; Sini, Germana A. M.; Trignano, Emilio; Nonnis, Rita; Sanna, Claudia; Rodio, Manuela; Tettamanzi, Matilde; Rubino, Corrado

doi:10.3390/jcm12031170

Cited by 5 publications

(4 citation statements)

References 58 publications

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“…This fact may also explain the limited number of patients that resulted eligible for the described technique over a sixteen-month period in a hub center for mammary carcinoma treatment. In case of mastectomy skin flap with a thickness less than 1 cm or pectoral fascia removal, the Authors opt for a subpectoral reconstruction or a pre-pectoral reconstruction with ADM, respectively, according to the Institutional Algorithm [ 23 ]. Contralateral reduction mammoplasty is most of the time required when the patient is eligible for unilateral skin reducing mastectomy.…”

Section: Discussionmentioning

confidence: 99%

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Autologous coverage for direct-to-implant pre-pectoral reconstruction in large and ptotic breasts: a new technique

Rubino,

Trignano,

Rodio

et al. 2024

Case Reports in Plastic Surgery and Hand Surgery

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Direct-to-implant (DTI) breast reconstruction after skin reducing mastectomy in large and ptotic breast is characterized by a high rate of complication. The Dermal Sling is commonly used to give extra coverage to the lower pole of the mammary implant to lower the risk of implant exposure in case of wound dehiscence at the T-junction. The aim of the paper is to detail an original technique that combines an inferior dermal sling with pectoral and serratus fascial flaps, to create a pre-pectoral pouch. We retrospectively review the clinical data of the patients who underwent Type IV/V mastectomy and DTI breast reconstruction with the described technique. Minor and major post operative complications were analyzed. Patient satisfaction and aesthetic outcomes were evaluated at one year of follow-up through Breast-Q and Validated Aesthetic Scale. Ten patients (fourteen breasts) were included in the study. Skin and/or NAC necrosis occurred in three breasts. One patient underwent implant removal due to periprosthetic infection. At one of follow-up no capsular contracture nor migration of the implant were clinically detected in all patients. One patient had a visible rippling at the upper quadrants of the new breast. Good patient satisfaction and aesthetic outcomes were reported. The association of fascial flaps and dermal sling is a viable option for breast reconstruction in patients with large and ptotic breasts. Along with providing an autologous coverage for the implant, it allows to maintain a good projection, maximize symmetrization in case of concomitant contralateral reduction mammoplasty and avoid any implant displacement.

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Section: Discussionmentioning

confidence: 99%

“…The surgical technique has been conceived for women with large and ptotic breasts who require skin or nipple-sparing mastectomy with reduction of the skin and are not willing or are not eligible for autologous tissue reconstruction. An institutional algorithm [ 23 ] was applied for patient selection.…”

Section: Methodsmentioning

confidence: 99%

Autologous coverage for direct-to-implant pre-pectoral reconstruction in large and ptotic breasts: a new technique

Rubino,

Trignano,

Rodio

et al. 2024

Case Reports in Plastic Surgery and Hand Surgery

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“… 41 Single-stage breast reconstruction, on the other hand, involves placing a permanent implant during the initial surgery. 42 This approach is typically used when there is enough remaining breast tissue to cover the implant and provide a natural-looking result.…”

Section: Discussionmentioning

confidence: 99%

Advances in Prepectoral Breast Reconstruction

Xie¹,

Yan²,

Zhu³

et al. 2023

TCRM

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Breast reconstruction can be divided into prepectoral breast reconstruction (PPBR) and subpectoral breast reconstruction (SPBR) according to the implant plane. The original prepectoral breast reconstruction was abandoned for a long time due to the frequent and severe complications. Now, advances in materials technology and improved methods of mastectomy have made safe prepectoral breast reconstruction possible. Moreover, a number of studies have gradually demonstrated the advantages of prepectoral breast reconstruction. As prepectoral breast reconstruction becomes more and more attractive, it is time to review the current advances in prepectoral breast reconstruction.

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“…14,15 Mastectomy flap thickness and vascularization were fundamental criteria for prepectoral reconstruction, and after confirmation of good perfusion and flap viability, assessment of internal dimensions determined the final implant size. [16][17][18][19][20][21] Achieving a complete fit between the implant and the periprosthetic space was crucial. 22 Implant size considerations aimed to prevent dead space, seroma formation, and complications like rippling, wrinkling, and skin necrosis.…”

Section: Methodsmentioning

confidence: 99%

Prepectoral Breast Reconstruction with Prosthesis and Acellular Dermal Matrix: A New Technique of ADM Implantation and Fixation

Tettamanzi,

Arrica,

Ziani

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Direct-to-implant (DTI) immediate breast reconstruction has proven to be an oncologically safe technique and linked to better overall results. The introduction of new surgical techniques has prompted us to develop an acellular dermal matrix fixation technique that reduces the rate of complications and implant loss. Methods: We retrospectively analyzed data from patients who underwent DTI prepectoral breast reconstruction with two different techniques of acellular dermal matrix fixation to the chest wall. Descriptive statistics were reported using frequencies and percentages for categorical variables, and means and SDs for continuous variables. Pearson chi-square test was used to compare differences in categorical variables. Univariable and multivariable logistic regression models were fitted to investigate the predictors of complications. Results: From October 2019 to March 2023, 90 DTI breast reconstructions were performed, 43 using the standard technique and 47 using the new technique. The new technique demonstrated a significant reduction of major complications (P = 0.010), namely seroma (13.9% versus 2.3%), skin necrosis (9.3% versus 2.3%), implant loss (7% versus 0%), wound dehiscence (9.3% versus 0%), and infection (4.7% versus 0%). Compared with the standard technique, the new one reduced the risk of complications by 76% (OR 0.24; 95% confidence interval 0.09–0.68; P = 0.007) and 73% (aOR 0.27; 95% confidence interval 0.08–0.92; P = 0.037), at univariable and multivariable regression models. No other significant predictor of complications was identified. Conclusions: The procedure performed with the proposed modality proved to be advantageous. Careful fixation of the prosthetic implant and the placement of two drains, were the keys to a drastic reduction in complications.

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One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm

Cited by 5 publications

References 58 publications

Autologous coverage for direct-to-implant pre-pectoral reconstruction in large and ptotic breasts: a new technique

Autologous coverage for direct-to-implant pre-pectoral reconstruction in large and ptotic breasts: a new technique

Advances in Prepectoral Breast Reconstruction

Prepectoral Breast Reconstruction with Prosthesis and Acellular Dermal Matrix: A New Technique of ADM Implantation and Fixation

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