Single stage, direct to implant pre-pectoral breast reconstruction

Abstract

Background: Given the current trends in skin preservation during mastectomy, improved biofilm reduction algorithms, and advancements in tissue bioengineering and perfusion assessment, acellular dermal matrix (ADM)-reinforced single stage, direct to implant insertion in the pre-pectoral space has become a viable alternative to two-stage expander-based, sub-pectoral reconstruction. Methods: The authors performed a retrospective review of their pre-pectoral cases evaluating outcomes for all single stage, direct to implant procedures. Outcomes reviewed included hematoma, seroma, infection, device loss or change, animation deformity and revisional procedures such as fat grafting. The anterior tenting surgical technique is also reviewed. Results: The authors have carried out 305 direct to implant pre-pectoral breast reconstructions using an anterior tenting technique with low complication rates and superior clinical and functional outcomes. The benefits of this technique include less patient discomfort, no need for postoperative expansion, virtually no subjective negative impact on upper extremity function and elimination of animation deformity. Longerterm follow-up demonstrates maintenance of the integrity and quality of the reconstructions over time. Conclusions: The authors consider single stage, pre-pectoral direct to implant breast reconstruction to be a state-of-the-art breast reconstruction technique and have found it to be safe and reproducible. This technique is their primary choice for immediate implant-based reconstruction following mastectomy.

Complication Rate of Prepectoral Implant-based Breast Reconstruction Using Human Acellular Dermal Matrices

“… 48 Lately, prepectoral reconstruction in the setting of radiotherapy has become a crucial topic of interest. 15 , 34 , 45 The present univariate logistic regression analysis suggests that previous or adjuvant radiation therapy should not be considered as an independent risk factor (Table 6 ).…”

Invited Discussion on: Skin Reducing Mastectomy and Prepectoral Breast Reconstruction in Large Ptotic Breasts

“…Sub-pectoral breast reconstruction has been the gold standard for implant-based reconstruction during the last century; however, due to anatomical deformity, reduction in function and strength secondary to partial or complete loss of normal muscle fiber architecture and postoperative pain, it created a gap for the development of prepectoral techniques. The applicability of acellular dermal matrix (ADM) for breast reconstruction is a consolidated reality, as skin and nipple sparing techniques became standard mastectomy approaches [1]. In the prepectoral plane, the implant could be wrapped or partially covered with a pocket approach, which is our preference (Fig.…”

“…Therefore, there is a structure of There is a concern about weight and tension on the mastectomy flaps impeding tissue perfusion as well as subsequent thinning of the overlying mastectomy skin caused by the prepectoral implant. However, ADM not only provides tissue reinforcement, but also better pocket control, and shape without the compressive effects of total sub-muscular coverage [1]. In addition, ADM-reinforced direct-to-implant reconstruction offloads direct pressure on the mastectomy flaps with the weight being taken almost entirely by the ADM, mitigating these concerns [4] (Fig.…”

A Tale of Two Sisters: Breast Reconstruction Options for Women With or at High Risk of Breast Cancer

“…The use of implants for breast reconstruction has stood the test of time and has been an option for women since the 1960s ( Jones & Antony, 2019 ). While the implants themselves have improved over time, the real advantage of this technique is that all surgery is limited to the area of the mastectomy, and morbidity and downtime for the patient are much less than with other techniques.…”

“…Some of these newer techniques include (1) nipple-sparing mastectomy, (2) support of the implant with acellular dermal matrices, and (3) fat grafting ( Jones & Antony, 2019 ). The nipple-sparing mastectomy technique recognizes that there is often plenty of skin and a natural nipple already present, so there may be no need to expand the skin and perform nipple reconstruction.…”